# Awareness of exercise importance, information sources, and adherence in predialysis chronic kidney disease in Japan: a web-based cross-sectional study

## TL;DR

This study explores how patients with predialysis chronic kidney disease in Japan perceive the importance of exercise, where they get information, and how well they follow advice.

## Contribution

The study identifies gaps in exercise adherence and highlights the role of frailty and physician-centric information sources in predialysis CKD management.

## Key findings

- 72.7% of patients were aware of the importance of physical activity, but adherence to exercise advice was suboptimal.
- Physicians were the primary source of information, while physical therapists were rarely cited.
- Frailty was independently associated with poor adherence to exercise advice.

## Abstract

Physical activity (PA) and exercise are key in the non-pharmacological management of chronic kidney disease (CKD). However, patient awareness, information sources, and adherence to advice are not well-established. Herein, we quantified the awareness of the importance of PA and exercise, identified information sources, described receipt of advice and adherence, and explored factors associated with poor adherence.

We conducted a web-based survey of adults with predialysis CKD in Japan. Inclusion criteria included being of age ≥50 years, physician-diagnosed CKD, no prior/active receipt of dialysis or transplant, ability to report recent serum creatinine or estimated glomerular filtration rates, and independence in activities of daily living. Questionnaires assessed awareness of importance (four-level scale), information sources, receipt of advice from healthcare professionals (yes/no), and adherence among recipients. Frailty was measured using the Kihon Checklist. Among recipients of exercise advice, correlates of poor adherence were examined using a modified Poisson regression with robust variance.

Of the 312 respondents, 285 met the inclusion criteria. Awareness of the importance of PA/exercise was very or moderately evident in 72.7% of respondents, and diet awareness was similarly evident in 85.3%. Physicians (70.1%) and online articles (33.3%) were the most common information sources; physical therapists were rarely cited (4.4%). Overall, 71.6% of respondents reported receiving PA/exercise advice: 12.3% almost completely adhered, 51.0% mostly adhered, 31.9% did not adhere adequately, and 4.9% were unsure how to follow the advice. Frailty was independently associated with poor adherence.

In predialysis CKD, awareness of exercise lags behind that of diet, information sources are physician-centered, and adherence to advice is often suboptimal, particularly in patients with frailty. These findings reveal a gap in implementation and underscore the need to standardize structured clinical advice and monitoring, integrate exercise professionals into kidney care teams, and provide tailored support for frail patients.

The online version contains supplementary material available at 10.1186/s12882-026-04850-z.