Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Abstract

Background and objectives Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.Design, setting, participants, & measurements In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009)(2010)(2011) were classified into five aerobic physical activity categories (never/ rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality.Results The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/ flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/ rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. ConclusionsThe findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.

Relationships between Neighborhood Walkability and Objectively Measured Physical Activity Levels in Hemodialysis Patients

“…HD patients commonly have sedentary lifestyles that increase their risk for an array of negative outcomes, and compounds upon their existing risk for cardiovascular morbidity and mortality [4, 6, 7, 14, 24-26]. O’Hare et al [27] studied a large cohort of 4,024 incident HD and peritoneal dialysis patients and observed that patients with sedentary lifestyles exhibited a 62% higher risk of one-year mortality (HR 1.62; 95% CI 1.16–2.27) compared with patients with active lifestyles.…”

“…Hemodialysis (HD) patients have an increased cardiovascular mortality and it has been shown that they are less active than their healthy counterparts [2-7]. Some common morbidities in HD populations have been linked to physical inactivity, such as anemia, bone mineral disorders, cardiovascular abnormalities, inflammation, malnutrition, and depression [4-6, 8, 9]. Urbanicity of residence (i.e., urban, suburban, rural) as well as neighborhoods environment have been shown to be associated with physical activity levels in the general and HD populations [10-14].…”

Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

“…It was postulated that exercise during HD would increase the flow of solutes from tissues to the vascular compartment and that these solutes would have greater access to the membrane of the dialyzer, thereby increasing the dialysis efficiency [16,17]. Most studies involving exercise in patients on dialysis were limited to assess the long-term effects on aerobic capacity of individuals [18,19,20]. A few studies have addressed the acute effects of intradialytic exercise, with focus on increasing dialysis efficacy and solute removal [16,17,21].…”

How could patient reported outcomes improve patient management in chronic myeloid leukemia?

“…The importance and relevance of these questionnaires is highlighted by a large, population-based study involving about half a million people included in the UK population biobank project, showing that self-reported health was the strongest predictor of survival among all the analyzed factors [12]. Self-reported QoL has been proved to impact on overall survival (OS) in various clinical conditions spanning from neoplastic diseases [13], arthritis [14], obstructive pulmonary diseases [15], hemodialysis [16], HIV infection [17] and in more than 2,000 elderly patients from a large integrated-delivery network in the USA [18]. Patient-reported outcomes (PRO) are defined as the measurement of every aspect of patient's health, including disease-related symptoms, autonomy, disease and therapy perception, toxicities or adverse events, physical, psychological, and social aspects, all as reported from the patient him/herself without any second-party interpretation.…”