Characterization of Physical Activity and Sitting Time Among Patients on Hemodialysis Using a New Physical Activity Instrument

Abstract

Objective Physical activity questionnaires usually focus on moderate to vigorous activities and may not accurately capture physical activity or variation in levels of activity among extremely inactive groups like dialysis patients. Design Cross-sectional study Setting Three dialysis facilities in the San Francisco Bay Area Subjects 68 prevalent hemodialysis patients Intervention We administered a new physical activity questionnaire designed to capture activity in the lower end of the range, the Low Physical Activity Questionnaire (LoPAQ). Main Outcome Measure Outcome measures were correlation with a validated physical activity questionnaire, the Minnesota Leisure Time Activity (LTA) questionnaire and with self-reported physical function (Physical Function score of the SF-36) and physical performance (gait speed, chair stand, balance, and Short Physical Performance Battery [SPPB]) . We also determined whether patients who were frail or reported limitations in activities of daily living (ADL) were less active on the LoPAQ. Results 68 participants (mean age 59 ± 14 years, 59% men) completed the study. Patients were inactive according to the LoPAQ, with a median (IQR) of 517 (204 – 1190) kcal/week of physical activity. Although activity from the LTA was lower than on the LoPAQ (411 (61 – 902) kcal/week), the difference was not statistically significant (p=0.20), and results from the two instruments were strongly correlated (rho =0.62, p < 0.001). In addition, higher physical activity measured by the LoPAQ was correlated with better self-reported functioning (rho = 0.64, p < 0.001), better performance on gait speed (rho = 0.32, p=0.02), balance (rho = 0.45, p < 0.001), and chair rising (rho = −0.32, p=0.03) tests and with higher SPPB total score (rho = 0.51, p < 0.001). Frail patients and patients with ADL limitations were less active than those who were not frail or limited. Conclusion The LoPAQ performed similarly to the Minnesota LTA questionnaire in our cohort despite being shorter and easier to administer.

The Impact of Hemodialysis on Spatio-Temporal Characteristics of Gait and Role of Exercise: A Systematic Review

“…The initial search yielded 431 citations. Of these 27 [ 5 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] studies met inclusion criteria ( Figure 1 ). Characteristics of the studies included are presented in Table 1 .…”

“…Characteristics of the studies included are presented in Table 1 . Sixteen [ 5 , 22 , 23 , 25 , 27 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 40 , 42 , 45 ] of the 27 studies published a single point data, four studies [ 28 , 29 , 30 , 34 ] utilized pre-post design to evaluate the effect of exercises and seven studies [ 24 , 26 , 38 , 41 , 44 , 46 , 47 ] used a controlled trial design to evaluate effect of either nutritional or exercise intervention in this population. The baseline values of the participants in these studies were utilized for analysis evaluating the effect of HD on spatio-temporal gait parameters.…”

“…Gait speed (GS): A total of 16 studies [ 5 , 23 , 25 , 27 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 39 , 44 , 45 , 46 , 47 ] reported GS in 23 sub-groups of participants ( Table 2 ). The mean GS was 1.01 m/s (95% CI: 0.95–1.07 m/s).…”

Exercise Guidelines for Chronic Kidney Disease Patients

“…A Low Physical Activity Questionnaire has been developed to assess and can additionally be used for monitoring physical activity. 8 Although it was developed for patients on hemodialysis, this instrument would also be pertinent for use with the CKD patient population. After identifying areas to improve on, the RDN may recommend structured activities including aerobic, strength, and flexibility exercises.…”

Comparison of difficulty with activities of daily living in elderly adults undergoing hemodialysis and community-dwelling individuals: a cross-sectional study

“…The present study showed that many elderly patients undergoing HD had moderate to severe difficulty in ADL tasks compared with communitydwelling elderly adults. Patients undergoing HD have multiple comorbidities [1,3], an inactive lifestyle [32], and physical frailty [4,5], and these factors form a vicious circle. Therefore, we consider that the deterioration of kidney function leading to HD and the initiation of HD adversely affected ADL difficulty similar to ADL dependency.…”