Factors influencing exercise participation by older adults requiring chronic hemodialysis: a qualitative study

Abstract

Despite the recognized health and psychosocial benefits of exercise for older adults with end-stage renal disease (ESRD), exercise participation remains poor. Previous research has attributed low levels of exercise to patient-related factors such as lack of motivation and fear of adverse consequences. This qualitative study involving focus group discussions with hemodialysis patients, nephrology nurses, and family care providers explored specific motivators and barriers to exercise participation in older adults requiring hemodialysis. Nurse participants were chosen for the health care provider focus groups because their prolonged and sustained contact with hemodialysis patients during the dialysis treatment sessions positions them well to encourage and promote exercise. Motivators to exercise included patient aspirations to exercise and their experiences of improvements from exercising, as well as the formal incorporation of exercise into the overall dialysis treatment plan. Barriers to exercise included nurses' lack of encouragement to exercise, transportation issues, and the use of exercise equipment that precludes participation by patients who recline during dialysis and inhibits exercise encouragement by nurses due to concerns of equipment-related injury. These findings support the need for a broader recognition of the systemic factors that may impede exercise participation by older adults requiring hemodialysis. A shift is required in the culture of ESRD treatment programs towards a wellness perspective that includes expectations of exercise encouragement by the health care team and participation by patients.

Exercise program to enhance physical performance and quality of life of older hemodialysis patients: a feasibility study

“…Barriers related to exercise training at home, such as lack of motivation and time, have been identified in other studies, [8,27] and may account for our findings.…”

“…[25] The high level of participation in intra-dialysis exercise in our study may be attributed to the following: our program supported the formal incorporation of exercise into the overall dialysis plan, signalling to patients and families that exercise is an important part of treatment; the exercise was individualized, supervised and incorporated patient's wishes and preferences; special equipment was provided that enabled patients to exercise in a reclined or supine position during HD; and exercise during dialysis provided a productive activity that did not require extra time. [8,26] Similar to our study, Pianta and Kutner [6] piloted an individualized exercise program with 25 older, low functioning patients. Only 48% of their patients regularly attended the exercise sessions.…”

“…[6] Despite the reported benefits of exercise, older HD patients tend to demonstrate low levels of participation or interest in exercise programs. [7] Based on findings from our research on barriers and facilitators to exercise in older HD patients, [8] we designed an exercise program to increase exercise participation in these patients. The objective of this pilot study was to evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older HD patients.…”

Clinical Challenges in the Treatment of Hemodialysis Patients with Hyperbaric Oxygen Therapy

“…[2] The hemodialysis treatment frequently takes 4-4.5 hours, and patients usually were exhausted after hemodialysis. [3] We observed that, though not all, a significant number of hemodialysis patients can not tolerate HBO therapy after hemodialysis treatment on the same day. If the patient will undergo HBO therapy on dialysis days, HBO therapy is performed first, and then the patient undergoes dialysis.…”

Effect of home-based exercise on functional ability of hemodialysis patients: a systematic review and meta-analysis

“…Despite the significant impact of exercise on hemodialysis patients, these patients are inactive and have reduced physical activity and function (18,19). Unawareness of the benefits of exercise, fear of injury, experience of disability, low power to exercise, lack of motivation, lack of sports facilities and lack of financial support are some of the reasons which decrease levels of mobility and exercise in hemodialysis patients (20)(21)(22)(23). Various problems caused by physical inactivity have some effects on various aspects of lives of patients undergoing hemodialysis.…”