Self-Reported Physical Activity in Patients on Chronic Hemodialysis: Correlates and Barriers

Abstract

Background and Aims: The knowledge of the barriers that are associated with decreased physical activity (PA) in patients on chronic hemodialysis (PCH) may be of primary importance for the nephrologists. Thus, we aimed to assess the barriers associated with the absent or reduced PA in PCH of a Mediterranean country. Methods: Patients were invited to answer the question ‘How often do you exercise during your leisure time?'. Also, patients included in the study were asked to answer questions regarding barriers to physical activity lower than desired. Results: We studied 105 patients. Forty (38.1%) patients reported to never exercise, 6 (5.7%) reported to exercise less than once/week, 4 (3.8%) once/week, 23 (21.9%) two to three times/week, 12 (11.4%) four to five times/week and 20 (19%) daily. Overall, 46 (43.8%) patients never exercised or exercised less than once/week (‘inactive') and 59 (56.2%) did exercise more often (‘active'). At the multivariate analysis, reduced walking ability, fatigue on the non-dialysis days, and shortness of breath were independently and negatively associated with PA. The same results were found when the reduced model of the multivariate logistic backward regression was built introducing in the model also clinical and laboratory variables. Conclusion: In PCH, fatigue on the non-dialysis days, reduced walking ability, and shortness of breath are barriers independently associated to decreased PA. Knowledge about the causes and mechanisms that generate these barriers has to be acquired.

Left Atrial Dysfunction in End-Stage Renal Disease Patients Treated by Hemodialysis

“…The clinical diagnosis of HFpEF is tricky in ESRD population because the heart failure symptoms - edema, shortness of breath, improvement after diuretic therapy or ultrafiltration [16] - are the same as in pure water retention. The lack of LAEF increase despite its size reduction in our study probably reflects the deleterious effect of long-term cyclic water retention between dialysis sessions similarly to the long-lasting heart failure [17] or simply chronic overhydration - we do not have patients on long-term daily hemodialysis for comparison. Indeed, longer dialysis vintage was associated with lower LAEF in our study.…”

“…The left atrial dilatation and frequent left ventricular hypertrophy due to repeated interdialytic water retention in ESRD patients represent mechanisms similar to HFpEF. Indeed, many conventionally dialyzed patients reported increased fatigue and shortness of breath preventing their physical activity [17]. …”

Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel

“…However, further research is required to better understand evidenced‐based interventions to target exercise behavior change in this population. For example, addressing fatigue (one of the most commonly reported barriers to exercise) may help to enable patients to engage in more exercise . However, there is a vicious circular relationship between fatigue and decreased physical activity and functioning, but as aforementioned, there are limited guidelines and evidence for the management of fatigue in these patients.…”

“…Poor physical condition including a reduced walking ability, 11 and symptoms associated with patient's disease and treatment regime 12 such as fatigue, 11,[13][14][15][16][17][18][19] tiredness, 20,21 pain, [15][16][17][18]22,23 shortness of breath, 11,13,15 lower extremity ulcers, 13,15 and weakness 16,24 were common barriers to exercise, as were existing musculoskeletal injuries or concerns, 16,23 previous surgeries, 17 and existing co-morbidities, for example, depression. 18 Given this high level of comorbidity, HCPs felt that they needed to be upskilled in terms of equipment use and exercise counseling skills to enable them to promote exercise.…”

Exercise and CKD: Skeletal Muscle Dysfunction and Practical Application of Exercise to Prevent and Treat Physical Impairments in CKD

“…Specific symptoms related to these comorbid conditions include chronic pain, fatigue, poor physical function, and dyspnea, as well as co-morbid diseases like cardiovascular disease (CVD), diabetes, and muscle wasting 75–77,79,83,89,92 . Cognitive and psychological barriers are also prominent, including a fear of falling, low motivation, depression, feelings of being a burden on the clinic staff, and poor exercise self-efficacy 76–78,83,84,92 .…”