January 29, 2019
2 min read

Patients with ESKD want exercise to improve quality of life, but they experience barriers

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Deborah Zimmerman

Patients with ESKD want to exercise to improve their quality of life but report barriers — like weakness and fatigue — when trying to incorporate it into their daily routines, according to a study published in the Clinical Journal of the American Society of Nephrology.

“Patients with ESKD are interested in exercise but they have several barriers that make exercise difficult or impossible for them,” Deborah Zimmerman, MD, MSc, of the division of nephrology in the department of medicine at the University of Ottawa and the Kidney Research Centre at Ottawa Hospital Research Institute, told Healio/Nephrology. “Equally as important, if they are to exercise, [is that] they are mostly interested in improvements in quality of life. There were very few differences by modality (PD and hemodialysis), but greater differences in desired outcomes by age.”

Researchers recruited 423 (mean age, 63 years) English- or French-speaking patients with ESKD from two tertiary care hospitals in Ottawa and Montreal who were treated with hemodialysis or PD. Participants completed an exercise survey during their regular home dialysis clinic visit or their in-center hemodialysis session. The survey assessed current physical activity levels, what benefits patients would like to get from exercise, what barriers to exercise patients encountered and preferred location and type of exercise. Researchers then used summary descriptive statistics to describe patient responses and separated patients by dialysis modality and age category (<65 or 65).

Patients with ESKD want to exercise to improve their quality of life but report barriers — like weakness and fatigue — when trying to incorporate it into their daily routines.
Source: Adobe Stock

Researchers found current activity levels were similar across modalities (P = .35) but that while 78% of younger patients walked at least 10 minutes at a time on 3 or more days, only 58% of older patients did (P = .001). The survey also revealed the two most desired benefits of exercise were improved energy (18%) and strength (14%). The third most desired benefit was improved sleep for patients on PD, maintenance of independence for patients on in-center hemodialysis and longevity for patients on home hemodialysis.

Both older and younger patients were interested in improving energy, but older patients were more interested in strength and maintenance of independence; while younger patients were more interested in longevity and transplant candidacy. As for barriers to exercise, researchers found 25% of patients were able to exercise without difficulty, with the major barriers for the others being fatigue (55%), feeling weak (49%) or shortness of breath (50%). Finally, regardless of modality or age category, patients preferred to exercise using a combination of aerobic and resistance training (41%) at home (73%).

“I think the most important thing for the health care team to consider when talking to patients about the importance of exercise is to encourage people to find ways to increase activity as part of their activities of daily living,” Zimmerman said. “The tremendous fatigue and other symptoms may prevent patients from doing exercise as a separate 'event.’ We need to understand how to help patients improve their fitness in ways that are sustainable for them and associated with the outcomes that are important to them.” – by Melissa J. Webb


Disclosures: The authors report no relevant financial disclosures.