“A Learned Soul to Guide Me”: The Voices of Those Living with Kidney Disease Inform Physical Activity Programming

Abstract

Purpose: The purpose of this study was to (a) confirm the barriers to and facilitators of physical activity (PA) among persons living with chronic kidney disease (CKD) in Ontario and (b) inform the design of a Kidney Foundation of Canada Active Living for Life programme for persons living with CKD. Method: Adults living with CKD in Ontario were invited to participate in a cross-sectional survey investigating opinions about and needs for PA programming. The 32-item survey contained four sections: programme delivery preferences, current PA behaviour, determinants of PA, and demographics. Data were summarized using descriptive statistics and thematic coding. Results: A total of 63 respondents participated. They had a mean age of 56 (SD 16) years, were 50% female, and were 54% Caucasian; 66% had some post-secondary education. The most commonly reported total weekly PA was 90 minutes (range 0-1,050 minutes). Most respondents (84%) did not regularly perform strength training, and 73% reported having an interest in participating in a PA programme. Conclusion: Individuals living with CKD require resources to support and maintain a physically active lifestyle. We identified a diversity of needs, and they require a flexible and individualized inter-professional strategy that is responsive to the episodic changes in health status common in this population.

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

“…Health care professionals, friends and family, and peer support were reported to be influential for encouraging exercise . However, the current lack of an “exercise culture” for dialysis patients was a reported barrier .…”

“…Some studies reported how patients perceived exercise counseling as part of the nurses’ role, but others reported patient concerns over staff workload and how patients were keen to not be perceived as a bother to staff . However, having a trusting relationship with their doctor, and doctor approval for exercise was as a facilitator for exercise engagement, as was peer support and seeing others exercise . Exercise was perceived as a way to develop camaraderie and positive common identities with others .…”

“…The intradialytic period can be used for training patients for goal setting and “action planning,” that is, planning when, where, and how the exercise will occur, thereby increasing self‐efficacy for exercise outside the unit . However, as alluded to in the policy section of this review, changes are needed to support the provision of specialized teams of exercise professionals to enable them to engage in the aforementioned roles . This is in addition to working with relevant patient champions and stakeholder to develop better links between dialysis centers and community facilities/activity resource groups, care partners, and family members …”

“…Most patients in developed countries have access to exercise equipment; however, the costs of these are not always reimbursed by payers, who could be proactively encouraging physical activity and exercise. In many regions, there is a total lack of reimbursement from health payers (government and health insurance companies) which preclude the funding of these interventions and the provision of exercise professionals required to oversee the implementation and running of exercise programmes for dialysis patients.…”

“…As such, building safe places to exercise, and improving access to exercise facilitates may encourage exercise behaviors among dialysis patients. The use of local nonrenal community resources in close proximity to dialysis clinics could be useful . Building “dialysis clinic gyms” could enhance physical activity and enable a place to exercise and store exercise equipment …”