Assessing Physical Function and Physical Activity in Patients with CKD

Painter, Patricia; Marcus, Robin L.

doi:10.2215/cjn.06590712

Cited by 168 publications

(127 citation statements)

References 88 publications

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“…Evaluation of physical functioning in maintenance hemodialysis (HD) patients is recommended by the Kidney Disease Outcomes Quality Initiative clinical practice guidelines [1] and European Renal Best Practice guidelines [2], as decreased physical functioning leads to a reduced quality of daily life and higher risk of mortality in this patient population [1][2][3][4]. These guidelines recommend assessment of physical functioning using both self-reported and openfield measures of physical performance [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

et al. 2018

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Background: Patients undergoing hemodialysis (HD) have difficulty performing activities of daily living (ADL) compared to healthy people. ADL difficulty is an early predictor of loss of independence and mortality in older community-living people. However, determinants of ADL difficulty in HD patients have not been clarified. This study aimed to identify factors associated with ADL difficulty in ambulatory HD patients. Methods: Subjects were 216 Japanese outpatients (130 men, 86 women; mean age, 67 years) undergoing maintenance HD three times a week. Clinical characteristics, depressive symptoms, motor function (leg strength, balance, and walking speed), and ADL difficulty related to lower-limb function such as mobility issues were compared across three difficulty levels (higher, middle, and lower) as classified according to the percentages of patients with perceived difficulty. Multivariate logistic regression analysis was performed to examine whether clinical characteristics, depressive symptoms, and motor function could discriminate ADL difficulty at each level. Receiver operating characteristic curve analysis was performed to determine cut-off values of motor function for predicting ADL difficulty at each level. Results: ADL difficulty was independently associated with age (odds ratio (OR) = 1.05, 95% confidence interval (CI) 1. 00-1.10; P = 0.039), presence of depressive symptoms (OR = 4.24, 95%CI 1.13-15.95; P = 0.033), and usual walking speed (OR = 0.94, 95%CI 0.90-0.97; P < 0.001) for higher level difficulty; age (OR = 1.06, 95%CI 1.02-1.10; P = 0.006), maximum leg strength (OR = 0.97, 95%CI 0.94-1.00; P = 0.043), and usual walking speed (OR = 0.96, 95%CI 0.93-0.98; P = 0.001) for middle level difficulty; and age (OR = 1.06, 95%CI 1.02-1.10; P = 0.006) and usual walking speed (OR = 0.93, 95%CI 0.90-0. 6; P < 0.001) for lower level difficulty. Cut-off values of usual walking speed for predicting ADL difficulty for higher, middle, and lower level difficulty were 83.7, 75.5, and 75.1 m/min, respectively. Conclusions: A slow walking speed and old age were significantly and independently associated with ADL difficulty in ambulatory HD patients. Presence of depressive symptoms was significantly and independently associated with ADL difficulty at the higher level of difficulty in ambulatory HD patients. These findings provide useful data for planning effective therapeutic regimens to prevent ADL difficulty in ambulatory HD patients.

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Section: Introductionmentioning

confidence: 99%

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

et al. 2018

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“…Previous studies in patients with CKD and patients on maintenance hemodialysis (MHD) have shown associations of physical activity with improved outcomes (10)(11)(12)(13)(14)(15)(16)(17)(18). However, it is uncertain whether the benefits of types and levels of physical activity apply for different outcomes, such as health-related quality of life (HRQOL), depression, and survival, in patients on MHD with diverse clinical characteristics.…”

Section: Introductionmentioning

confidence: 99%

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Lopes

Lantz

Morgenstern

et al. 2014

Clinical Journal of the American Society of Nephrology

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128

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Background and objectives Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.Design, setting, participants, & measurements In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009)(2010)(2011) were classified into five aerobic physical activity categories (never/ rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality.Results The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/ flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/ rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. ConclusionsThe findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.

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“…In addition, the device used in NHANES recorded uniaxial movement; hence, information on use of stationary bikes, elliptical trainers, or equipment that primarily involved upper body movement, such as rowing, may not have been recorded accurately. These might have resulted in underestimation of MVPA (29). However, these issues are unlikely to have led to underestimation of light-intensity activity.…”

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confidence: 99%

Light-Intensity Physical Activities and Mortality in the United States General Population and CKD Subpopulation

Beddhu

Wei

Marcus

et al. 2015

Clinical Journal of the American Society of Nephrology

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120

110

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Background and objectives Sedentary behavior is associated with increased mortality in the general population. Whether replacing sedentary behavior with low-or light-intensity activities confers a survival benefit in the general or CKD populations is unknown.Design, setting, participants, & measurements This observational analysis of the 2003-2004 National Health and Nutrition Examination Survey examined the associations of low-and light-intensity activities with mortality. On the basis of the number of counts/min recorded by an accelerometer, durations of sedentary (,100/min), low (100-499/min), light (500-2019/min), and moderate/vigorous ($2020/min) activity were defined and normalized to 60 minutes. The mortality associations of 2 min/hr less sedentary duration in conjunction with 2 min/ hr more (tradeoff) spent in one of the low, light, or moderate/vigorous activity durations while controlling for the other two activity durations were examined in multivariable Cox regression models in the entire cohort and in the CKD subgroup.Results Of the 3626 participants included, 383 had CKD. The mean sedentary duration was 34.467.9 min/hr in the entire cohort and 40.866.8 in the CKD subgroup. Tradeoff of sedentary duration with low activity duration was not associated with mortality in the entire cohort or the CKD subgroup. Tradeoff of sedentary duration with light activity duration was associated with a lower hazard of death in the entire cohort (hazard ratio, 0.67; 95% confidence interval, 0.48 to 0.93) and CKD subgroup (hazard ratio, 0.59; 95% confidence interval, 0.35 to 0.98). Tradeoff of sedentary duration with moderate/vigorous activity duration had a nonsignificant lower hazard in the entire cohort and CKD subgroup.Conclusions Patients with CKD are sedentary nearly two thirds of the time. Interventions that replace sedentary duration with an increase in light activity duration might confer a survival benefit.

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Assessing Physical Function and Physical Activity in Patients with CKD

Cited by 168 publications

References 88 publications

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

Light-Intensity Physical Activities and Mortality in the United States General Population and CKD Subpopulation

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