Benefits and Barriers to and Desired Outcomes with Exercise in Patients with ESKD

Abstract

Background and objectives Patients with ESKD are sedentary. When patient-identified barriers to exercise are addressed, recruitment and retention in exercise trials remain low, suggesting that the trial design may not resonate with them. Therefore, we conducted a survey of patients on dialysis to assess perceived benefits and barriers to exercise and discover preferred outcomes and exercise type by dialysis modality and age in anticipation of designing future randomized, controlled trials.Design, setting, participants, & measurements English-and French-speaking patients with ESKD treated with hemodialysis or peritoneal dialysis were recruited from two tertiary care hospitals in Ottawa and Montreal, Canada. Summary descriptive statistics were used to describe patient responses; then, they were separated by dialysis modality and age category. ResultsThe survey was completed by 423 participants. Current activity levels were similar across modalities (P=0.35); 78% of younger patients walked at least 10 minutes at a time on 3 or more days compared with only 58% of older patients (P=0.001). The two most desired benefits of exercise were improved energy (18%) and strength (14%). The third priority differed, such that improved sleep, maintenance of independence, and longevity were selected by patients on peritoneal dialysis, patients on in-center hemodialysis, and patients on home hemodialysis, respectively. Older patients were most interested in improvements in energy, strength, and maintenance of independence, whereas younger patients were interested in improving energy, longevity, and transplant candidacy. Only 25% of patients were able to exercise without difficulty; the major barriers for the remaining patients were feeling patients were feeling too tired (55%), short of breath (50%), and too weak (49%). If patients were to exercise, they wanted to exercise at home (73%) using a combination of aerobic and resistance training (41%), regardless of modality or age category. ConclusionsThe majority of patients undergoing maintenance dialysis in two tertiary hospitals in Ottawa and Montreal report similar desired outcomes and barriers, with greater differences by age category than modality.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Although there are few studies of exercise and volume, 174 combined aerobic and resistance training has been associated with SBP and diastolic BP reductions. 175 Although many dialysis patients want to exercise, 176 barriers to exercise of any type include fatigue, dialysis access, time constraints, comorbidities, fear, and (for intradialytic exercise) clinic personnel workload. 177,178…”

Canadian Society of Nephrology Commentary on the Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

“… 89 - 91 Taken together with the known general health benefits of exercise in patients with and without CKD, 92 , 93 we suggest that patients with CKD G3 to G5 exercise, formulating a plan adapting to their functional level and preferences. 94 , 95 Also by generalization from the general population, limiting tobacco 96 and alcohol use, 97 fall-prevention strategies, 98 and improving our understanding of frailty 99 may reduce fracture risk, are unlikely to be harmful, and may convey additional health benefits. 80 …”

The impact of exercise intervention for patients undergoing hemodialysis on fatigue and quality of life

“…[ 14 ] Also, trials assessing exercise interventions for fatigue have been published and add to the evidence base of the association of exercise and fatigue in HD patients. [ 15 ] However, on one side, some patients, caregivers, and health providers considered that exercise would aggravate fatigue symptoms, [ 16 ] on the other hand, most patients prefer to a sedentary lifestyle at home because they may experience post-dialysis fatigue providing a barrier to participating exercise. [ 17 ] Therefore, a systematic review and meta-analysis will be performed to determine the therapeutic efficacy of exercise interventions for patients undergoing HD on fatigue and HRQoL, to provide further evidence for health providers and patients.…”