Standardising the measurement of physical activity in people receiving haemodialysis: considerations for research and practice

Abstract

BackgroundPhysical activity (PA) is exceptionally low amongst the haemodialysis (HD) population, and physical inactivity is a powerful predictor of mortality, making it a prime focus for intervention. Objective measurement of PA using accelerometers is increasing, but standard reporting guidelines essential to effectively evaluate, compare and synthesise the effects of PA interventions are lacking. This study aims to (i) determine the measurement and processing guidance required to ensure representative PA data amongst a diverse HD population, and; (ii) to assess adherence to PA monitor wear amongst HD patients.MethodsClinically stable HD patients from the UK and China wore a SenseWear Armband accelerometer for 7 days. Step count between days (HD, Weekday, Weekend) were compared using repeated measures ANCOVA. Intraclass correlation coefficients (ICCs) determined reliability (≥0.80 acceptable). Spearman-Brown prophecy formula, in conjunction with a priori ≥ 80% sample size retention, identified the minimum number of days required for representative PA data.ResultsSeventy-seven patients (64% men, mean ± SD age 56 ± 14 years, median (interquartile range) time on HD 40 (19–72) months, 40% Chinese, 60% British) participated. Participants took fewer steps on HD days compared with non-HD weekdays and weekend days (3402 [95% CI 2665–4140], 4914 [95% CI 3940–5887], 4633 [95% CI 3558–5707] steps/day, respectively, p < 0.001). PA on HD days were less variable than non-HD days, (ICC 0.723–0.839 versus 0.559–0.611) with ≥ 1 HD day and ≥ 3 non-HD days required to provide representative data. Using these criteria, the most stringent wear-time retaining ≥ 80% of the sample was ≥7 h.ConclusionsAt group level, a wear-time of ≥7 h on ≥1HD day and ≥ 3 non-HD days is required to provide reliable PA data whilst retaining an acceptable sample size. PA is low across both HD and non- HD days and future research should focus on interventions designed to increase physical activity in both the intra and interdialytic period.

Exercise for people living with frailty and receiving haemodialysis: a mixed-methods randomised controlled feasibility study

“… 11 Physical activity (PA) was objectively measured using the SenseWear Armband Pro 3 (BodyMedia, Pittsburgh PA, USA) for seven consecutive days, including HD. Established criteria were used to ensure representative data for average daily wear-time, steps per day and time (minutes per day) spent in sedentary (defined as 0–1.5 metabolic equivalents (METS)), light (1.6–2.9 METS) moderate (3–6 METS) and vigorous (˃6 METS) PA. 23 Patient-reported outcomes (PROMs) collected are outlined in online supplemental material 4 . 11 All outcomes were collected at baseline and 6 months.…”

Accelerometry Correlates in Body Composition, Physical Fitness, and Disease Symptom Burden: A Pilot Study in End-Stage Renal Disease

“…It has long been known that HD patients are debilitated ( Gutman et al, 1981 ) and report low levels of physical activity, assessed with questionnaires ( DeOreo, 1997 ), resulting in atrophy and reduced functioning ( Diesel et al, 1993 ; Moore et al, 1993 ). Newer studies that have used accelerometers to measure physical activity in HD patients have shown inconsistent results due to differences in the devices used, poorly reported valid wearing times, and varying minimum valid days for measurement ( Young et al, 2019 ). Therefore, comparison with previous studies regarding average MVPA in HD patients was difficult.…”

“…Several studies used accelerometers to measure physical activity in the HD population (Kim et al, 2014;Gomes et al, 2015;Kopple et al, 2015;Broers et al, 2017), where the main findings revealed significantly lower physical activity compared to matched sedentary renal disease-free controls, with the lowest physical activity on HD days (Kim et al, 2014;Gomes et al, 2015;Kopple et al, 2015). A study from Japan found no difference between physical activity on dialysis and non-dialysis days (Morishita et al, 2014), which contrasts with physical activity patterns in Western populations (Young et al, 2019), and highlights the need for more studies with objectively measured physical activity. Specifically, we need additional data on the extent of decline in habitual physical activity in dialysis patients, influence of dialysis procedures themselves, and characteristics of patient subgroups at greatest risk for inactivity.…”

“…There is a lack of objective assessment of physical activity in populations with chronic diseases. The use of accelerometers to objectively measure physical activity in HD patients is increasing ( Young et al, 2019 ). Compared to accelerometers, the International Physical Activity Questionnaire (IPAQ) underestimates light physical activity, which is the main form of physical activity in HD patients ( da Costa Rosa et al, 2015 ).…”

“…The World Health Organization (WHO) recommendation for physical activity in chronic conditions includes at least 150–300 min of moderate-intensity aerobic physical activity per week ( Bull et al, 2020 ). However, physical activity is low in HD patients, especially on HD days ( Young et al, 2019 ), and we need to understand this phenomenon better. There are many causes of reduced physical activity in dialysis patients, and time spent undergoing HD treatment is certainly one of them ( da Costa Rosa et al, 2015 ).…”