Study examines barriers to exercise experienced by dialysis patients

A new study has identified several barriers that make it difficult for dialysis patients to exercise. The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), also explored the benefits that these patients would like to gain from exercising, if they were able to do so.

People with end stage kidney disease tend to be sedentary and are at high risk of worsening functional impairment after starting dialysis. Exercise may mitigate this risk and help to improve patients' quality of life, but there is often a disconnect between what researchers and patients think is important. To address this, a team led by Deborah Zimmerman, MD, MSc and Danielle Moorman, MD, MSc (The Ottawa Hospital and the University of Ottawa) designed a study to better understand patient perspectives about the benefits and barriers to exercise, the types of exercise that patients are interested in, and the types of outcomes that are most important to them if they were to exercise. The researchers also examined whether these differ depending on patients' age and the type of dialysis that they use.

For the study, the investigators surveyed 423 patients with end stage kidney disease who were undergoing dialysis. Among the major findings:

• The 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 peritoneal dialysis, in-center hemodialysis, and home dialysis patients, respectively.
• Older patients were most interested in improving energy and strength, as well as maintaining independence, while young patients were interested in improving energy, longevity, and transplant candidacy.
• Only 25% of patients could exercise without difficulty; the major barriers for the reaming patients were feeling too tired (55%), too weak (49%), or short of breath (50%).
• If patients were to exercise, they wanted to exercise at home (73%) using a combination of aerobic and resistance training (41%), regardless of dialysis type or age.

"The majority of dialysis patients included in this study, regardless of modality, believe exercise would be beneficial, but report several barriers to participating in an exercise program that will need to be addressed in any proposed exercise program and/or clinical study," said Dr. Zimmerman. "The fatigue and weakness experienced by patients may mandate an exercise program that can be incorporated into their activities of daily living at home or in their neighborhood."

In an accompanying Patient Voice editorial, Nichole Jefferson noted that, as a chronic kidney disease patient of over 15 years, the article resonated with her on different levels. She also explained that at various times over the course of her disease, she has viewed exercise in different terms. "Reading this article and the surveys utilized made me realize that maybe we need to re-define exercise," she wrote.