In chronic dialysis patients low levels of physical activity are a strong - yet potentially modifiable - mortality predictor. We evaluated the prevalence of social, psychological and clinical barriers to physical activity and their relationship with sedentary lifestyle in patients at Dialysis facilities in Italy.
We used questionnaires exploring comorbidity burden (Charlson), performance status (Karnofski), physical functioning/autonomy (ADL), participation in physical activity (HAP, AAS, MAS), patient attitudes/preferences, and barriers to physical activity perceived by either patients or clinical staff. A cut-off value of < 53 at the AAS/HAP score was used to define sedentary lifestyle.
We enrolled 275 patients, (166 males, 60.4%), mean age (SD) 67.1 yrs (14.4), 72.4% of patients > 60 years); median (IQ range) dialysis vintage 49 months (24-101); mean (SD) Charlson score 6.9 (2.4), Karnofski index 73.6 (20.1), ADL score 5.2 (1.6); 181/275 patients (65.9%) had low physical activity levels. Two hundred fourty-eight participants (90.2%) reported at least one barrier to physical activity, 237 (86.2%) reported at least two barriers, 31 (11.3%) reported at least three barriers, and 30 (10.9%) reported at least four barriers. At multivariable analysis, after adjusting for age, sex and comorbidity burden, the number of endorsed barriers (OR 1.095, 95% CI 1.029 to 1.165; P=0.004), pain on dialysis days (OR 2.585, 95% CI 1.295 to 5.158; P=0.007), and chest pain (OR 3.199, 95% CI 1.077 to 9.500; P=0.036) were independently associated with physical inactivity. Lack of time for exercise counseling and the firm belief about low compliance/interest by the patients toward exercise were the most frequent barriers reported by nephrologists (50) and nurses (94).
We identified a number of patient-related and health personnel-related barriers to physical activity in chronic hemodialysis patients. Solutions for these barriers should be addressed in future studies aimed at increasing the level of physical activity in this population.
