In patients on chronic dialysis, a sedentary lifestyle is a strong, yet potentially modifiable, predictor of mortality. The present multicentric study evaluated social, psychological and clinical barriers hindering physical activity in this population.
We explored the association between barriers to physical activity and sedentary habit in adult ESRD patients at 31 chronic dialysis facilities in Italy. We used different questionnaires exploring participation in physical activity, physical functioning, patient’s attitudes and preferences, and barriers to physical activity perceived by either patients or nephrologists/nurses.
We enrolled 744 patients, (males 62%), mean age 65 yrs (56% > 65 years); median dialysis vintage 48 months (IQR 22-92 mo); mean Charlson score 3.9 (SD 2.0), mean Activities of Daily Living score 5.5 (SD 1.3). Six hundred eighty-eight patients (92.5%) reported at least one barrier to physical activity. At multivariable analysis, after adjusting for age, gender, level of education and comorbidities, most of the explored barriers were independently associated with inactivity. The association was particularly strong for pain, either on dialysis days (OR 3.41, 95% CI 2.27 to 5.11, P<0.001) or on non-dialysis days (OR 3.21, 95% CI 2.01 to 5.13, P<0.001), fatigue on non-dialysis days (OR 2.44, 95% CI 2.64 to 3.63, P<0.001), and inability to travel (OR 4.12, 95% CI 2.53 to 6.60, P<0.001). Physician’s concern was also associated with patients’ inactivity (OR 6.01, 95% CI 1.29 to 27.99, P=0.022). 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 and nurses.
We identified a number of patient-related and healthcare personnel-related barriers to physical activity in patients on chronic dialysis. This issue should be addressed in future studies aimed at increasing the level of physical activity in this population.
