Abstract
There is strong evidence that hemodialysis (HD) patients with a sedentary lifestyle have a higher risk of death compared to peers who engage in regular physical activity. Therefore, monitoring physical activity is of utmost importance. However, there is a lack of data on objectively measured physical activity behaviors in HD patients. Therefore, this study aimed to objectively measure physical activity in HD patients throughout the week, with particular attention to dialysis and non-dialysis days. We also examined how objectively measured physical activity correlated with physical fitness, body composition, and disease burden. Daily physical activity, body composition, serum parameters, comorbidity index, sit-to-stand, and hand-grip strength tests were measured in 14 HD patients. Daily physical activity was measured using the Actigraph GT9X accelerometer. The Dialysis Symptom Index questionnaire was also used. We found significant differences in anthropometric variables (weight, body mass index, overhydration, lean tissue index, and fat tissue index, all p < 0.05) and phase angle (p < 0.01) between HD patients reaching and patients not reaching physical activity guidelines for patients with chronic diseases. HD patients showed to be less active during dialysis days compared to non-dialysis days as indicated in sedentary time (–11.7%; p = 0.001), light (–47.3%; p = 0.003), moderate (–51.5%; p = 0.001), moderate to vigorous (–49.3%; p = 0.001), and vigorous (–34.3%; p = 0.067) physical activity. No significant correlations were found among serum parameters, symptom burden, and comorbidity burden, but a very large and positive correlation was found between phase angle and total moderate to vigorous physical activity (p < 0.01). Our findings support the need to implement physical activity on dialysis days in HD units to mitigate the effects of sedentary behavior. Prospective, long-term studies evaluating the use of accelerometers in HD patients and their effects on physical activity are needed.
Highlights
Patients with chronic kidney disease (CKD) suffer from high morbidity and mortality associated with cardiovascular disease and poor quality of life (Foley et al, 1995; Codreanu et al, 2006)
When we compared the subgroup of patients reaching and not reaching World Health Organization (WHO) recommendations for physical activity, we found significant differences in their body composition: weight (p = 0.022), BMI (p = 0.031), overhydration (p = 0.033), lean tissue index (p = 0.024), and phase angle (p = 0.002), and no differences in other health-related variables, such as comorbidity score, symptom burden, physical fitness, and biochemistry parameters
Measures of physical fitness showed no significant correlation with sedentary time or time spent in moderate to vigorous physical activity (MVPA). This pilot study examined the association among objectively measured physical activity, selected measures of physical fitness, body composition, and disease burden in HD patients; it examined the magnitude of differences in physical activity between dialysis and non-dialysis days and between subjective characteristics of the 14 HD patients reaching and not reaching physical activity
Summary
Patients with chronic kidney disease (CKD) suffer from high morbidity and mortality associated with cardiovascular disease and poor quality of life (Foley et al, 1995; Codreanu et al, 2006). 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. 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
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