Abstract
Background and aim of the studyIn hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population.MethodsIn this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff’s attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile–Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers.ResultsMost barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. We found a significant interaction between staff’s attitude and barriers (adjusted P values ranging between 0.03 [“I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in patients not endorsing barriers.ConclusionsBarriers and non-proactive staff’s attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff’s attitude.
Highlights
In patients with end-stage kidney disease on hemodialysis the degree of physical activity is low, even if compared to age-matched sedentary subjects [1]
Sedentarism is an important factor of frailty and disability in patients with chronic kidney disease (CKD) [2], especially in those on routine hemodialysis [3]
Counseling on the implementation of exercise is low among nephrologists [17], while a proactive approach by specialized teams may help in the empowerment and motivation of patients [18]
Summary
In patients with end-stage kidney disease on hemodialysis the degree of physical activity is low, even if compared to age-matched sedentary subjects [1]. The assessment of the effects of healthcare staff’s attitude on patients’ level of physical activity has been attempted only in qualitative studies using purposive sampling and thematic saturation [13], focus groups and semistructured interviews [15,19,20]. It is not known whether a proactive staff’s attitude may directly and quantitatively modify the effects of patient-perceived barriers on the level of physical activity in this population. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population
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