Reasons for Nonparticipation in a Sustained Hemodialysis Intradialytic Exercise Program

Abstract

Patients with end-stage kidney disease requiring hemodialysis suffer frailty and poor physical function. Exercise can improve physical function; however, barriers exist to intradialytic exercise programs. The objective of this study was to explore patients' reasons for not exercising in an extant intradialytic exercise program. We conducted a retrospective analysis reporting the reasons for not exercising in an intradialytic exercise program in two hemodialysis centers over a 4-week period. We explored whether patient characteristics and the presence of an exercise professional were associated with missed exercise sessions. Seventy-five patients participating in the intradialytic exercise program completed 57% of prescribed intradialytic exercise sessions. The three most frequently reported reasons from patients not exercising were refusal (24%), followed by fatigue (19%) and symptoms (14%). Patients were more than twice as likely to exercise if a kinesiologist was present (odds ratio [OR]: 2.26, confidence interval [CI]: 1.5, 3.4 P=.03). They were less likely to exercise if they were women (OR: 0.66, CI: 0.45, 0.95 P=.002), had been on dialysis greater than 60months (OR: 0.55, CI: 0.37, 0.80 P<.002), or had more than two comorbid conditions (OR: 0.63, CI: 0.43, 0.90, P=.01). Patient adherence to intradialytic exercise programs is strongly associated with the presence of exercise professionals.