Barriers to Exercise Participation in Patients with End-Stage Renal Disease Receiving Hemodialysis: A Qualitative Study
The qualitative descriptive study aimed to describe the barriers to exercise in patients with end-stage renal disease (ESRD) receiving hemodialysis. Participants were 13 patients with ESRD receiving hemodialysis 3 times a week for more than 3 months. Data was collected by in-depth interview with an open-ended questionnaire which has been verified for content validity by experts, using tape recorder and field note. Content analysis method was used to analyze the data. Trustworthiness was established following the guidelines of the Lincoln and Cuba.
The findings showed that barriers to exercise were described in 5 groups: 1) being in a transitional period – could not adapt oneself 1.1) feeling of uncertainty 1.2) Lack of intensity and consistency in exercise; 2) symptoms disturbed to exercise; 3) anxiety – fear of vascular access complications and side effects; 4) personal characteristics and co-factors; and 5) lack of motivation and confidence in exercise.
Recommendations: Since nurses are closely with patients, they should be an educator who provides knowledge related to the importance and usefulness of exercise, set up appropriate physical exercise for patients and advise them on safety of physical exercise. Nurses can also help to increase social support from family, friends, and related health care professions; organizing group activities to enhance motivation of the patients in order to do regularly and continuously exercise.
Bootwicha, C. (2018). Factors Associated with Exercise Behaviors of Elderly in The Health and Environment Promotion Club, Sai Mai District, Bangkok Metropolitan. (Master), Krirk University, (in thai)
Bossola, M., Pellu, V., Di Stasio, E., Tazza, L., Giungi, S., & Nebiolo, P. E. (2014). Self-reported physical activity in patients on chronic hemodialysis: correlates and barriers. Blood purification, 38(1), 24-29.
Fiaccadori, E., Sabatino, A., Schito, F., Angella, F., Malagoli, M., Tucci, M., . . . Regolisti, G. (2014). Barriers to physical activity in chronic hemodialysis patients: a single-center pilot study in an Italian dialysis facility. Kidney Blood Press Res, 39(2-3), 169-175. doi:10.1159/000355793
Jampawal, T. (2018). State Anxiety. Buddhist psychology Journal, 3(1), 13-20. (in thai)
Jhamb, M., Liang, K., Yabes, J., Steel, J. L., Dew, M. A., Shah, N., & Unruh, M. (2013). Prevalence and correlates of fatigue in chronic kidney disease and end-stage renal disease: are sleep disorders a key to understanding fatigue? Am J Nephrol, 38(6), 489-495. doi:10.1159/000356939
Jhamb, M., McNulty, M. L., Ingalsbe, G., Childers, J. W., Schell, J., Conroy, M. B., . . . Dew, M. A. (2016). Knowledge, barriers and facilitators of exercise in dialysis patients: a qualitative study of patients, staff and nephrologists. BMC Nephrol, 17(1), 192. doi:10.1186/s12882-016-0399-z
Jhamb, M., Weisbord, S. D., Steel, J. L., & Unruh, M. (2008). Fatigue in patients receiving maintenance dialysis: a review of definitions, measures, and contributing factors. Am J Kidney Dis, 52(2), 353-365. doi:10.1053/j.ajkd.2008.05.005
Johansen, K. L., Kaysen, G. A., Dalrymple, L. S., Grimes, B. A., Glidden, D. V., Anand, S., & Chertow, G. M. (2012). Association of physical activity with survival among ambulatory patients on dialysis: the Comprehensive Dialysis Study. Clin J Am Soc Nephrol, 8(2), 248-253. doi:10.2215/CJN.08560812
Kidney Disease Improving Global outcome (KDIGO). (2012). KDIGO Clinical Practic Guideline for Anemia in Chronic Kifney Disease. Jounal of The International Society of Nephrology, 2(4), 283-287.
Levey, A. S., de Jong, P. E., Coresh, J., El Nahas, M., Astor, B. C., Matsushita, K., . . . Eckardt, K. U. (2011). The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int, 80(1), 17-28. doi:10.1038/ki.2010.483
Li, Y. N., Shapiro, B., Kim, J. C., Zhang, M., Porszasz, J., Bross, R., . . . Kopple, J. D. (2016). Association between quality of life and anxiety, depression, physical activity and physical performance in maintenance hemodialysis patients. Chronic Dis Transl Med, 2(2), 110-119. doi:10.1016/j.cdtm.2016.09.004
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic Inqury. Newbury Park: SAGE.
Ma, S, Lui, J., Brooks, D., & Parsons, T. L. (2012). The availability of exercise rehabilitation programs in hemodialysis centers in Ontario. Canadian Association of nephrology Nurses and Technologists, 22(4), 26-32.
Manfredini, F., Mallamaci, F., D'Arrigo, G., Baggetta, R., Bolignano, D., Torino, C., . . . Zoccali, C. (2017). Exercise in Patients on Dialysis: A Multicenter, Randomized Clinical Trial. J Am Soc Nephrol, 28(4), 1259-1268. doi:10.1681/ASN.2016030378
Michou, V., Kouidi, E., Liakopoulos, V., Dounousi, E., & Deligiannis, A. (2019). Attitudes of hemodialysis patients, medical and nursing staff towards patients' physical activity. Int Urol Nephrol, 51(7), 1249-1260. doi:10.1007/s11255-019-02179-1
Painter, P., & Roshanravan, B. (2013). The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease. Curr Opin Nephrol Hypertens, 22(6), 615-623. doi:10.1097/MNH.0b013e328365b43a
Painter, P., Ward, K., & Renae, D. Nelson. (2011). Self-Reported Physical Activity in Patients with End Stage Renal Disease. Nephrology Nursing Journal, 38(2), 139-148.
Palitnonkert, A., Suebvises, P., Kannang, O., Srisoy, K., Matta, R, ., Bunrot, W., & Saesue, M. (2018). Factors Related to Exercise Behavior of Physical Therapy Students in Huachiew Chalermprakiet University. Huachiew Chalermprakit University Journal of Health Sciecne, 21(42), 55-64. (in thai)
Palmer, S., Vecchio, M., Craig, J. C., Tonelli, M., Johnson, D. W., Nicolucci, A., . . . Strippoli, G. F. (2013). Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int, 84(1), 179-191. doi:10.1038/ki.2013.77
Polsingchan, S., & Rungruang, K. (2018). Factors Related to Resilience Quotient of End Stage Renal Disease (ESRD) Pateints Receiving Hemodialyasis at Surin Hospital. Boromrajonani Collage of Nursing, Uttaradit Journal, 10(1), 129-141. (in thai)
Praepataraprasit, Raphassa., Putwatana, Panwadee., & Prapaipanich, Wonnapha. (2014). Factors Related to Sleep Disorders in Patients with End Stage Renal Disease Undergoing Hemodialysis. Ramathibodi Nursing Journal, 20(2), 221-235. (in thai)
Spielberger, C.D. (1966). Anxiety and Behavior. New York: Academic Press.
Spielberger, C.D., Gorsuch, R.L., & Lushene, R.E. . (1970). Manual for the State-Trait Anxiety Inventory (Self Evaluation Questionnaire). Palo Alto, CA: Consulting Psychologists Press.
Tentori, F., Elder, S. J., Thumma, J., Pisoni, R. L., Bommer, J., Fissell, R. B., . . . Robinson, B. M. (2010). Physical exercise among participants in the Dialysis Outcomes and Practice Patterns Study (DOPPS): correlates and associated outcomes. Nephrol Dial Transplant, 25(9), 3050-3062. doi:10.1093/ndt/gfq138
The Nephrology Society of Thailand. (2015). Annual Report Thailand Renal Peplacement Tharapy 2015. Retrieved from http://www.nephrothai.org/images/Final_TRT_report_2015_ฉบับแก้ไข.pdf (in thai)
Wang, X. X., Lin, Z. H., Wang, Y., Xu, M. C., Kang, Z. M., Zeng, W., & Ma, Y. C. (2020). Motivators for and Barriers to Exercise Rehabilitation in Hemodialysis Centers: A Multicenter Cross-Sectional Survey. Am J Phys Med Rehabil, 99(5), 424-429. doi:10.1097/PHM.0000000000001360
Wongsree, C., & Assalee, R. (2016). Experience of Using Social Support in End Stage Renal Disease Patients Receiving Hemodialysis. Thai Red Cross Nursing Journal, 9(2), 132-144. (in thai)
Yoddumnern-Attig, B., & Tangchonlatip, K. (2009). Qualitative data analysis: management and interpretation. Institute for Population and Social Research: Mahidol University. (in thai)
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