International Urology and Nephrology

, Volume 39, Issue 4, pp 1303–1311 | Cite as

Factors influencing exercise participation by older adults requiring chronic hemodialysis: a qualitative study

  • Pia C. KontosEmail author
  • Karen-Lee Miller
  • Dina Brooks
  • Sarbjit Vanita Jassal
  • Lily Spanjevic
  • Gerald Michael Devins
  • Mary Jane De Souza
  • Carol Heck
  • Judith Laprade
  • Gary Naglie
Original Article


Despite the recognized health and psychosocial benefits of exercise for older adults with end-stage renal disease (ESRD), exercise participation remains poor. Previous research has attributed low levels of exercise to patient-related factors such as lack of motivation and fear of adverse consequences. This qualitative study involving focus group discussions with hemodialysis patients, nephrology nurses, and family care providers explored specific motivators and barriers to exercise participation in older adults requiring hemodialysis. Nurse participants were chosen for the health care provider focus groups because their prolonged and sustained contact with hemodialysis patients during the dialysis treatment sessions positions them well to encourage and promote exercise. Motivators to exercise included patient aspirations to exercise and their experiences of improvements from exercising, as well as the formal incorporation of exercise into the overall dialysis treatment plan. Barriers to exercise included nurses’ lack of encouragement to exercise, transportation issues, and the use of exercise equipment that precludes participation by patients who recline during dialysis and inhibits exercise encouragement by nurses due to concerns of equipment-related injury. These findings support the need for a broader recognition of the systemic factors that may impede exercise participation by older adults requiring hemodialysis. A shift is required in the culture of ESRD treatment programs towards a wellness perspective that includes expectations of exercise encouragement by the health care team and participation by patients.


Hemodialysis End stage renal disease Exercise Older adults Focus groups 



This research was jointly funded by the Canadian Institutes of Health Research, Institute of Aging Pilot Grant Program, and the Collaborative Research Program: Rehabilitation & Long-Term Care and the Canadian Nurses Foundation Nursing Care Partnership. The Toronto Rehabilitation Institute receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care in Ontario. We wish to thank all of the patients, family members, and staff who participated in this study. We also gratefully acknowledge the administrative support we received from both hospitals that facilitated the implementation of the study.


  1. 1.
    Colangelo RM, Stillman MJ, Kessler-Fogil D, Kessler-Hartnett D (1997) The role of exercise in rehabilitation patients with end-stage renal disease. Rehabil Nurs 22(6):288–292PubMedGoogle Scholar
  2. 2.
    Kouidi EJ (2001) Central and peripheral adaptations to physical training in patients with end-stage renal disease. Sports Med 31(9):651–655PubMedCrossRefGoogle Scholar
  3. 3.
    Pianta TF, Kutner NG (1999) Improving physical functioning in the elderly dialysis patient: relevance of physical therapy. ANNA J 26(1):11–21PubMedGoogle Scholar
  4. 4.
    Lysaght MJ (2002) Maintenance dialysis population dynamics: current trends and long-term implications. J Am Soc Nephrol 13:S37–S40PubMedCrossRefGoogle Scholar
  5. 5.
    Sioson ER, Kerfoot S, Ziat LM (1993) Rehabilitation outcome of older patients with end stage renal disease and lower extremity amputation. J Am Geriatr Soc 41:667–668PubMedGoogle Scholar
  6. 6.
    Painter P, Carlson L, Carey S, Paul SM, Myll J (2000) Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients. Am J Kidney Dis 35(3):482–492PubMedGoogle Scholar
  7. 7.
    Painter P, Carlson L, Carey S, Paul SM, Myll J (2000) Low-functioning hemodialysis patients improve with exercise training. Am J Kidney Dis 36:600–608PubMedGoogle Scholar
  8. 8.
    Mercer T, Crawford C, Gleeson NP, Naish PF (2002) Low-volume exercise rehabilitation improves functional capacity and self-reported functional status of dialysis patients. Am J Phys Med Rehabil 81(3):162–167PubMedCrossRefGoogle Scholar
  9. 9.
    Kong CH, Tattersall JE, Greenwood RN, Farrington K (1999) The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant 14:2927–2931PubMedCrossRefGoogle Scholar
  10. 10.
    Stenvinkel P, Elinder C, Bárány P (2000) Physical activity promotes health also among dialysis patients. Int J Cardiol 72:299–300PubMedCrossRefGoogle Scholar
  11. 11.
    Johansen KL, Kaysen G, Young B, Hung A, da Silva M (2002) Longitudinal study of nutritional status, body composition, and physical function in hemodialysis patients. Am J Clin Nutr 77(4):842–846Google Scholar
  12. 12.
    Kouidi E, Grekas D, Deligiannis A, Tourkantonis A (2004) Outcomes of long-term exercise training in dialysis patients: comparison of two training programs. Clin Nephrol 61:S31–S38PubMedGoogle Scholar
  13. 13.
    Goodman ED, Ballou MB (2004) Perceived barriers and motivators to exercise in hemodialysis patients. Nephrol Nurs J 31(1):23–29PubMedGoogle Scholar
  14. 14.
    Johansen KL, Sakkas GK, Doyle J, Shubert T, Dudley RA (2003) Exercise counseling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis 41(1):171–178PubMedCrossRefGoogle Scholar
  15. 15.
    Painter P, Carlson L, Carey S, Myll J, Paul S (2004) Determinants of exercise encouragement practices in hemodialysis staff. Nephrol Nurs J 31(1):67–74PubMedGoogle Scholar
  16. 16.
    Mays N, Pope C (1995) Qualitative research: rigour and qualitative research. BMJ 311:109–112PubMedGoogle Scholar
  17. 17.
    Rowan M, Huston P (1997) Qualitative research articles: information for authors and peer reviewers. CMAJ 157:1442–1446PubMedGoogle Scholar
  18. 18.
    Morse J (1995) Designing funded qualitative research. In: Denzin NK, Lincoln YS (eds) Handbook of qualitative research. Sage, Thousand Oaks, CA, pp 220–235Google Scholar
  19. 19.
    Denzin NK, Lincoln YS (1998) Collecting and interpreting qualitative materials. Sage, Thousand Oaks, CAGoogle Scholar
  20. 20.
    Glesne C, Peshkin A (1992) Becoming qualitative researchers: an introduction. Longman, White Plains, NYGoogle Scholar
  21. 21.
    Kuckartz U (1995) Case-oriented quantification. In: Kelle U (ed) Computer-aided qualitative data analysis. Sage, London, pp 158–166Google Scholar
  22. 22.
    Barbour RS (2001) Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 322:1115–1117PubMedCrossRefGoogle Scholar
  23. 23.
    Naglie G, Jassal V, Tomlinson G, Richardson R (2002) Frailty in elderly hemodialysis patients at a large university hospital dialysis center. Gerontol 42(special issue 1):239–240Google Scholar
  24. 24.
    Curtin RB, Lowrie EG, DeOreo PB (1999) Self-reported functional status: an important predictor of health outcomes among end-stage renal disease patients. Adv Ren Replace Ther 6(2):133–139PubMedGoogle Scholar
  25. 25.
    K/DOQI Workgroup (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45(4 suppl 3):S1–S153Google Scholar
  26. 26.
    Mendelssohn DC, Chery A (1994) Dialysis utilisation in the Toronto region from 1981 to 1992. Can Med Assoc J 150(7):1099–1105Google Scholar
  27. 27.
    Rocco M, Burkart J (1993) Prevalence of missed treatments and early sign-offs in hemodialysis patients. J Am Soc Nephrol 4(5):1178–1183PubMedGoogle Scholar
  28. 28.
    Painter PL, Nelson-Worel JN, Hill MM, Thornbery DR, Shelp WR, Harrington AR et al (1986) Effects of exercise training during hemodialysis. Nephron 43(2):87–97PubMedCrossRefGoogle Scholar
  29. 29.
    Williams A, Stephens R, McKnight T, Dodd S (1991) Factors affecting adherence of end-stage renal disease patients to an exercise programme. BJSM 25(2):90–93Google Scholar
  30. 30.
    Konstantinidou E, Koukouvou G, Kouidi E, Deligiannis A, Tourkantonis A (2001) Exercise renal rehabilitation: comparison of three exercise programs. J Rehabil Med 34:40–45CrossRefGoogle Scholar
  31. 31.
    Moug SJ, Grant S, Creed G, Boulton JM (2004) Exercise during haemodialysis: West of Scotland pilot study. Scott Med J 49:14–17PubMedGoogle Scholar
  32. 32.
    Ridley J, Hoey K, Ballagh-Howes N (1999) The exercise-during-hemodialysis program: report on a pilot study. CANNT 9:20–26PubMedGoogle Scholar
  33. 33.
    Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J (2004) Physical activity participation among persons with disabilities. Am J Prev Med 26(5):419–425PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Pia C. Kontos
    • 1
    • 2
    Email author
  • Karen-Lee Miller
    • 2
  • Dina Brooks
    • 3
    • 1
  • Sarbjit Vanita Jassal
    • 4
    • 5
  • Lily Spanjevic
    • 1
  • Gerald Michael Devins
    • 6
    • 7
  • Mary Jane De Souza
    • 8
  • Carol Heck
    • 3
    • 9
  • Judith Laprade
    • 3
  • Gary Naglie
    • 5
    • 1
    • 10
    • 11
  1. 1.Toronto Rehabilitation InstituteTorontoCanada
  2. 2.Department of Public Health SciencesUniversity of TorontoTorontoCanada
  3. 3.Department of Physical TherapyUniversity of TorontoTorontoCanada
  4. 4.Division of NephrologyUniversity Health NetworkTorontoCanada
  5. 5.Department of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  6. 6.Department of Behavioural Science, University Health NetworkUniversity of TorontoTorontoCanada
  7. 7.Department of PsychiatryUniversity of TorontoTorontoCanada
  8. 8.Faculty of Physical Education and HealthUniversity of TorontoTorontoCanada
  9. 9.ResearchUniversity Health NetworkTorontoCanada
  10. 10.Department of MedicineUniversity of TorontoTorontoCanada
  11. 11.Division of General Internal Medicine and Toronto General Research InstituteUniversity Health NetworkTorontoCanada

Personalised recommendations