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