Journal of Nephrology

, Volume 30, Issue 6, pp 729–741 | Cite as

Barriers to exercise for patients with renal disease: an integrative review

Review

Abstract

Renal disease is a common health condition that leads to loss of physical function, frailty, and premature loss of independence in addition to other severe comorbidities and increased mortality. Increased levels of physical activity and initiation of exercise training is recommended in the current guidelines for all patients with renal disease, but participation and adherence rates are low. The barriers to exercise and physical activity in patients with renal disease are not well defined and currently based on patient provider perception and opinion. There have been no published reviews that have synthesized published findings on patient reported barriers to exercise. This integrative literature review therefore aimed to identify the current understanding of patient reported barriers to regular exercise. This integrative review found that patient perceived barriers to exercise are not consistent with the barriers that have been identified by renal disease specialists and healthcare providers, which were disinterest, lack of motivation, and being incapable of exercise. The patient reported barriers identified through this review were complex and diverse, and the most frequently reported patient perceived barrier to exercise was low energy levels and fatigue. It is clear that additional research to identify patient perceived barriers to exercise is needed and that patient directed interventions to address these barriers should be developed. This integrative review provides information to the interdisciplinary nephrology team that can be used to tailor their assessment of barriers to exercise and provide exercise education for patients with renal disease.

Keywords

Renal disease Chronic kidney disease Exercise Barriers 

Notes

Acknowledgements

Portions of this manuscript are to be presented at the Sigma Theta Tau International's 28th International Nursing Research Congress, July 2017.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Centers for Disease Control and Prevention (CDC) (2016) Chronic Kidney Disease (CKD) Surveillance Project. https://nccd.cdc.gov/ckd/. Accessed 30 Sep 2016
  2. 2.
    United States Renal Data System (USRDS) (2015) Chap. 1: ESRD Incidence, Prevalence, Patient Characteristics and Modalities. https://www.usrds.org/2015/view/v2_01.aspx. Accessed 30 Sep 2016
  3. 3.
    Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA et al (2016) Global prevalence of chronic kidney disease—a systematic review and meta-analysis. PLoS One 11(7):e0158765CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Murtagh FEM, Addington-Hall J, Higginson IJ (2007) The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis 14(1):82–99CrossRefPubMedGoogle Scholar
  5. 5.
    Johansen KL (2007) Exercise in the end-stage renal disease population. J Am Soc Nephrol 18(6):1845–1854CrossRefPubMedGoogle Scholar
  6. 6.
    O’Sullivan D, McCarthy G (2007) An exploration of the relationship between fatigue and physical functioning in patients with end stage renal disease receiving haemodialysis. J Clin Nurs 16(11c):276–284CrossRefPubMedGoogle Scholar
  7. 7.
    Miller BW, Cress CL, Johnson ME, Nichols DH, Schnitzler MA (2002) Exercise during hemodialysis decreases the use of antihypertensive medications. Am J Kidney Dis 39(4):828–833CrossRefPubMedGoogle Scholar
  8. 8.
    Momeni A, Nematolahi A, Nasr M (2014) Effect of intradialytic exercise on echocardiographic findings in hemodialysis patients. Iran J Kidney Dis 8(3):207–211PubMedGoogle Scholar
  9. 9.
    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):482–492CrossRefPubMedGoogle Scholar
  10. 10.
    Smart N, McFarlane J, Cornelissen V (2010) The effect of exercise therapy on physical function, biochemistry and dialysis adequacy in haemodialysis patients: a systematic review and meta-analysis. Open J Nephrol 03(01):25CrossRefGoogle Scholar
  11. 11.
    National Kidney Foundation (NKF) (2005) KDOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45(Supplement):3S1–154Google Scholar
  12. 12.
    Kidney Disease Improving Global Outcomes (KDIGO) (2012) KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 2(5):337–405CrossRefGoogle Scholar
  13. 13.
    Finkelstein J, Joshi A, Hise MK (2006) Association of physical activity and renal function in subjects with and without metabolic syndrome: a review of the third national health and nutrition examination survey (NHANES III). Am J Kidney Dis 48(3):372–382CrossRefPubMedGoogle Scholar
  14. 14.
    Tentori F, Elder SJ, Thumma J, Pisoni RL, Bommer J, Fissell RB et al (2010) Physical exercise among participants in the dialysis outcomes and practice patterns study (DOPPS): correlates and associated outcomes. Nephrol Dial Transplant 25(9):3050–3062CrossRefPubMedGoogle Scholar
  15. 15.
    Deligiannis A, Kouidi E, Tourkantonis A (1999) Effects of physical training on heart rate variability in patients on hemodialysis. Am J Cardiol 84(2):197–202CrossRefPubMedGoogle Scholar
  16. 16.
    Kouidi EJ, Grekas DM, Deligiannis AP (2009) Effects of exercise training on noninvasive cardiac measures in patients undergoing long-term hemodialysis: a randomized controlled trial. Am J Kidney Dis 54(3):511–521CrossRefPubMedGoogle Scholar
  17. 17.
    Parsons TL, Toffelmire EB, King-VanVlack CE (2004) The effect of an exercise program during hemodialysis on dialysis efficacy, blood pressure and quality of life in end-stage renal disease (ESRD) patients. Clin Nephrol 61(4):261–274CrossRefPubMedGoogle Scholar
  18. 18.
    Konstantinidou E, Koukouvou G, Kouidi E, Deligiannis A, Tourkantonis A (2002) Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. J Rehab Med 34(1):40–45CrossRefGoogle Scholar
  19. 19.
    Moher D, Tetlzlaff J, Altman DG, The Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Allen K, Gappmaier E (2001) Exercise habits and attitudes of patients undergoing hemodialysis. Cardiopulm Phys Ther J 12(1):11Google Scholar
  21. 21.
    Delgado C, Johansen KL (2012) Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant 27(3):1152–1157CrossRefPubMedGoogle Scholar
  22. 22.
    Boller JE (2001) The ecology of exercise: an interpretive phenomenological account of exercise in the lifeworld of persons on maintenance hemodialysis. Dissertation, University of California, San FranciscoGoogle Scholar
  23. 23.
    Goodman ED, Ballou MB (2004) Perceived barriers and motivators to exercise in hemodialysis patients. Nephrol Nurs J 31(1):23–29PubMedGoogle Scholar
  24. 24.
    Sieverdes JC, Raynor PA, Armstrong T, Jenkins CH, Sox LR, Treiber FA (2015) Attitudes and perceptions of patients on the kidney transplant waiting list toward mobile health-delivered physical activity programs. Prog Transplant 25(1):26–34CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kolewaski CD, Mullally MC, Parsons TL, Paterson ML, Toffelmire EB, King-Van Vlack CE (2005) Quality of life and exercise rehabilitation in end stage renal disease. CANNT J 15(4):22–29PubMedGoogle Scholar
  26. 26.
    Kontos PC, Miller KL, Brooks D, Jassal SV, Spanjevic L, Devins GM et al (2007) Factors influencing exercise participation by older adults requiring chronic hemodialysis: a qualitative study. Int Urol Nephrol 39(4):1303–1311CrossRefPubMedGoogle Scholar
  27. 27.
    Bossola M, Pellu V, Di Stasio E, Tazza L, Giungi S, Nebiolo PE (2014) Self-reported physical activity in patients on chronic hemodialysis: correlates and barriers. Blood Purif 38(1):24–29CrossRefPubMedGoogle Scholar
  28. 28.
    Fiaccadori E, Sabatino A, Schito F, Angella F, Malagoli M, Tucci M et al (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):169–175CrossRefPubMedGoogle Scholar
  29. 29.
    Clarke AL, Young HML, Hull KL, Hudson N, Burton JO, Smith AC (2015) Motivations and barriers to exercise in chronic kidney disease: A qualitative study. Nephrol Dial Transplant 30(11):1885–1892CrossRefPubMedGoogle Scholar
  30. 30.
    Byrne K, Russell M (2011) Physical activity levels of patients with chronic kidney disease requiring dialysis. Physiother Irel 32(2):29–33Google Scholar
  31. 31.
    Darawad MW, Khalil AA (2013) Jordanian dialysis patients’ perceived exercise benefits and barriers: a correlation study. Rehabil Nurs 38(6):315–322CrossRefPubMedGoogle Scholar
  32. 32.
    Rosa CSC, Bueno DR, Souza GD, Gobbo LA, Freitas IF, Sakkas GK et al (2015) Factors associated with leisure-time physical activity among patients undergoing hemodialysis. BMC Neph. doi:10.1186/s12882-015-0183-5 Google Scholar
  33. 33.
    Zheng J, You LM, Lou TQ, Chen NC, Lai DY, Liang YY et al (2010) Development and psychometric evaluation of the dialysis patient-perceived exercise benefits and barriers scale. Int J Nurs Stud 47(2):166–180CrossRefPubMedGoogle Scholar
  34. 34.
    Olsen J, Baisch MJ (2014) An integrative review of information systems and terminologies used in local health departments. J Am Med Inform Assoc 21(e1):e20–e27CrossRefPubMedGoogle Scholar
  35. 35.
    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):171–178CrossRefPubMedGoogle Scholar
  36. 36.
    Young HM, Hudson N, Clarke AL, Dungey M, Feehally J, Burton JO et al (2015) Patient and staff perceptions of intradialytic exercise before and after implementation: a qualitative study. PLoS One 10(6):e0128995CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Aucella F, Battaglia Y, Bellizzi V, Bolignano D, Capitanini A, Cupisti A (2015) Physical exercise programs in CKD: lights, shades and perspectives (corrected). J Nephrol 28(2):143–150CrossRefPubMedGoogle Scholar
  38. 38.
    Heiwe S, Jacobson SH (2011) Exercise training for adults with chronic kidney disease. Cochrane DB Syst Rev 10. doi:10.1002/14651858.CD003236.pub2
  39. 39.
    Polaschek N (2003) Living on dialysis: concerns of clients in a renal setting. J Adv Nurs 41(1):44–52CrossRefPubMedGoogle Scholar
  40. 40.
    McCann K, Boore JRP (2000) Fatigue in persons with renal failure who require maintenance haemodialysis. J Adv Nurs 32(5):1132–1142CrossRefPubMedGoogle Scholar
  41. 41.
    National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2016) Manage Patients with CKD: treat Complications and Comorbidities. https://www.ncbi.nlm.nih.gov/pubmed/. Accessed 11 Nov 2016
  42. 42.
    Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U et al (2012) Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 380(9838):247CrossRefPubMedGoogle Scholar
  43. 43.
    Sallis JF, Hovell MF (1990) Determinants of exercise behavior. Exerc Sport Sci Rev 18(1):307–330CrossRefPubMedGoogle Scholar
  44. 44.
    Sechrist KR, Walker SN, Pender NJ (1987) Development and psychometric evaluation of the exercise benefits/barriers scale. Res Nurs Health 10(6):357–365CrossRefPubMedGoogle Scholar
  45. 45.
    Ingledew DK, Markland D, Sheppard KE (2004) Personality and self-determination of exercise behaviour. Pers Indiv Differ 36(8):1921–1932CrossRefGoogle Scholar
  46. 46.
    Wight JP, Edwards L, Brazier J, Walters S, Payne JN, Brown CB (1998) The SF36 as an outcome measure of services for end stage renal failure. Qual Health Care 7(4):209–221CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Hayhurst WSG, Ahmed A (2015) Assessment of physical activity in patients with chronic kidney disease and renal replacement therapy. Springerplus 4(1):1–8CrossRefGoogle Scholar
  48. 48.
    Cobo G, Gallar P, Gama-Axelsson T, Di Gioia C, Qureshi AR, Camacho R et al (2015) Clinical determinants of reduced physical activity in hemodialysis and peritoneal dialysis patients. J Nephrol 28(4):503–510CrossRefPubMedGoogle Scholar
  49. 49.
    Newton JL, Jones DEJ (2010) Making sense of fatigue. Occup Med 60(5):326–329CrossRefGoogle Scholar
  50. 50.
    Davies N (2011) Healthier lifestyles: behaviour change. Nurs Times 23(107):20–23Google Scholar

Copyright information

© Italian Society of Nephrology 2017

Authors and Affiliations

  1. 1.Department of Biobehavioral Health Science (M/C 802), College of NursingUniversity of Illinois at ChicagoChicagoUSA

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