Determination of Exercise Barriers in Patients Undergoing Hemodialysis

Yıl 2021, , 102 - 114, 30.09.2021

Muhammet Akkoyun Zülfünaz Özer

https://doi.org/10.47565/ndthdt.2021.38

Öz

Aim: This study was conducted to determine exercise limitations
and affecting factors in patients undergoing hemodialysis.
Materials and Methods: This study was carried out with 200
patients undergoing dialysis treatment in two hemodialysis
centers on the European side of Istanbul between December
2020 and February 2021. Research data were collected through
face-to-face interviews with Introductory Information Form,
Modified Charlson Comorbidity Index (MCKI), International
Physical Activity Questionnaire (IPAQ), and Exercise
Benefits/Barriers Scale for Dialysis Patients (DPEBBS).
Results: The average age of the patients was 57.52±16.42 years
and the average undergoing hemodialysis year was 5.72±4.33.
61% of the patients were male, 77% were married, 28% were
primary school graduated and 62% were unemployed. It was
determined that 86.5% of the patients had different chronic
diseases, 27.5% smoked, 10% regularly exercised, and 35.5%
were overweight. It was determined that 43.2% did not want to
exercise, 21.4% were not informed about exercising by health
professionals, and 10.9% did not exercise because they did not
have an area to exercise. Based on the weekly MET total scores;
15% of patients were inactive, 78% minimally active and 7%
sufficiently active. The average MCKI score of the patients was
found to be 6.54±5.04. DPEBBS total score average was
62.09±9.28. DPEBBS average scores show statistically
significant differences according to gender, educational status,
employment status, smoking, activity and regular exercise
status. A negative and significant correlation was found between
age, undergoing hemodialysis time and MCKI and DPEBBS.
Conclusion: It was seen that the patients’ perception of benefits
of exercising was moderate in the patients who have been
undergone hemodialysis, and their physical activity levels were
not sufficient. Exercise is thought to be beneficial in patients
who men, university graduates, full-time workers, those who are
active enough, those at a young age, those with short undergoing
hemodialysis time and patients with low comorbidity.

Anahtar Kelimeler

Exercise, Limitations, Physical Activity, Patient, Hemodialysis

Hemodiyaliz Uygulanan Hastalarda Egzersiz Engellerinin Belirlenmesi/Determination of Exercise Barriers in Patients Undergoing Hemodialysis

Öz

Amaç: Bu çalışma hemodiyaliz uygulanan hastalarda egzersiz engelleri ve etkileyen faktörlerin saptanması amacıyla yapılmıştır. 

Gereç ve Yöntemler: Bu araştırma, İstanbul’da Avrupa yakasında bulunan iki diyaliz merkezinde Aralık 2020-Şubat 2021 tarihleri arasında 200 hemodiyaliz hastası ile gerçekleştirilmiştir. Araştırma verileri, Tanıtıcı Bilgi Formu, ‘Modifiye Charlson
Komorbidite İndeksi (MCKİ)’, ‘Uluslararası Fiziksel Aktivite Anketi (IPAQ’) ve ‘Diyaliz Hastalarında Egzersiz Yararları/Engelleri Ölçeği (DPEBBS)’ ile yüz yüze görüşme yöntemiyle toplanmıştır.
Bulgular: Hastaların, yaş ortalaması 57,52±16,42 olup hemodiyaliz uygulama yıl ortalaması 5,72±4,33’tür. Hastaların %61’i erkek, %77’si evli, %28’i ilkokul mezunu, %62’si çalışmamaktadır. Hastaların, %86,5’inin farklı kronik hastalıkları bulunduğu, %27,5’inin sigara kullandığı, %10’unun düzenli egzersiz yaptığı ve %35,5’inin fazla kilolu olduğu tespit edilmiştir. Hastaların %43,2’sinin egzersiz yapmak istemediği, %21,4’ünün egzersiz konusunda sağlık çalışanları tarafından bilgilendirilmediği ve %10,9’unun egzersiz yapacak alanı olmadığı için egzersiz yapmadığı belirlenmiştir. Haftalık MET toplam puanına göre hastaların %15’i inaktif, %78’i minimal aktif ve %7’si ise yeterince aktiftir. Hastaların MCKİ puan ortalaması 6,54±5,04 bulunmuştur. DPEBBS toplam puan ortalaması 62,09±9,28 bulunmuştur. Cinsiyet, eğitim durumu, çalışma durumu, sigara içme, aktivite durumu ve düzenli egzersiz yapma durumlarına göre DPEBBS ortalamaları istatistiksel olarak anlamlı farklılık göstermektedir. Yaş, hemodiyaliz uygulama süresi ve MCKİ ile DPEBBS arasında negatif yönde ve anlamlı bir ilişki bulunmuştur.
Sonuç: Hemodiyaliz uygulanan hastaların egzersiz yararları algısının orta düzeyde, fiziksel aktivite düzeylerinin ise yeterli olmadığı görülmüştür. Erkekler, üniversite mezunları, tam zamanlı çalışanlar, yeterli aktif olanlar, genç yaşta olanlar, hemodiyaliz uygulama süresi az olanlar ve komorbiditesi az olan hastalar egzersizin yararlı olduğunu düşünmektedir.

Anahtar Kelimeler

Egzersiz, Engeller, Fiziksel Aktivite, Hasta, Hemodiyaliz

Kaynakça

• 1. Topbaş E. Kronik böbrek hastalığının önemi, evreleri ve evrelere özgü bakımı. Nefroloji Hemşireliği Dergisi. 2015; 10(1): 53-9.
• 2. Seyahi N, Ateş K, Süleymanlar G. Current status of renal replacement therapy in Turkey: A summary of the Turkish Society of Nephrology Registry Report. Current Status of Renal Replacement Therapy in Turkey. Turkish Journal of Nephrology. 2020; 29(1): 6-11. doi: 10.5152/turkjnephrol.2020.4249
• 3. Bakaloudi DR, Siargkas A, Poulia KA., Dounousi E, Chourdakis M. The effect of exercise on nutritional status and body composition in hemodialysis: A Systematic Review. Nutrients. 2020; 12(10): 3071. doi:10.3390/nu12103071
• 4. Wu X, Yang L, Wang Y, Wang C, Hu R, Wu Y. Effects of combined aerobic and resistance exercise on renal function in adult patients with chronic kidney disease: a systematic review and meta-analysis. Clinical Rehabilitation. 2020; 34(7): 851-65. doi:10.1177/0269215520924459
• 5. Mohseni R, Zeyidi AE, Ilali E, Adib-Hajbaghery M, Makhlough A. The effect of ıntradialytic aerobic exercise on dialysis efficacy in hemodialysis patients: A randomized controlled trial. Oman Medical Journal. 2013; 28(5): 345-9. doi: 10.5001/omj.2013.99
• 6. Soyupek F, Aşkın A. Diyaliz hastalarında egzersizin önemi. Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi.2010; 17(1): 33-7.
• 7. Taş D, Akyol A. Diyaliz Hastalarında Egzersiz Yararları/Engelleri Ölçeği’nin Türkçeye uyarlanması: geçerlik güvenirlik çalışması. Nefroloji Hemşireliği Dergisi. 2019; 14(1): 17-25.
• 8. Demir GT, Cicioğlu Hİ. Fiziksel Aktiviteye Katılım Motivasyonu Ölçeği (FAKMÖ): Geçerlik ve Güvenirlik Çalışması. Journal of Human Sciences 2018; 15(4): 2479-92. doi: 10.14687/jhs.v15i4.5585
• 9. Türkiye Fiziksel Aktivite Rehberi (2014). Erişim: https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-hareketli-hayatdb/Fiziksel_Aktivite_Rehberi/Turkiye_Fiziksel_Aktivite_Rehberi.pdf Erişim Tarihi: 20.05.2021
• 10. Gould DW, Graham-Brown M, Watson EL, Vıana JL, Smıth AC. Physiological benefits of exercise in pre-dialysis chronic disease. Nephrology 2014; 19(9): 519-27. doi:10.1111/nep.12285
• 11. Wilkinson TJ, Shur NF, Smith AC. “Exercise as medicine” in chronic kidney disease. Scandinavian Journal of Medicine &Science in Sports 2016; 26(8): 985-8. doi: 10.1111/sms.12714
• 12. Shimoda T, Matsuzawa R, Yoneki K, Harada M, Watanabe T, Matsumoto M, et al. Changes in physical activity and risk of allcause mortality in patients on maintence hemodialysis: a retrospective cohort study. BMC Nephrology. 2017; 18(1): 1-8. doi: 10.1186/s12882-017-0569-7
• 13. Foy CG. Physical activity for patients with CKD. In Psychosocial Aspects of Chronic Kidney Disease. Academic Press. 2021; 117-139. doi: 10.1016/B978-0-12-817080-9.00006-3
• 14. Taler SJ, Agarwal R, Bakris GL, Flynn JT, Nilsson PM, Rahman M, et al., KDOQI US commentary on the 2012 KDIGO clinical practice guideline for management of blood pressure in CKD. American Journal of Kidney Diseases 2013; 62(2): 201-13. doi:10.1053/j.ajkd.2013.03.018
• 15. O'Connor E, Koufaki P, Clark R, Lindup H, Mercer TH, Macdougall I, Greenwood S. Renal rehabilitation: the benefits, barriers and exercise options. Journal of Renal Nursing. 2014; 6(1): 29-33. doi:10.12968/jorn.2014.6.1.29
• 16. Orcy RB, Dias PS, LC-Seus T, Barcellos FC, Bohlke M. Combined resistance and aerobic exercise is better than resistance training alone to improve functional performance of haemodialysis patients- Results of a randomized controlled trial. Physiotherapy Research International. 2012; 17(4): 235-43. doi:10.1002/pri.1526
• 17. Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, et al. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. American Journal of Kidney Diseases. 2015; 66(5): 884-930. doi: 10.1053/j.ajkd.2015.07.015
• 18. Lumsdon A. The importance of exercise for patients with kidney disease. Journal of Renal Nursing. 2014; 6(6): 302-3. doi: 10.12968/jorn.2014.6.6.302
• 19. Darawad MW, Khalil AA. Jordanian dialysis patients' perceived exercise benefits and barriers: a correlation study. Rehabilitation Nursing Journal. 2013; 38(6): 315-22. doi: 10.1002/rnj.98
• 20. Çapık C. İstatistiksel güç analizi ve hemşirelik araştırmalarında kullanımı: Temel bilgiler. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2014; 17(4):268-74.
• 21. Zelle DM, Klaassen G, Van Adrichem E, Bakker SJ, Corpeleijn E, Navis G. Physical inactivity: a risk factor and target for intervention in renal care. Nature Reviews Nephrology 2017; 13(3): 152. doi: 10.1038/nrneph.2016.187
• 22. Charlson ME, Pompel P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases. 1987; 40(5): 373–83.
• 23. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. Journal of Clinical Epidemiology. 1994; 47 (11): 1245-51.
• 24. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Medicine & Science in Sports & Exercise. 2003; 35(8): 1381-95. doi: 0195-9131/03/3508-1381
• 25. Sağlam M, Arıkan H, Savcı S, İnal-İnce D, Boşnak-Güçlü M, Karabulut E, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111(1):278-84. doi: 10.2466/06.08.PMS.111.4.278-284
• 26. Zheng J, You LM, Lou TQ, Chen NC, Lai DY, Liang YY, et al., Development and psychometric evaluation of the Dialysis patient-perceived Exercise Benefits and Barriers Scale. International Journal of Nursing Studies. 2010; 47(2): 166-80. doi: 10.1016/j.ijnurstu.2009.05.023
• 27. Wilkinson TJ, Clarke AL, Nixon DG, Hull KL, Song Y, Burton JO, et al. Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study. Nephrology Dialysis Transplantation. 2021; 36(4): 641-9. doi:10.1093/ndt/gfz235
• 28. Duman D, Erdem E, Ecder T. Hemodiyaliz Hastalarında Fiziksel Aktivitenin Pedometre ile Değerlendirilmesi. Türk Nefroloji Diyaliz ve Transplantasyon Dergisi. 2018; 27 (2): 173-7. doi: 10.5262/tndt.2018.3049
• 29. Morishita S, Tsubaki A, Shirai N. Physical function was related to mortality in patients with chronic kidney disease and dialysis. Hemodialysis International. 2017; 21(4): 483-9. doi:10.1111/hdi.12564
• 30. Avesani CM, Trolonge S, Deléaval P, Baria F, Mafra D, Faxén-Irving G, et al. Physical activity and energy expenditure in haemodialysis patients: an international survey. Nephrology Dialysis Transplantation. 2012; 27(6): 2430-4. doi: 10.1093/ndt/gfr692
• 31. Atik D, Coşar AA, Çınar S. Hemodiyaliz hastalarında metabolik sendrom ve fiziksel aktivite. Çağdaş Tıp Dergisi. 2014; 4(2): 69-75.
• 32. Başarır S, Pakyüz SÇ. Hemodiyaliz hastalarının sağlıklı yaşam biçimi davranışlarının değerlendirilmesi. Nefroloji Hemşireliği Dergisi. 2015; 10(1): 19-31.
• 33. Özkaraman A, Alparslan G, Babadağ B, Gökçe S, Gölgeli H, Derin Ö, Bilgin M. Hemodiyaliz yapılan kronik böbrek hastalarında sağlıklı yaşam biçimi davranışlarının değerlendirilmesi. Osmangazi Tıp Dergisi. 2016; 38(2): 51-61. doi: 10.20515/otd.54752
• 34. Regolisti G, Maggiore U, Sabatino A, Gandolfini I, Pioli S, Torino C, et al. Interaction of healthcare staff’s attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment. PLoS One. 2018; 13(4): e0196313. doi:10.1371/journal.pone.0196313
• 35. Delgado C, Johansen KL. Barriers to exercise participation among dialysis patients. Nephrology Dialysis Transplantation. 2012; 27(3): 1152-7. doi: 10.1093/ndt/gfr404
• 36. Jefferson NM. A patient’s view on exercise and ESKD. Clinical Journal of the American Society of Nephrology. 2014; 14:171. doi: 10.2215/CJN.00150119
• 37. Wang X-X, Lin Z-H, Wang Y, Xu M-C, Kang Z-M, Zeng W, Ma YC. Motivators for and barriers to exercise rehabilitation in hemodialysis centers: a multicenter cross-sectional survey. American Journal of Physical Medicine & Rehabilitation. 2020;99(5):424–9. doi: 10.1097/PHM.0000000000001360
• 38. Clarke AL, Jhamb M, Bennett PN. Barriers and facilitators for engagement and implementation of exercise in end-stage kidney disease: Future theorybased interventions using the Behavior Change Wheel. In: Seminars in Dialysis. 2019; 32(4): 308–19. doi: 10.1111/sdi.12787.
• 39. Ghafourifard M, Mehrizade B, Hassankhani H, Heidari M. Hemodialysis patients perceived exercise benefits and barriers: the association with health-related quality of life. BMC Nephrology. 2021; 22(1): 1-9. 1) 22:94. doi:10.1186/s12882-021-02292-3.
• 40. Lightfoot CJ, Wilkinson TJ, Song Y, Burton JO, Smith AC. Perceptions of exercise benefits and barriers: the influence on physical activity behaviour in individuals undergoing haemodialysis and peritoneal dialysis. Journal of Nephrology. 2021; 1-11. doi: 10.1007/s40620-021-01024-y
• 41. Kronik Hastalıklar Risk Faktörleri Araştırması (2013). Erişim: https://sbu.saglik.gov.tr/ekutuphane/kitaplar/khrfat.pdf Erişim Tarihi: 20.05.2021
• 42. Sağlık İstatistikleri Yıllığı 2016 (2017). Erişim: https://dosyasb.saglik.gov.tr/Eklenti/13183,sy2016turkcepdf.pdf?0 Erişim Tarihi: 20.05.2021
• 43. Fiaccadori E, Sabatino A, Schito F, Angella F, Malagoli M, Tucci M, et al. Barriers to Physical Activity in Chronic Hemodialysis Patients: A Single-Center Pilot Study in an Italian Dialysis Facility. Kidney and Blood Pressure Research. 2014; 39:169-75. doi: 10.1159/000355793
• 44. Barcellos FC, Santos IS, Umpierre D, Bohlke M, Hallal PC. Efects of exercise in the whole spectrum of chronic kidney disease: a systematic review. Clinical Kidney Journal. 2015; 8(6):753–65. doi: 10.1093/ckj/sfv099
• 45. Matsuzawa R, Roshanravan B. Management of physical frailty in patients requiring hemodialysis therapy. Recent Advances in Dialysis Therapy in Japan. 2018; 196: 101–9. doi: 10.1159/000485707