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The combination of chronic kidney disease, dialysis treatment and compromised physical function has a negative impact on the health of individuals living with kidney failure. Although physical exercise is proven to be beneficial for this population, the percentage of patients who adhere to it is small and perceived barriers can impair its adherence. Thus, we investigated the perception of benefits and barriers to physical exercise in patients undergoing hemodialysis.
A cross-sectional study conducted in six dialysis units in different cities of Brazil. Patients undergoing treatment > 3 months, 2 to 6x/week and who obtained a score ≥ 3 points on the Six-Item Screener for cognitive screening were included. We applied the Brazilian-Portuguese Version of Dialysis patient-perceived Exercise Benefits and Barriers Scale (DPEBBS-BP), translated, adapted and psychometrically validated into Brazilian-Portuguese. Each item can be answered using a 4-point Likert scale, where 1 means ''strongly disagree'', 2 ''disagree'', 3 ''agree'' and 4 ''strongly agree''. Higher scores indicate greater perception of benefits and barriers. In the description of the results, the answers were grouped with the sum of the scores: disagree (strongly disagree and disagree) and agree (strongly agree and agree). Data on benefits and barriers were compared between genders and adults vs. older adults (≥ 65 years old) using the student t test. A p <0.05 was considered significant.
299 patients (57±15 years; 35% older; 65% male; 36 [IQR: 18 - 68] months on HD) were included in the analysis. The overall scores for benefits and barriers were 48.3±6.3 and 35.2±7.1, respectively. Patients agreed that exercise is beneficial for “improving the strength of the muscles in the arms and legs” (n=295, 98.6%), “preventing muscle weakening” (n=293, 98%) and “improving bone health” (n=292, 97.6%). Regarding barriers, the most frequently scored were “tiredness prevents me from exercising” (n=207, 69.3%), “I worry that exercise could affect my arteriovenous fistula/catheter” (n=199, 66.6%) and “body pain prevents me from exercising” (n=197, 65.9%). Furthermore, 89% (n=266) of participants disagreed that “exercise is harmful for dialysis patients”. In sensitivity analyses, there was no difference in benefit scores when comparing men and women (p=0.172), while women had a higher barrier score (p=0.007). Older patients (≥65 years) had a lower benefit score (p=0.030) compared to younger patients, but there was no difference for barriers (p=0.084).
Patients recognize more benefits linked to their physical condition. The barriers identified are related to the symptoms of the disease itself and hemodialysis treatment, as well as the fear that exercise may interfere with the arteriovenous fistula/catheter. Additionally, women perceived more exercise-related barriers, while older individuals perceived fewer benefits of exercise.