Antonio Alberto Lopes1, Brett Lantz2, Hal Morgenstern3, Mia Wang4, Brian A Bieber4, Brenda W Gillespie5, Yun Li5, Patricia Painter6, Stefan H Jacobson7, Hugh C Rayner8, Donna L Mapes4, Raymond C Vanholder9, Takeshi Hasegawa10, Bruce M Robinson4, Ronald L Pisoni4. 1. Department of Internal Medicine, School of Medicine, Federal University of Bahia, Salvador, BA, Brazil; 2. Arbor Research Collaborative for Health, Ann Arbor, Michigan; University of Michigan, Ann Arbor, Michigan; 3. Arbor Research Collaborative for Health, Ann Arbor, Michigan; Departments of Epidemiology, Environmental Health Sciences, and Department of Urology, School of Medicine, University of Michigan, Ann Arbor, Michigan; 4. Arbor Research Collaborative for Health, Ann Arbor, Michigan; 5. Arbor Research Collaborative for Health, Ann Arbor, Michigan; Biostatistics, School of Public Health and. 6. Department of Physical Therapy, University of Utah, Salt Lake City, Utah; 7. Division of Nephrology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden; 8. Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom; 9. Nephrology, University Hospital, Gent, Belgium; and. 10. Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Tokyo, Japan.
Abstract
BACKGROUND AND OBJECTIVES: Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-2011) were classified into five aerobic physical activity categories (never/rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality. RESULTS: The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. CONCLUSIONS: The findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.
BACKGROUND AND OBJECTIVES: Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-2011) were classified into five aerobic physical activity categories (never/rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality. RESULTS: The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status. CONCLUSIONS: The findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.
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