physio, university hospitals of leicester leicester kidney … · 2018. 5. 2. · physio,...

Chronic Kidney Disease (CKD):

Patient Perspectives on

Exercise

Heather MacKinnon

Physio, University Hospitals of Leicester

Leicester General Hospital

Leicester Kidney Exercise Team

Chronic Kidney Disease

CKD leads to Extremely increased CV risk

Muscle wasting

Reduced bone density

Renal anaemia

This results in Reduced exercise tolerance

Poor QoL

Significant mental health effects


Exercise in CKD

Growing body of evidence• NSF

• NICE QS

• Cochrane review

• Renal Association guidelines


Accepted into NHS research portfolio

Ongoing 5 year research program.

Aiming to create “Renal Rehab” and assess results

Research Question

What do patients with chronic kidney

disease perceive to be benefits and risks

of exercise and what barriers and

facilitators influence physical activity?


Method

Questionnaires completed by pt’s

attending renal out-patient clinics

Comprise

Demographics

3 physical activity questionnaires

Stage of change questionnaire

Self-efficacy questionnaire

Free text comments section


Questions from survey

Q1: What do you think are the benefits of being more active?

Q2: What do you think are the drawbacks or negative effects of being more active?

Q3: What might help people with kidney disease to become more active?

Q4: What can make it difficult for people with kidney disease to be more active?


Data analysis

Demographic data analysed in Excel

Qualitative data analysis

Continuous comparison supported by

Nvivo specialist software


Results

475 questionnaires completed

333 had completed some part of the free

text boxes

Mean age 59 years (sd=17, range:16-89

years)

198 (59%) were male


Q1: What do you think are the benefits of

being more active?

Perceived Benefits

General health benefits

Psychological health

benefits

Cardiovascular benefit

• BP specific

• General CV benefit

Weight loss

Improved functional ability

“More exercise the better

for their health”

“Helps to feel better and

gives a sense of

wellbeing”

“Being able to join in

more family activities”


Q2: What do you think are the drawbacks or

negative effects of being more active?

Perceived risks

None

Fatigue

Injury

Pain

SOB


Q3: What might help people with kidney

disease to become more active?

Perceived Facilitators

Support

Education

Gentle exercise

Don’t know

Motivation

“…organised activity

sessions for out-patients

as part of their care would

be beneficial… people

like me if left to their own

devices will probably not

get involved in an

exercise programme.”


Q4: What can make it difficult for people with

kidney disease to be more active?

Physical Fatigue

Nonspecific

Co-morbidities

Psychological Reduced motivation

Anxiety

Social Time

Cost

“It's a catch 22 situation

knowing exercise would

help, but often being too

tired to do it.”

“Lack of energy that they

have and worrying the

little they have would then

result in no energy”


Discussion

Large sample

Open free text questions

Results similar to US data (Delgado & Johansen 2012)

Perceptions similar to those proposed by Smith & Burton (2012)

Some barriers similar to those in healthy older US women (Heesch, Brown & Blanton 2000)

Acknowledge my perspective as a physio


Conclusions

Significant benefits for these patients if they engage in exercise

• Physical

• Psychological

• Quality of life

Multi-factorial barriers to exercise

Majority of patient’s aware of benefits of exercise

Ongoing research


Acknowledgements

Many thanks to • CATP scheme

• Alice Smith

• LKET team

• UHL

The overarching study program is funded

by research grant from the British Renal

Society


Questions?

Thanks for listening


physio, university hospitals of leicester leicester kidney … · 2018. 5. 2. · physio,...

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