Chronic Kidney Disease (CKD): Patient Perspectives on Exercise Heather MacKinnon Physio, University Hospitals of Leicester Leicester General Hospital Leicester Kidney ExerciseTeam
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
Leicester Kidney Exercise Team
Exercise in CKD
Growing body of evidence• NSF
• NICE QS
• Cochrane review
• Renal Association guidelines
Leicester Kidney Exercise Team
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?
Leicester Kidney Exercise Team
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
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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?
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Data analysis
Demographic data analysed in Excel
Qualitative data analysis
Continuous comparison supported by
Nvivo specialist software
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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
Leicester Kidney Exercise Team
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”
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Q2: What do you think are the drawbacks or
negative effects of being more active?
Perceived risks
None
Fatigue
Injury
Pain
SOB
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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.”
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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”
Leicester Kidney Exercise Team
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
Leicester Kidney Exercise Team
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
Leicester Kidney Exercise Team
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
Leicester Kidney Exercise Team
Questions?
Thanks for listening
Leicester Kidney Exercise Team