PHYSICAL ACTIVITY MEASURED BY PEDOMETER AND HUMAN ACTIVITY PROFILE IN HEMODIALYSIS PATIENTS

Abstract BACKGROUND AND AIMS Physical inactivity is associated with increased mortality in hemodialysis patients and the level is still unclear. Several studies have surveyed physical activity in hemodialysis patients with subjective methods by questionnaires, and some have used objective methods based on accelerometers or pedometers in small population. This study aimed to investigate the level of physical activity of hemodialysis patients with a combination of pedometer and questionnaire and explore the influencing factors limiting the physical activity. METHOD A multi-center cross-sectional survey using pedometer and Human Activity Profile (HAP) was performed in 505 hemodialysis patients. The pedometer (Omron, HJ-321) measured daily steps by continuously wearing for a week. HAP can provide a maximum activity score (MAS) reflecting the most taxing activity the patient is still doing, and an adjusted activity score (AAS) reflecting the level of daily activity. Linear regression was performed to explore factors related to the physical activity. RESULTS A total of 505 patients were included in this study. The average age (means ± SE) was 49.69 ± 13.96 years with 141 (27.92%) patients were elderly (≥60 years old), and 339 (67.13%) were male. Patients walked 4585.84 ± 2887.40 steps/day, 94.65% of patients had physical activity levels below the guideline recommended level (10 000 steps/day), and 60% were in sedentary lifestyle (<5000 steps/day). The AAS score was 63.85 ± 13.99, 112 patients were impaired (<53 points), and 275 were moderately active (≥53 and <74 points). The univariate linear regression showed that the elderly, unemployed, diabetic nephropathy and patients with diabetes or >3 complications had fewer steps and lower MAS and AAS scores (P < 0.05). Besides, the number of steps in patients undergoing hemodialysis 5 times every 2 weeks was significantly lower than that of patients 3 times/week (P = 0.020). And for MAS and AAS, the ability to perform daily activities was significantly impaired in females and patients over 36 months of hemodialysis (P < 0.05). In multivariate linear regression, elderly patients with >3 complications were associated with lower levels of physical activity (P < 0.05). Females [–2.72 (–5.21 to –0.24); P = 0.032] with hypertension [6.14 (1.89–10.40); P = 0.005), congestive heart failure [5.24 (0.94–9.53); P = 0.017] and ischemic heart disease [6.48 (1.01–11.94); P = 0.020] were more likely to have impaired daily physical activity. CONCLUSION This survey demonstrates that hemodialysis patients are engage in physical inactivity. Elderly hemodialysis patients with more complications are prone to physical inactivity. Patients undergoing hemodialysis 5 times every 2 weeks are more likely to be live with sedentary lifestyle, while female patients with hypertension, congestive heart failure and ischemic heart disease are more impaired in daily physical activity. We should pay attention to the physical inactivity of hemodialysis patients.