P211
Exercise and Physical Activity Behaviour in Chronic Kidney Disease: Patient Perspectives
and Readiness to Change.
1
Clarke AL, 1Young HML, 1Hull KL,2Hudson N, 1Burton JO, 1Smith AC.
1
Leicester Kidney Exercise Team, Dept of Renal Medicine, University Hospitals of Leicester
and Dept of Infection, Immunity and Inflammation, University of Leicester
2
School of Applied Social Sciences, De Montfort, University.
Background: Patients with Chronic Kidney Disease (CKD) suffer from a wide range of
physiological and psychological complications. Exercise is beneficial for CKD patients and is
recommended in NICE guidelines, but it is rarely integrated into the care plan and patients
typically lead sedentary lifestyles. In the general population and other chronic disease groups,
physical inactivity is often related to low self-efficacy and lack of readiness to change, but the
reasons underlying this are not fully understood. Patient perspectives around increasing physical
activity and exercise behaviour have not been explored in the UK chronic kidney disease
population. Here we present the findings of a two-part mixed methods study exploring physical
activity-related readiness to change and self-efficacy, and patient perceived motivators and
barriers to exercise.
Purpose: A mixed-methods study consisting of two separate parts. Part 1 aimed to investigate
readiness to change physical activity and exercise self-efficacy in patients with CKD, using a
survey. Part 2 aimed to explore patient perceived motivators and barriers towards exercise and
physical, using qualitative methodology.
Methods: In Part 1, 399 patients with CKD Stage 1-5 pre-dialysis (223 male, age range 16-93
years) completed a survey at routine outpatient clinic appointments. The survey included two
validated questionnaires: (1) Stage of Change (SOCQ), which identifies a patient’s readiness to
change physical activity behaviour; and (2) Exercise Self-Efficacy Questionnaire (SEQ), which
explores confidence to exercise.
In Part 2, a purposive sample of 36 patients with CKD Stage 1-5 pre-dialysis (20 male, age
range 26-81 years) were recruited to participate in a qualitative exploration of patient-perceived
barriers and motivators to exercise in CKD. 3 focus groups and 22 semi-structured interviews
were facilitated by researchers uninvolved in clinical care. All interviews and focus groups were
audio recorded, transcribed verbatim and translated where necessary, and were subjected to
thematic analysis.
Results: In Part 1, the SOCQ showed that 54% of patients considered themselves to participate
in some form of exercise behaviour, while 24% were contemplating exercise and only 22%
were pre-contemplation (no interest in exercise). Self-efficacy was significantly lower for
patients who were in the pre-contemplation or contemplation stages compared to patients who
were in the preparation, action or maintenance stages (Z=-4.81, P<0.005).
Part 2 showed that patient-perceived barriers to physical activity primarily included older age,
fatigue, fears relating to injury, negative effects of medication, and negative social comparisons
to others and former self. Themes for motivation included previously or currently experienced
physical and emotional benefits, the social enjoyment of exercise, the knowledge and desire to
be responsible for their own health, goal setting, and support provided by family.
Conclusion: This study demonstrates that the majority of patients with CKD are open to the
idea of increasing their physical activity levels. Low self-efficacy was an important factor in
changing exercise behaviour, and a number of patient-perceived barriers and motivators to
exercise were identified.
Relevance: This information is an important first stage in the development of a CKD- specific
exercise behaviour change intervention with a focus on improving self-efficacy and goal setting,
and designed to assist in finding solutions to barriers and utilising patient-reported motivators to
exercise.