Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: The DOPPS

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 activitywith 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 patientswere greater in clinics offering exercise programs.Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inverselywith depression symptoms andmortality (adjusted hazard ratio of death for very active versus never/ rarely active, 0.60; 95%confidence interval, 0.47 to 0.77). Similar associationswith 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.