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Original ArticlesEpidemiology and Outcomes
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Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients: The DOPPS

Antonio Alberto Lopes, Brett Lantz, Hal Morgenstern, Mia Wang, Brian A. Bieber, Brenda W. Gillespie, Yun Li, Patricia Painter, Stefan H. Jacobson, Hugh C. Rayner, Donna L. Mapes, Raymond C. Vanholder, Takeshi Hasegawa, Bruce M. Robinson and Ronald L. Pisoni
CJASN October 2014, 9 (10) 1702-1712; DOI: https://doi.org/10.2215/CJN.12371213
Antonio Alberto Lopes
*Department of Internal Medicine, School of Medicine, Federal University of Bahia, Salvador, BA, Brazil;
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Brett Lantz
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
‡University of Michigan, Ann Arbor, Michigan;
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Hal Morgenstern
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
Departments of §Epidemiology,
‖Environmental Health Sciences, and
¶Department of Urology, School of Medicine, University of Michigan, Ann Arbor, Michigan;
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Mia Wang
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
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Brian A. Bieber
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
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Brenda W. Gillespie
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
**Biostatistics, School of Public Health and
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Yun Li
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
**Biostatistics, School of Public Health and
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Patricia Painter
††Department of Physical Therapy, University of Utah, Salt Lake City, Utah;
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Stefan H. Jacobson
‡‡Division of Nephrology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden;
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Hugh C. Rayner
§§Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom;
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Donna L. Mapes
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
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Raymond C. Vanholder
‖‖Nephrology, University Hospital, Gent, Belgium; and
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Takeshi Hasegawa
¶¶Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Tokyo, Japan
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Bruce M. Robinson
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
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Ronald L. Pisoni
†Arbor Research Collaborative for Health, Ann Arbor, Michigan;
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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 activity with 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 patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with 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.

  • hemodialysis
  • outcomes
  • depression
  • mortality
  • Received December 6, 2013.
  • Accepted June 11, 2014.
  • Copyright © 2014 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 9 (10)
Clinical Journal of the American Society of Nephrology
Vol. 9, Issue 10
October 07, 2014
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Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients: The DOPPS
Antonio Alberto Lopes, Brett Lantz, Hal Morgenstern, Mia Wang, Brian A. Bieber, Brenda W. Gillespie, Yun Li, Patricia Painter, Stefan H. Jacobson, Hugh C. Rayner, Donna L. Mapes, Raymond C. Vanholder, Takeshi Hasegawa, Bruce M. Robinson, Ronald L. Pisoni
CJASN Oct 2014, 9 (10) 1702-1712; DOI: 10.2215/CJN.12371213

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Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients: The DOPPS
Antonio Alberto Lopes, Brett Lantz, Hal Morgenstern, Mia Wang, Brian A. Bieber, Brenda W. Gillespie, Yun Li, Patricia Painter, Stefan H. Jacobson, Hugh C. Rayner, Donna L. Mapes, Raymond C. Vanholder, Takeshi Hasegawa, Bruce M. Robinson, Ronald L. Pisoni
CJASN Oct 2014, 9 (10) 1702-1712; DOI: 10.2215/CJN.12371213
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Keywords

  • hemodialysis
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  • depression
  • mortality

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