Physical Activity in Patients With Chronic Kidney Disease: The Effects of Caregivers and Residential Factors

Introduction Physical inactivity is common in chronic kidney disease (CKD) patients; several patient- and disease-related factors are linked to a sedentary lifestyle, but social and environmental influences remain unexplored. This study evaluates the level of physical activity in patients with CKD and investigates the associations with caregivers' physical activity levels, characteristics of the residential environment, and objective measures of exercise capacity. Methods Eighty CKD patients (20 per CKD stage 2-4) were included; patients and their carers filled out the International Physical Activity Questionnaire (IPAQ), questionnaires about residential environment and past exercise habits. The CKD patients also performed a 30-sec sit-to-stand-test (30-STS) as a measure of exercise capacity. Results According to the IPAQ-score, CKD patients were largely inactive (only 10% reported health-enhancing activity levels); no differences were found between CKD stages. The 30-STS was also impaired, and the number of repetitions significantly decreased with advancing CKD stages (14.2±2.9 vs. 12.6±5.4 vs. 10.4±3.3 vs. 10.5±3.5; p=0.008). Carers were also highly inactive but still had higher physical activity compared to patients (moderate intensity metabolic equivalents (METS) p=0.03, vigorous intensity METS p=0.053); no correlation between carers' and patients' physical activity was noted (p=0.702). Patients' physical activity was associated with residential factors: living in a detached house compared to an apartment (p=0.013 for moderate intensity and p=0.017 for vigorous METS), having a garden (p=0.019 for moderate intensity and p=0.022 for vigorous METS) and accessing house by stairs (p=0.037 for vigorous METS), were associated with higher physical activity. Conclusions Physical activity was significantly reduced in CKD patients, irrespectively disease stage. Carers were also highly inactive, but no association was found between the patients' and carers' daily activities. Residential characteristics were the only factors found to be associated to patients' physical activity levels. Personalized, supportive interventions are required, taking into account the patients' social support and microenvironment, in order to increase the physical activity level in this population.