Exercise in Individuals With CKD: A Focus Group Study Exploring Patient Attitudes, Motivations, and Barriers to Exercise.

ABSTRACT

RATIONALE & OBJECTIVE: Data suggest that exercise is beneficial for patients with chronic kidney disease (CKD) to reduce cardiovascular disease and the progression of CKD. Despite these benefits, the majority of patients with CKD remain sedentary. The purpose of this study was to identify attitudes, motivators, and barriers to exercise among individuals with CKD. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: 10 focus groups (41 adult participants with CKD stages 3-4 who were not currently exercising) from the Denver Metro Area. ANALYTICAL APPROACH: Thematic analysis. Clinics were purposively sampled. Focus groups were recorded and transcribed. RESULTS: We identified 7 themes reflecting perceptions of exercise of patients with CKD improvement in health and quality of life; motivation from family, friends, or peers; limitations due to comorbid conditions; challenges due to environmental factors (safety, weather, and cost concerns); lack of time; family as a barrier; and lack of provider counseling on type of exercise and the benefits. Participants recognized the benefits of exercise on health, but exercise was not viewed to have a significant impact on CKD. Having a friend, family member, or group to exercise with was viewed as a significant motivator. However, particularly in Spanish-speaking participants, family was often seen as a barrier if they were not willing to exercise with the patients. Most participants expressed receiving limited information from their kidney provider regarding how exercise affected their kidney health. Spanish-speaking participants in particular expressed frustration with their nephrologist's lack of advice regarding exercise. LIMITATIONS: Potential selection bias and inclusion of only sedentary patients with CKD. CONCLUSIONS: Barriers and motivators to exercise were similar among participating men and women with CKD. Lack of advice from kidney providers regarding exercise was a significant barrier. Exercise interventions in patients with CKD should include not only increased patient self-efficacy and social support, but also counseling and prescribing of exercise by nephrologists.