Year

2012

Degree Name

Doctor of Philosophy

Department

School of Nursing, Midwifery & Indigenous Health

Abstract

Background The level of physical activity has been reported as being very low in people with severe kidney disease. Most of these studies have been from the USA and have involved exercise testing programs. There has been little research on self-reported physical activity in the severe kidney disease population within the Australian context. Most studies into physical activity have reported findings from brief intervention exercise studies. These studies have included aerobic styled exercise, resistance styled exercise, or a combination of both aerobic and resistance exercise. Further studies have shown that low levels of physical activity are detrimental to physical function, psychological and emotional well-being and quality of life of those with severe renal disease. In contrast, this is the first naturalistic non-experimental study of physical activity in the Australian renal context investigating disease parameters and routine practices.

Aim The aims of this study were to investigate the baseline level of physical activity in those with stage 4 and 5 chronic kidney disease to investigate an association between physical activity, severity of disease, emotional well-being and quality of life. A further aim of this study was to investigate exercise practices within Australian renal units for people with severe kidney disease. The central focus of the study was to base the investigation in a representative renal department using a naturalistic design.

Methodology This thesis consists of four separate but related studies using a purposive and convenience sampling frame. Information was obtained from the study participants by self-report questionnaire. Study 1 involved predialysis patients (stage 4 CKD) and study 2 involved a longitudinal study of those with end stage chronic kidney disease. Measures included demographic data, physical activity recall data, the Beck Depression Inventory, and the SF-36. Study 3 investigated patient awareness of national Physical Activity Guidelines for adult Australians. Study 4 investigated the uptake of physical activity interventions within Australian renal units to gain insight into exercise rehabilitation practices within those units.

Results Findings from this study demonstrated that people with severe renal disease generally reported undertaking less weekly physical activity (measured by time, frequency and intensity) than that recommended for a health benefit. Physical activity was reduced with increasing severity of kidney disease. There was also some indication that the level of physical activity and physical function does influence health related quality of life and emotional well-being, although this needs further investigation. The low level of participation in regular physical activity may be influenced negatively by the dominant culture and practice of Australian renal units. Although renal health professionals reported being aware of the benefits of physical activity, respondents stated that more could be done to promote this. Commonly reported constraints included lack of resources to support physical activity programs, and poor leadership in encouraging the development and implementation of such programs.

Conclusion This study makes an original contribution to knowledge in that it is the first naturalistic study of the link between physical activity and severe kidney disease within the Australian context. Those with CKD/ESCKD disease are more likely to report insufficient physical activity. Physical activity should be actively encouraged and be incorporated into the management of those with CKD/ESCKD to promote an improvement in both physical and mental health which will decrease the burden of CKD/ESCKD on the Australian Healthcare system. Renal nurses are in a prime position to take a lead role in the promotion of regular physical activity to the people they care for and thereby improve patient outcomes.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.