The Effects of an Intra-Dialytic Exercise Program on Self-Efficacy and Physical Activity: A Pilot Study
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Background: Levels of physical activity are significantly lower among individuals with end-stage renal disease (ESRD) compared to their healthy sedentary counterparts. Low levels of self-efficacy (SE) with respect to exercise may contribute to a sedentary lifestyle in the ESRD population. Therefore, in a pilot investigation we examined the effects of an 8-week intra-dialytic (ID) exercise program on SE and physical activity (PA) in hemodialysis (HD) patients and determined the appropriateness and sensitivity of the selected outcome measures and proposed intervention. Methods: HD patients were randomized into an Exercise group (EX, n=4) or a Control group (CON, n=4). The EX group cycled for approximately 60 min during HD, thrice weekly for 8 weeks. The CON group continued with their usual activity. At 8 weeks, participants in both groups had the option to participate in the exercise program. Physical Activity was determined using the Human Activity Profile (Maximal Activity Score, MAS; Adjusted Activity Score, AAS) and SE was evaluated using the Chronic Disease Self-Efficacy Scale (CDSES) and Exercise Self-Efficacy Scale (ESES). Measures were obtained at pre, post and 8 weeks following the intervention. Results: No significant changes in PA or SE occurred between or within groups at any time point. Limited statistical power due to the small sample size and a ceiling effect due to initial high-function levels of the participants may have contributed to the lack of significant changes. MAS and AAS were generally lower in the CON group. Age was significantly associated with the AAS, MAS, and the Perform Social/Recreational Activities sub-scale of the CDSES. Serum albumin was significantly related to the AAS and the Exercise Regularly and Do Chores sub-scales of the CDSES. Conclusions: Age and albumin should be taken into account when assessing physical activity in HD patients. Recruitment of additional participants is required to more clearly define the role of intra-dialytic exercise in enhancing exercise self-efficacy and physical activity in HD patients.