부산대학교 도서관

It is well documented that haemodialysis patients have low physical activity (PA) levels compared to their healthy counterparts. Increasing PA has been shown to increase some areas of quality of life and improve physical function. Utilising the Medical Research Council (MRC) methodology for developing complex interventions, I developed and intervention and measurement methods that aimed to increase PA levels in haemodialysis patients. Stage 1 of this research program used qualitative and quantitative methods to investigate the motivators and barriers towards PA in this population to inform the exercise intervention and investigated the acceptability and utility of wearable sensors as a measure of physical activity and a prompting tool for interviewing. One hundred and one participants were approached, and 98 participants (23 female) completed self-report PA questionnaires. A subset of 20 participants (9 female) went on to wear accelerometers and wearable devices to capture one week's worth of activity on both dialysis and non-dialysis days and take part in semi-structured interviews. Participants described a desire to be more active but said that the burden and associated symptoms of dialysis were barriers towards achieving a physically active lifestyle. Motivators and cues to action identified by participants included a health care professional to support them with PA, and exercise programmes to be accessible on dialysis days. The use of wearable cameras was found to be an acceptable method of quantifying activity levels in this population which may be used in future research. Overall findings from stage 1 were used to inform stage 2 to co-design a safe, acceptable and sustainable PA intervention with patients and staff, and to provide education to engage patients and improve health outcomes. In stage 2, the feasibility study, participants were given a 10-minute instructor-led training on how to perform chair-based exercises (CBE), up to three times a week for six weeks pre-dialysis. Participants were encouraged to continue exercises at home and functional mobility assessments taken at baseline, month three and six. These included Timed-up-and Go, 10 metre walk test, hand rip and a battery of quality of life questionnaires. Sixteen participants were recruited, one withdrew, one was transplanted, and one had insufficient data. Of the thirteen participants, six completed the study and the remaining seven missed final functional mobility tests due to the commencement of the Covid-19 pandemic lockdown in March 2020. Participant feedback indicated that CBE is an acceptable method of exercise. For some participants confidence and motivation increased during the intervention and they engaged in more PA on non-dialysis days. Mobility assessments improved over the six-month period.