Original ResearchDaily Walking Dose and Health-related Quality of Life in Patients With Chronic Kidney Disease
Introduction
Chronic kidney disease (CKD) sustainably contributes to the global health burden, with its high prevalence, poor outcomes, and high costs,1 currently making it the 16th leading cause of morbidity,2 and is expected to become the fifth leading cause of death worldwide.3 CKD will gradually progress to end-stage kidney disease, which requires renal replacement therapy through hemodialysis, peritoneal dialysis, or kidney transplantation.4 Patients with CKD usually have other comorbidities, such as hypertension, diabetes, and cardiovascular diseases.5 In addition, patients may also develop fatigue, loss of muscle mass, and other symptoms associated with CKD, leading to a decline in physical activity.6
A previous study has shown that patients with CKD have a much lower prevalence of physical activity, which worsens as the disease progresses.7 In addition, cardiorespiratory fitness parameters and muscle function were also lower in these patients.8 A recent qualitative study found that fatigue, fear of exercise complications, inadequate family support, and environmental safety are the main obstacles affecting patients with CKD.9 However, it has been reported that physical impairment and psychological problems in patients with CKD lead to a decline in health-related quality of life (HRQOL).10 In contrast, physical activity or exercise appears to be an effective treatment for depression, thus reducing mortality and hospitalization in the general and CKD population.11 A systematic review revealed that regular exercise had significant beneficial effects on physical fitness, walking ability, HRQOL, and cardiovascular and nutritional parameters in adults with CKD.12 Therefore, patients with CKD may benefit from physical activities, but the exact form of exercise recommended for them has not reached a consensus.
Walking is one of the most health-conscious forms of exercise, which can benefit weight maintenance,13 improve cardiovascular health,14 and lower blood pressure.15 Recent studies have shown that walking, as a daily form exercise in patients with CKD, may improve cardiopulmonary function and regulate blood pressure, blood glucose, and lipid levels in patients with CKD; moreover, it plays a vital role in enhancing the quality of life of patients with CKD.16 Nowadays, walking is considered the most popular form of exercise for patients with CKD and is associated with reduced overall mortality and risk of renal replacement therapy.17 Monitoring one's daily steps is an easy and accessible way to set physical activity goals for oneself.18 Moreover, some studies have shown that having an increased daily walking step count is associated with lower mortality in the general population.19,20 There is no standard walk to recommend for patients with CKD. This study aimed to investigate the association between daily walking steps and HRQOL in patients with predialysis CKD.
Section snippets
Participants
Patients with CKD stages 1 to 5 not receiving dialysis treatment were recruited from the RETARD cohort study, which has been previously described.21 A total of 580 participants who had complete baseline laboratory tests and questionnaires on their daily step count and the Short Form-36 Health Survey (SF-36) were enrolled in this study. Written informed consent was obtained from all participants. The study complied with the 1964 Helsinki declaration and its later amendments or comparable ethical
Participation and Dropout Rates
From February 2020 to April 2020, a total of 580 patients with nondialysis-dependent CKD were enrolled in this study; the research flow chart is shown in Figure 1. Of these, 19 participants did not meet the required percentage of recorded daily step count days, while three participants dropped out during the study period. Finally, 558 participants completed the daily step count and HRQOL investigation scale. No exercise-related adverse events occurred during the entire study according to the
Discussion
This study showed an inverse U-shaped relationship between the daily walking step count and quality of life in patients with CKD. Lower and higher daily walking steps were independently associated with a low HRQOL in adults with CKD.
Walking is a common form of physical activity, regardless of location, culture, age, and gender.24 Walking improves not only physical fitness, but also mental health.25 A previous study showed that for physically independent elderly Japanese individuals, a higher
Practical Application
Our study contributes to the current literature by discussing the suitable walking dose for patients with CKD. Those patients could gain the greatest benefit of the PCS and MCS between these daily steps. However, further investigations are warranted to provide more specific walking doses for patients with CKD according to different age groups and physical states.
Credit Authorship Contribution Statement
Jiachuan Xiong: Writing – original draft. Hongmei Peng: Writing – original draft, Data curation. Zhikai Yu: Formal analysis. Yan Chen: Investigation, Resources. Shi Pu: Investigation, Resources. Yang Li: Investigation, Resources. Xia Huang: Investigation, Resources. Xiangchun Tang: Investigation, Resources. Jing He: Investigation, Resources. Yu Shi: Methodology, Funding acquisition. Jinghong Zhao: Conceptualization, Supervision, Writing – review & editing.
Acknowledgments
The authors would like to thank all the RETARD cohort study group members for their assistance in recruiting participants and data collection. They are grateful to all the participants for their cooperation.
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Financial Disclosure: The authors declare that they have no relevant financial interests.
Support: This study was supported by Nursing Innovation Fund of Army Military Medical University (NO. 2020m1).
Ethical approval: The study was approved by the ethics committee of the Xinqiao Hospital Army Medical University (institutional review board approval number 2018-006-01).
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These authors contributed equally.