Impact of healthcare staff attitude on barriers to physical exercise in hemodialysis patients: a quantitative assessment

Background and objectives: In hemodialysis patients, a sedentary lifestyle is a strong yet potentially modifiable predictor of mortality. We explored whether the healthcare staff’s attitude towards exercise could modify the impact of patient-perceived barriers on the level of physical activity in this population. Design, setting, participants, and measurements: We performed a prospective cross-sectional assessment of the effects of the interaction between healthcare staff’s attitude towards exercise with patient-perceived barriers on self-reported physical activity in hemodialysis patients. Six hundred eight adult patients and 440 members of the healthcare staff were recruited in 16 hemodialysis units in Italy. Patient-perceived barriers and healthcare staff’s attitude towards exercise were assessed by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either patient-perceived barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile – Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. To provide a clearer appraisal of this interaction, we employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers. Results: Most barriers were negatively associated with the HAP-AAS (adjusted decrease in HAP-AAS attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. There was a significant interaction between staff’s attitude and barriers on the HAP-AAS (adjusted P values ranging between 0.03 [ “I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in the patients not endorsing barriers. Conclusion: Barriers reduce physical activity of hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive dialysis staff’s attitude.