Barriers to implementation of physical activity in patients on chronic hemodialysis: the IPAD study-L-


In patients on chronic dialysis, a sedentary lifestyle is a strong, yet potentially modifiable, predictor of mortality. The present multicentric study evaluated social, psychological and clinical barriers hindering physical activity in this population.

Patients and Methods

We explored the association between barriers to physical activity and sedentary habit in adult ESRD patients at 16 chronic dialysis facilities in Italy. We used different questionnaires exploring participation in physical activity, physical functioning, patient’s attitudes and preferences, and barriers to physical activity perceived by either patients or nephrologists/nurses. 


We enrolled 608 patients, (males 62.7%), mean age 64.8 yrs (56% > 65 years); median dialysis vintage 47.5 months (IQR 20-96 mo); mean Charlson score 4.0 (SD 2.0), mean Activities of Daily Living score 5.5 (SD 1.2)(Fig. 1). Barriers are shown in Fig. 2 and 3. Five hundred sixty-two (92.5%) reported at least one barrier to physical activity. At multivariable analysis, after adjusting for age, gender, level of education and comorbidities, most of the explored barriers were independently associated with inactivity (Fig.4). Physician’s concern was also associated with patients’ inactivity (Fig. 4). Lack of time for exercise counseling and the firm belief about low compliance/interest by the patients toward exercise were the most frequent barriers reported by nephrologists and nurses (Fig. 5-6). 


We identified a number of patient-related and healthcare personnel-related barriers to physical activity in patients on chronic dialysis. This issue should be addressed in future studies aimed at increasing the level of physical activity in this population.