Physical functioning is a major problem for individuals with end-stage renal disease (ESRD) and has a devastating impact on the older adult with this condition. Functional decline in older individuals with ESRD is independently associated with increased morbidity, poor quality of life, hospitalization, and mortality. Furthermore, individuals with ESRD have a high burden of comorbidity. Forty-five percent of persons who initiate therapy for ESRD have diabetes; almost 80% have a history of hypertension; and the prevalence of cardiovascular disease in individuals with ESRD is much higher than in the general population. Thus, the potential benefits of physical activity training in older adults with ESRD are numerous. While the goal to preserve or improve older ESRD patients' level of physical activity is undisputed, progress in this area is slow. Older individuals with ESRD have not been targeted for inclusion in most physical activity intervention studies. To date, research findings about the benefits of physical activity training in ESRD patients are not generalizable to the older adult with this condition, and empirical evaluations of the effects of physical activity training on this population is sorely needed. Moreover, strategies designed to improve physical functioning in ESRD patients have been developed empirically rather than being based on a sound theoretical understanding of underlying cognitive processes that may influence the extent to which ESRD patients engage in regular physical activity. Important variables known to affect active engagement in physical activity have been ignored in ESRD physical activity intervention studies. We propose a theory-based, physical activity training pilot intervention study guided by the Commonsense Model of Self-Regulation and Self- Efficacy Theory.
The specific aims of the proposed pilot study are to (1) test the effects of a 12-week, individually prescribed, home-based, low to moderate intensity physical activity training intervention on older hemodialysis patients' level of physical functioning, physical activity, illness representations, exercise self- efficacy, outcome expectancies for exercise, and depression (i.e., effect size); and (2) evaluate the feasibility and appropriateness of the research plan for a full-scale clinical trial. This study will contribute to the nephrology community's understanding of the effects of physical activity training on health outcomes in older individuals with ESRD. Findings from this study will also suggest theory- based intervention pathways to improve functioning in individuals with ESRD. ? ? ?
