title: Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS.
abstract: OBJECTIVE
  Physical activity has been associated with better health status in diverse populations, but the association in patients on maintenance hemodialysis is less established. Patient-reported physical activities and associations with mortality, health-related quality of life, and depression symptoms in patients on maintenance hemodialysis in 12 countries were examined.
  
  
  METHODS
  In total, 5763 patients enrolled in phase 4 of the Dialysis Outcomes and Practice Patterns Study (2009-2011) were classified into five aerobic physical activity categories (never/rarely active to very active) and by muscle strength/flexibility activity using the Rapid Assessment of Physical Activity questionnaire. The Kidney Disease Quality of Life scale was used for health-related quality of life. The Center for Epidemiologic Studies Depression scale was used for depression symptoms. Linear regression was used for associations of physical activity with health-related quality of life and depression symptoms scores. Cox regression was used for association of physical activity with mortality.
  
  
  RESULTS
  The median (interquartile range) of follow-up was 1.6 (0.9-2.5) years; 29% of patients were classified as never/rarely active, 20% of patients were classified as very active, and 20.5% of patients reported strength/flexibility activities. Percentages of very active patients were greater in clinics offering exercise programs. Aerobic activity, but not strength/flexibility activity, was associated positively with health-related quality of life and inversely with depression symptoms and mortality (adjusted hazard ratio of death for very active versus never/rarely active, 0.60; 95% confidence interval, 0.47 to 0.77). Similar associations with aerobic activity were observed in strata of age, sex, time on dialysis, and diabetes status.
  
  
  CONCLUSIONS
  The findings are consistent with the health benefits of aerobic physical activity for patients on maintenance hemodialysis. Greater physical activity was observed in facilities providing exercise programs, suggesting a possible opportunity for improving patient outcomes.
authors.affiliation: Department of Internal Medicine, School of Medicine, Federal University of Bahia, Salvador, BA, Brazil;
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Lopes
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan; University of Michigan, Ann Arbor, Michigan;
authors.forename: Brett
authors.initials: B
authors.lastname: Lantz
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan; Departments of Epidemiology, Environmental Health Sciences, and Department of Urology, School of Medicine, University of Michigan, Ann Arbor, Michigan;
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Mia
authors.initials: M
authors.lastname: Wang
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Brian A
authors.initials: BA
authors.lastname: Bieber
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan; Biostatistics, School of Public Health and.
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Gillespie
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan; Biostatistics, School of Public Health and.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Physical Therapy, University of Utah, Salt Lake City, Utah;
authors.forename: Patricia
authors.initials: P
authors.lastname: Painter
authors.affiliation: Division of Nephrology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden;
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.affiliation: Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, United Kingdom;
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Rayner
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Donna L
authors.initials: DL
authors.lastname: Mapes
authors.affiliation: Nephrology, University Hospital, Gent, Belgium; and.
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Vanholder
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hasegawa
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Robinson
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, Michigan;
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009043:Motor Activity; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality / Q000523:psychology; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012307:Risk Factors; D057185:Sedentary Behavior; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: depression; hemodialysis; mortality; outcomes