title: Motivations and barriers to exercise in chronic kidney disease: a qualitative study.
abstract: BACKGROUND
  Exercise has the potential to modulate a number of complications associated with chronic kidney disease (CKD). However, typically, CKD patients lead very sedentary lifestyles, the reasons for which are not fully known. The aim of this qualitative study was to gain an understanding of the motivators, barriers and beliefs held by CKD patients regarding exercise.
  
  
  METHODS
  We conducted 3 focus groups and 22 semi-structured interviews. Data were collected from nephrology outpatient clinics in the United Kingdom. A total of 36 individuals with CKD stages 1-5 not requiring renal replacement therapy, aged 26-83 years participated in this study. This manuscript outlines the findings from patients with CKD stages 3-5. Focus groups and interviews were transcribed verbatim and analysed thematically.
  
  
  RESULTS
  Positive attitudes to exercise reflected autonomous motivations including: exercising for health; enjoyment and social interaction. Family support and goal setting were seen as motivators for exercise and the accessibility of local facilities influenced activity levels. Barriers to exercise were poor health, fear of injury or aggravating their condition, a lack of guidance from healthcare professionals and a lack of facilities.
  
  
  CONCLUSIONS
  These findings are an important first stage in the development of a CKD-specific exercise behaviour change intervention. Interventions should operate at multiple levels, with a focus on improving patient autonomy and exercise self-efficacy, support networks and the physical environment (e.g. the accessibility of local facilities). In addition, strategies are required to ensure that the healthcare system is actively promoting and routinely supporting exercise for all patients with CKD.
authors.affiliation: Leicester Kidney Exercise Team, UoL Academic Unit, Department of Renal Medicine, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Clarke
authors.affiliation: Leicester Kidney Exercise Team, UoL Academic Unit, Department of Renal Medicine, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Hannah M L
authors.initials: HM
authors.lastname: Young
authors.affiliation: Leicester Kidney Exercise Team, UoL Academic Unit, Department of Renal Medicine, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Hull
authors.affiliation: School of Applied Social Sciences, De Montfort University, Leicester, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Hudson
authors.affiliation: Leicester Kidney Exercise Team, UoL Academic Unit, Department of Renal Medicine, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: James O
authors.initials: JO
authors.lastname: Burton
authors.affiliation: Leicester Kidney Exercise Team, UoL Academic Unit, Department of Renal Medicine, University Hospitals of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000523:psychology*; D006113:United Kingdom
keywords: chronic kidney disease (CKD); exercise; focus group; qualitative research; semi-structured interview