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Original Article

The Levels of Physical Activity and Its Relationships with Depression, Health-related Quality of Life, Sleep Disturbance, and Physiological Indicators in Hemodialysis Patients

Youngjoo Park1, Haejung Lee2
Korean Journal of Adult Nursing 2015;27(6):718-727.
Published online: December 31, 2015

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Corresponding author: Lee, Haejung College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-870, Korea. Tel: +82-51-510-8344, Fax: +82-51-510-8308, E-mail: haejung@pusan.ac.kr
• Received: October 5, 2015   • Accepted: December 11, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to identify the levels of physical activity and its relationships with depression, health-related quality of life (QoL), sleep disturbance, and physiological indicators in hemodialysis patients.
  • Methods
    The participants in this study were 139 patients undergoing hemodialysis in the hospitals in Busan andYangsan-si. Data were collected using hematologic tests and questionnaires that contained items about individual characteristics, International Physical Activity Questionnaires (IPAQ), Center For Epidemiological Studies Depression Scale (CES-D), a 12-item Short-Form Health Survey (SF-12), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using descriptive statistics, one way ANOVA, and correlation.
  • Results
    Mean age of the participants was 59.91±12.63 and mean physical activity levels were 1,660.35±1,654.17. Patients who performed higher physical activities during their daily activities reported lower levels of depression (F=4.16, p=.018) and higher levels of QOL (PCS: F=5.00, p=.008, MCS: F=8.66, p<.001) than those of the others who did not perform physical activities.
  • Conclusion:
    This study showed that the levels of physical activity among hemodialysis patients was significantly associatedwith their depression and QOL. Developing strategies for enhancing physical activity is warranted to improve depression and QOL among hemodialysis patients.
  • Key Words: Renal dialysis; Motor activity; Depression; Quality of life; Dyssomnias
Table 1.
Characteristics of the Participants (N=139)
Characteristics Categories n (%) or M±SD
Age (year)   59.91±12.63
64 ≤ (59.0) 82
65 ≥ (41.0) 57
Gender Male 87 (62.6)
Female 52 (37.4)
Occupation Yes 16 (11.5)
No 123 (88.5)
Monthly income (10,000 won) 100 ≤ 89 (64.0)
100 ＞ 50 (36.0)
Marital status Married 84 (60.4)
Living alone 55 (39.6)
Religion Yes 86 (61.9)
No 53 (38.1)
Level of education Middle school ≤ 55 (39.6)
High school ≥ 84 (60.4)
Number of family 0 32 (23.0)
1 52 (37.4)
2 22 (15.8)
3 ≥ 33 (23.7)
Hemodialysis period (year)   4.56±4.55
1 ≤ 36 (25.9)
2~5 65 (46.8)
5 ≥ 38 (27.3)
DM Yes 73 (52.5)
No 66 (47.5)
HT Yes 70 (50.4)
No 69 (49.6)
Table 2.
Physical Activity, Depression, Quality of Life, and Sleep Disturbance of the Participants (N=139)
Variables Categories M±SD n(%) Min Max
IPAQ Inactive 1,600.54±1,654.17 55 (39.6) 0.0 5,940.0
Minimally active 55 (39.6)
HEPA 29 (20.9)
Depression 16 ≤ 16.7±9.4 81 (58.3) 1.0 44.0
16 ＞ 58 (41.7)
SF-12:PCS 39.2 ≤ 39.2±9.1 63 (45.3) 17.1 55.6
39.2 ＞ 76 (54.7)
SF-12:MCS 46.6 ≤ 46.6±11.2 70 (50.4) 18.8 69.1
46.6 ＞ 69 (49.6)
Sleep Disturbance 5 ≤ 7.8±4.4 47 (33.8) 0.0 19.0
5 ＞ 92 (66.2)

IPAQ=international physical activity questionnaire; Inactive= 600; ＜ Minimally active=600~3000; HEPA= 3000 ＞ (MET-min/week); CES-D=Center for Epidemiological Studies Depression Scale; PSQI=Pittsburgh Sleep Quality Index; SF-12:PCS=Physical Component Summary Score; SF-12:MCS=Mental Component Summary Score; HEPA=health enhancing physical activity.

Table 3.
Differences in Depression, PCS, MCS, Sleep Disturbance, and Physiological Indicators according to Physical Activity (N=139)
Variables Categories Inactive Minimally active HEPA F p
n (%) & M±SD n (%) & M±SD n (%) & M±SD
Psychometric index Depression 19.09±9.33 16.11±9.42 13.14±8.37 4.16 .018
SF-12: PCS 36.24±8.90 40.88±9.24 41.45±7.90 5.00 .008
SF-12: MCS 42.19±10.94 48.26±11.18 51.65±8.81 8.66 ＜.001
Sleep disturbance 8.64±4.59 7.44±3.87 6.72±4.86 2.05 .132
Physiological Indicators Phosphorous 4.79±1.68 5.08±1.36 5.61±1.40 2.79 .065
Potassium 5.04±0.94 5.14±0.85 5.73±0.84 6.11 .003
Calcium 8.96±1.08 8.85±1.18 9.01±0.99 0.24 .785
BUN 60.09±20.60 61.59±16.28 71.00±17.57 3.60 .030
Cr 8.84±3.25 9.17±2.75 13.88±16.41 4.38 .014
Albumin 4.03±0.49 4.08±0.40 4.08±0.25 0.21 .807
Hemoglobin 10.19±0.94 10.55±1.37 10.36±1.07 1.30 .273

IPAQ=International Physical Activity Questionnaire, Inactive= 600, ＜ Minimally active=600~3,000, HEPA= 3,000 ＞ (MET-min/week), CES-D=Center For Epidemiological Studies Depression Scale, PSQI=Pittsburgh Sleep Quality Index, SF-12: PCS=Physical Component Summary Score, SF-12: MCS=Mental Component Summary Score, HEPA=health enhancing physical activity.

Table 4.
Relationships of Physical Activity with Depression, Quality of Life and Sleep Disturbance (N=139)
Variables X1 X2 X3 X4 X5
IPAQ (X1) 1
CES-D (X2) -.213* 1
PSQI (X3) -.091 .486** 1
SF-12: PCS (X4) .189* -.299** -411** 1
SF-12: MCS (X5) .252** -512** -.274** .108 1

IPAQ=International Physical Activity Questionnaire; CES-D=Center For Epidemiologic Studies Depression Scale; PSQI=Pittsburgh Sleep Quality Index; SF-12:PCS=Physical Component Summary Score; SF-12:MCS=Mental Component Summary Score; *p .05, ** ＜ p .01. ＜

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    The Levels of Physical Activity and Its Relationships with Depression, Health-related Quality of Life, Sleep Disturbance, and Physiological Indicators in Hemodialysis Patients
    Korean J Adult Nurs. 2015;27(6):718-727.   Published online December 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.6.718
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    The Levels of Physical Activity and Its Relationships with Depression, Health-related Quality of Life, Sleep Disturbance, and Physiological Indicators in Hemodialysis Patients
    Korean J Adult Nurs. 2015;27(6):718-727.   Published online December 31, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.6.718
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    The Levels of Physical Activity and Its Relationships with Depression, Health-related Quality of Life, Sleep Disturbance, and Physiological Indicators in Hemodialysis Patients
    The Levels of Physical Activity and Its Relationships with Depression, Health-related Quality of Life, Sleep Disturbance, and Physiological Indicators in Hemodialysis Patients

    Characteristics of the Participants (N=139)

    Characteristics Categories n (%) or M±SD
    Age (year)   59.91±12.63
    64 ≤ (59.0) 82
    65 ≥ (41.0) 57
    Gender Male 87 (62.6)
    Female 52 (37.4)
    Occupation Yes 16 (11.5)
    No 123 (88.5)
    Monthly income (10,000 won) 100 ≤ 89 (64.0)
    100 ＞ 50 (36.0)
    Marital status Married 84 (60.4)
    Living alone 55 (39.6)
    Religion Yes 86 (61.9)
    No 53 (38.1)
    Level of education Middle school ≤ 55 (39.6)
    High school ≥ 84 (60.4)
    Number of family 0 32 (23.0)
    1 52 (37.4)
    2 22 (15.8)
    3 ≥ 33 (23.7)
    Hemodialysis period (year)   4.56±4.55
    1 ≤ 36 (25.9)
    2~5 65 (46.8)
    5 ≥ 38 (27.3)
    DM Yes 73 (52.5)
    No 66 (47.5)
    HT Yes 70 (50.4)
    No 69 (49.6)

    Physical Activity, Depression, Quality of Life, and Sleep Disturbance of the Participants (N=139)

    Variables Categories M±SD n(%) Min Max
    IPAQ Inactive 1,600.54±1,654.17 55 (39.6) 0.0 5,940.0
    Minimally active 55 (39.6)
    HEPA 29 (20.9)
    Depression 16 ≤ 16.7±9.4 81 (58.3) 1.0 44.0
    16 ＞ 58 (41.7)
    SF-12:PCS 39.2 ≤ 39.2±9.1 63 (45.3) 17.1 55.6
    39.2 ＞ 76 (54.7)
    SF-12:MCS 46.6 ≤ 46.6±11.2 70 (50.4) 18.8 69.1
    46.6 ＞ 69 (49.6)
    Sleep Disturbance 5 ≤ 7.8±4.4 47 (33.8) 0.0 19.0
    5 ＞ 92 (66.2)

    IPAQ=international physical activity questionnaire; Inactive= 600; ＜ Minimally active=600~3000; HEPA= 3000 ＞ (MET-min/week); CES-D=Center for Epidemiological Studies Depression Scale; PSQI=Pittsburgh Sleep Quality Index; SF-12:PCS=Physical Component Summary Score; SF-12:MCS=Mental Component Summary Score; HEPA=health enhancing physical activity.

    Differences in Depression, PCS, MCS, Sleep Disturbance, and Physiological Indicators according to Physical Activity (N=139)

    Variables Categories Inactive Minimally active HEPA F p
    n (%) & M±SD n (%) & M±SD n (%) & M±SD
    Psychometric index Depression 19.09±9.33 16.11±9.42 13.14±8.37 4.16 .018
    SF-12: PCS 36.24±8.90 40.88±9.24 41.45±7.90 5.00 .008
    SF-12: MCS 42.19±10.94 48.26±11.18 51.65±8.81 8.66 ＜.001
    Sleep disturbance 8.64±4.59 7.44±3.87 6.72±4.86 2.05 .132
    Physiological Indicators Phosphorous 4.79±1.68 5.08±1.36 5.61±1.40 2.79 .065
    Potassium 5.04±0.94 5.14±0.85 5.73±0.84 6.11 .003
    Calcium 8.96±1.08 8.85±1.18 9.01±0.99 0.24 .785
    BUN 60.09±20.60 61.59±16.28 71.00±17.57 3.60 .030
    Cr 8.84±3.25 9.17±2.75 13.88±16.41 4.38 .014
    Albumin 4.03±0.49 4.08±0.40 4.08±0.25 0.21 .807
    Hemoglobin 10.19±0.94 10.55±1.37 10.36±1.07 1.30 .273

    IPAQ=International Physical Activity Questionnaire, Inactive= 600, ＜ Minimally active=600~3,000, HEPA= 3,000 ＞ (MET-min/week), CES-D=Center For Epidemiological Studies Depression Scale, PSQI=Pittsburgh Sleep Quality Index, SF-12: PCS=Physical Component Summary Score, SF-12: MCS=Mental Component Summary Score, HEPA=health enhancing physical activity.

    Relationships of Physical Activity with Depression, Quality of Life and Sleep Disturbance (N=139)

    Variables X1 X2 X3 X4 X5
    IPAQ (X1) 1
    CES-D (X2) -.213* 1
    PSQI (X3) -.091 .486** 1
    SF-12: PCS (X4) .189* -.299** -411** 1
    SF-12: MCS (X5) .252** -512** -.274** .108 1

    IPAQ=International Physical Activity Questionnaire; CES-D=Center For Epidemiologic Studies Depression Scale; PSQI=Pittsburgh Sleep Quality Index; SF-12:PCS=Physical Component Summary Score; SF-12:MCS=Mental Component Summary Score; *p .05, ** ＜ p .01. ＜
    Table 1. Characteristics of the Participants (N=139)

    Table 2. Physical Activity, Depression, Quality of Life, and Sleep Disturbance of the Participants (N=139)

    IPAQ=international physical activity questionnaire; Inactive= 600; ＜ Minimally active=600~3000; HEPA= 3000 ＞ (MET-min/week); CES-D=Center for Epidemiological Studies Depression Scale; PSQI=Pittsburgh Sleep Quality Index; SF-12:PCS=Physical Component Summary Score; SF-12:MCS=Mental Component Summary Score; HEPA=health enhancing physical activity.

    Table 3. Differences in Depression, PCS, MCS, Sleep Disturbance, and Physiological Indicators according to Physical Activity (N=139)

    IPAQ=International Physical Activity Questionnaire, Inactive= 600, ＜ Minimally active=600~3,000, HEPA= 3,000 ＞ (MET-min/week), CES-D=Center For Epidemiological Studies Depression Scale, PSQI=Pittsburgh Sleep Quality Index, SF-12: PCS=Physical Component Summary Score, SF-12: MCS=Mental Component Summary Score, HEPA=health enhancing physical activity.

    Table 4. Relationships of Physical Activity with Depression, Quality of Life and Sleep Disturbance (N=139)

    IPAQ=International Physical Activity Questionnaire; CES-D=Center For Epidemiologic Studies Depression Scale; PSQI=Pittsburgh Sleep Quality Index; SF-12:PCS=Physical Component Summary Score; SF-12:MCS=Mental Component Summary Score; *p .05, ** ＜ p .01. ＜

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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