Activity trackers may increase physical activity of people with kidney disease
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Most people with advanced kidney disease are physically inactive. This inactivity is associated with increased dialysis symptom burden, hospitalization and mortality.1
In people with advanced kidney disease (AKD), 10 minutes of increased daily physical activity is associated with a 22% decrease in mortality risk.2
We frequently encourage people with AKD to exercise in order to improve fitness, increase strength and in some cases to lose excess weight. Although most patients understand the value of physical activity, many do not make exercise a priority.
Wearable activity trackers (WATs), such as wrist devices and integrated phone apps, have the potential to help achieve sustained increases in the activity of people with AKD.
WATs offer motivation
Motivational theory tells us that the more autonomous the motivation stimulus is, the more sustainable behavior change will be.3 WATs support this autonomy by providing intrinsic rewards to the wearer. For example, the wearer is motivated to exceed the number of steps they took the day before.
This motivation can be increased further by facilitating exercise choice and through online and face-to-face peer relationships that develop using WATs.4 In a study of over 800 healthy adults, wearing activity trackers alone increased and maintained moderate to vigorous physical activity over a sustained 12-month period.5
Globally, wearable activity trackers have grown rapidly in popularity. Brands such as Fitbit, Jawbone, Gruve, LumoBack, BodyMedia, Polar Active, Pebble, Fitmeter, Personal Activity Monitor, Apple Watch and Withings Pulse have experienced increased usage, with 200 million people worldwide expected to enjoy such devices by 2022.2
Incorporated into a mobile phone app, activity trackers enable convenient and immediate feedback relating to daily steps and energy expenditure.
Activity trackers and AKD
Although cross-sectional studies measuring activity in patients with AKD are common (see Figure), controlled studies testing the hypothesis that wearable trackers increase activity are scarce. A recent study among patients on peritoneal dialysis and hemodialysis showed an increase of over 2,000 steps per day among those who wore and set goals with WATs, compared with a non-activity tracker group.6 However, this change was not sustained following the study, suggesting immediate feedback may have limited value once the novelty has worn off. Measuring our activity, or lack thereof, from our daily step count may be of limited value in the absence of new information, jointly agreed strategies or achievable goals.
Global anecdotal experience with WATs among dialysis patients has shown that many patients embraced trackers but can get bored with them, and some stopped using them. Some would attach the tracker to their shoes during intradialytic cycling, enabling a way of counting cycling cadence. So, although activity trackers play a role in increasing activity, additional strategies are required to effect sustained behavior change. Additional strategies may include:
- provide clear instructions on how to use trackers;
- set attainable individual goals;
- ·one-on-one or group peer mentoring;
- social online community activity participation;
- professional exercise support (physical therapists, exercise physiologists, kinesiologists);
- support a “walking across America” marathon or similar;
- document steps at each dialysis visit (similar to documenting weight and blood pressure);
- ensure the type of tracker suits the person;
- integrate with mobile phone;
- ensure shuffle and asymmetrical gaits are counted;
- frequent data download to address data, battery and memory capacity; and
- encourage dialysis staff to wear trackers.
Future studies
One ongoing 16-center study in Australia titled, “Structured exercise program to reduce fatigue in patients receiving dialysis: a preference-stratified adaptive trial (M-FIT)” will use a phone app with exercise professional support to address fatigue and activity.7
The use and proficiency of wearable and mobile technology is high in the AKD population.8 Accordingly, interventions such as WATs are well accepted by people with AKD and thus, we can be hopeful that people with AKD will embrace these types of technologies to set activity goals. Furthermore, accepting activity tracking technology can lead to other mobile health innovations that result in greater patient engagement, increased remote monitoring, improved treatment adherence and real-time symptom management.
The way forward
Although nephrology clinicians are not exercise specialists, we are in a privileged position to help patients increase their physical activity and maintain their independence. Within this scope of responsibility, it is incumbent on us to provide a pathway to activity and exercise for people with AKD. Encouraging the use of WATs and mobile phone step-tracking apps with individualized additional strategies may be a first step toward increasing physical activity. Systematic integration of physical activity, activity tracking, coaching and peer support in the routine care for patients on dialysis may encourage a more active lifestyle, which may ultimately improve the quality and the quantity of life for people with AKD.
References:
1. Clarkson MJ, et al. Am J Physiol Renal Physiol.2019;doi:10.1152/ajprenal.00317.2018.
2. Matsuzawa R, et al. Clin J Am Soc Nephrol. 2012;doi:10.2215/CJN.03660412.
3. Nuss K, et al. Am J Health Promot. 2020;doi:10.1177/0890117120939030.
4. Karapanos E, et al. Psychol Well Being. 2016;doi:10.1186/s13612-016-0042-6.
5. Finkelstein EA, et al. Lancet Diab Endocrin. 2016;doi:10.1016/S2213-8587(16)30284-4.
6. Sheshadri A, et al. Am J Kidney Dis. 2020;doi:10.1053/j.ajkd.2019.07.026.
7. Commonwealth of Australia. Medical Research Future Fund. Available at: www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/359-million-boost-for-rare-cancers-rare-diseases-and-unmet-medical-needs. Accessed June 15, 2021.
8. Hussein WF, et al. Clin J Am Soc Nephrol.: 2020;doi:10.2215/cjn.11690720.
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