Physical Activity Dose for Hemodialysis Patients: Where to Begin? Results from a Prospective Cohort Study

Ryota Matsuzawa, Baback Roshanravan, Takahiro Shimoda, Noritaka Mamorita, Kei Yoneki, Manae Harada, Takaaki Watanabe, Atsushi Yoshida, Yasuo Takeuchi, Atsuhiko Matsunaga

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Objective Greater physical activity is associated with lower risk of mortality in persons with kidney disease; however, little is known about the appropriate dose of physical activity among hemodialysis patients. Here detected the minimum level of habitual physical activity to help inform interventions aimed at improving outcomes in the dialysis population. Design The design was prospective cohort study. Subjects Clinically stable outpatients in a hemodialysis unit from October 2002 to March 2014 were assessed for their eligibility to be included in this 7-year prospective cohort study. We used the Youden index to determine the optimal cutoff points for physical activity. The prognostic effect of physical activity on survival was estimated by Cox proportional hazards regression analysis. The number of steps per nondialysis day was recorded by accelerometer at study entry. Main Outcome Measure The main outcome measure was all-cause mortality. Results There were 282 participants who had a mean age of 65 ± 11 years and 45% were female. A total of 56 deaths occurred during the follow-up period (56 months [interquartile range: 29-84 months]). The cutoff value for the physical activity discriminating those at high risk of mortality was 3,752 steps. After adjustment for the effect of confounders, the hazard ratio in the group of <4,000 steps was 2.37 (95% confidence interval: 1.22-4.60, P =.01) compared with the others. Conclusions Engaging in physical activity is associated with decreased mortality risk among hemodialysis patients. Our findings of a substantial mortality benefit among those who engage in at least 4,000 steps provide a basis for as a minimum initial recommendation kidney health providers can provide for mobility disability-free hemodialysis patients.

Original languageEnglish (US)
Pages (from-to)45-53
Number of pages9
JournalJournal of Renal Nutrition
Issue number1
StatePublished - Jan 2018
Externally publishedYes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Nephrology


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