Physical activity and posttraumatic growth in patients receiving maintenance hemodialysis : a longitudinal study

Abstract

End-stage renal disease (ESRD) is the final stage of chronic kidney disease, indicating a severe loss of kidney function. Hemodialysis is the major treatment modality for ESRD in mainland China, and the prevalence of patients with hemodialysis-treated ESRD is expected to increase in the following decades. The research on ESRD and dialysis has primarily focused on the deleterious effects of disease and its treatment, such as elevated depressive symptoms and anxiety symptoms. However, understanding of psychological adjustment in dialysis population can benefit from a more balanced approach by integrating positive psychological experiences. The current research examined posttraumatic growth (PTG) and its association with physical activity in patients on maintenance hemodialysis. This thesis presents a comprehensive systematic review of quantitative and qualitative studies on relationship between physical activity and PTG. To better synthesize the findings, a meta-analysis of quantitative studies was conducted to examine the average effect size for association between leisure-time physical activity and PTG, and a meta-ethnographic synthesis of qualitative studies was conducted to examine the processes linking physical activity and PTG. The meta-analysis revealed a positive, yet small, correlation between leisure-time physical activity and PTG. These effect sizes did not differ by measurements of PTG and participants’ age and sex but were smaller in studies with a binary variable of physical activity and a longer period since the stressful event. The meta-ethnographic synthesis identified potential mechanisms linking physical activity and PTG, including perception of self, social experiences, health effects, and philosophical re-evaluation. However, the systematic review highlights methodological limitations of previous studies, including predominantly using a cross-sectional design, employing less reliable measurements of physical activity, and examining solely the leisure-time or total physical activity. This study used a prospective design to examine the predictive effect of context-specific physical activity on PTG and test the mediating effect of emotional distress and social support on this relationship in patients receiving maintenance hemodialysis. A consecutive sample of 150 patients from two hemodialysis units participated in this study, and 117 of them completed the assessment at the 12-month follow-up. The patients reported small to moderate levels of PTG in general, and patients were more likely to report higher levels of PTG if they were married, and perceived more social support and less emotional distress. Higher levels of physical activity in multiple contexts could predict greater PTG. Within the contexts of physical activity, transport-related, household, and leisure-time physical activity were positively associated with subsequent PTG. Social support mediated the relationship between household physical activity and PTG at baseline and follow-up, and depressive symptoms mediated the relationship of total physical activity with PTG at baseline. The current research has provided empirical support for the link between physical activity and PTG in different daily contexts in patients receiving maintenance hemodialysis. Further study is suggested to test the alternative directional link of PTG to physical activity, use objective assessment of physical activity, and investigate additional potential factors that mediate the physical activity–PTG relationship in different daily contexts.