Patient Activation Impacts Exercise in Older Adults With Kidney Disease

Moderate-to-strenuous exercise reduces risk for disability and cardiovascular disease, yet many older adults with chronic kidney disease (CKD) remain sedentary. Most exercise interventions in patients with CKD are not grounded in models of behavior change and are thus limited by dropout. We aimed to test whether patient activation-the knowledge, confidence, and skill to engage in a behavior-associates with exercise frequency. We further aimed to explore characteristics of adults reporting high versus low activation. Our overarching goal was to provide initial evidence of whether activation could be a target for an exercise intervention for older adults with CKD.

We conducted a convergent parallel mixed-methods study informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model. We collected psychological (including Patient Activation Measure-13 [PAM-13]) and physiological factors corresponding to each component of COM-B. We cross-sectionally tested whether patient activation was associated with exercise (via the Exercise Vital Sign). We interviewed participants and their caregivers.

Of 232 adults with CKD stage 3B to 5 (median age: 69 years, 45% women, 26% Black), 26 adults and 9 caregivers contributed to the qualitative component. A 20-point increase in PAM-13 associated with a 0.63 (95% confidence interval: 0.24-1.03; P < 0.05) increase in weekly exercise days, independent of demographics, comorbidities, cognition, and frailty. Activated participants reported more caregiver support, a sense of identity tied to vocation, and altruism.

Patient activation associates with exercise frequency in older adults with CKD. Based on qualitative findings, improving activation may involve caregiver support, volunteerism, and vocational rehabilitation.