基于PEAKING队列探讨慢性肾脏病患者运动的促进与阻碍因素

背景　运动有利于改善慢性肾脏病（CKD）患者的预后，但运动在CKD患者的普及程度仍较低。目的　探索CKD患者进行运动的意愿、动机、促进与障碍等行为改变因素，为未来的运动干预提供基础。方法　于2019年3-6月，采用目的抽样法从PEAKING队列中选取不同体力活动水平、不同规律运动情况的CKD患者（n=10）进行半结构式定性访谈。访谈内容主要包括：患者对CKD的认识，日常活动安排，对运动与疾病关系的认识，进行规律运动的促进与阻碍因素等。最后利用内容分析法进行访谈资料分析归纳，按照国际公认的定性研究报告标准（COREQ）进行报告。结果　促进CKD患者运动的因素包括：意识到运动可能有益于身心理健康（启动因素）；体验到运动带来的益处、自律（坚持运动的内在因素）；来自家庭、运动专业人员及社会水平的支持（保持运动的外部因素）。阻碍CKD患者运动的因素有：年老、心肺肾等相关合并症及疲劳感（身体状况因素）；担心骨骼及肾脏损伤（运动相关损伤潜在风险的担忧）；时间、地方、设施和陪伴不足（缺乏体育锻炼条件）。结论　在CKD患者中开展运动干预，需要增加运动获益宣传、增强自我效能及增加外部支持等促进因素，注意预防运动相关损伤和创造锻炼条件以减少阻碍因素。

Facilitators and Barriers to be Physically Active in Patients with Chronic Kidney Disease Based on PEAKING Cohort

Background　Exercise is beneficial to improve the prognosis of patients with chronic kidney disease（CKD）.However，the popularity of exercise is still low in this population. Objective　To explore factors related to behavior change such as perception，motivation，facilitators and barriers of exercise in patients with CKD，in order to provide the basis for the future exercise intervention. Methods　The purpose sampling method was used to select CKD patients（n=10） with different physical activity levels and regular exercise conditions from the PEAKING cohort for the semi-structured qualitative interview from March to June in 2019. The content of the interview included patient's view on CKD，daily physical activities，opinions about the relationship between exercise and CKD，and the facilitators and barriers to the regular exercise. Content analysis method was used to analyze and summarize the interview data and results were reported according to the Consolidated Criteria for Reporting Qualitative Studies（COREQ）. Results　Facilitators to exercise included awareness of the benefits of exercise for physical and mental health（initiator），experience of the benefits of exercise and self-discipline after exercise（internal factors to maintain exercise），and support from families，exercise professionals and society（external factors to maintain exercise）. Barriers to exercise included aging，cardiopulmonary and renal comorbidities and fatigue（physical factors），fear of bone and kidney damage（concerns about the potential risks of exercise-related injuries），insufficient time，places，facilities and companions（lack of supportive factors）. Conclusion　In the exercise intervention in patients with CKD，it is recommended to emphasize those facilitators such as promoting benefits from exercise，enhancing the self-efficacy and improving external support，and to reduce barriers such as paying attention to preventing exercise-related injuries and creating more exercise conditions.