Construction and Application of Exercise Intervention Programs during Dialysis for Elderly Maintenance Hemodialysis Patients Based on Multiple Theoretical Models
Objective: To construct a dialysis-based exercise intervention program based on the Multi-Theory Model (MTM) and explore its effects on the physical function and long-term exercise behavior of elderly maintenance hemodialysis patients. Methods: Using the convenience sampling method, 70 elderly MHD patients from two tertiary hospitals in Hebei Province from September 2025 to February 2026 were selected as the research subjects. They were divided into the control group and the intervention group according to the dialysis duration, with 35 cases in each group. The control group received routine care, while the intervention group implemented the MTM-based exercise intervention on the basis of routine care for 12 weeks. The physical function (SPPB), 6-minute walking distance, lower limb muscle strength, exercise self-efficacy, and exercise compliance of the two groups were compared before the intervention and at 4,8, and 12weeks of the intervention. Results: After the intervention, the SPPB score, 6-minute walking distance, lower limb muscle strength, exercise self-efficacy, and exercise compliance of the intervention group were all better than those of the control group, and all indicators continued to improve with the extension of the intervention time, and the differences were statistically significant (P < 0.05). Conclusion: The MTM-based exercise intervention during dialysis can effectively improve the physical function, muscle strength, and exercise endurance of elderly MHD patients, as well as enhance exercise self-efficacy and exercise compliance, which is conducive to promoting the formation of long-term exercise behavior in patients and can provide new intervention ideas for the exercise rehabilitation and long-term behavior management of elderly hemodialysis patients.
[1] Andrassy KM, 2013, Comments on “KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease”. Kidney International, 84(3): 6223.
[2] Chinese National Renal Data System (CNRDS), 2013, China Dialysis Registration Data. https://www.cnrds.net
[3] Jha V, Garcia-Garcia G, Iseki K, et al., 2013, Chronic Kidney Disease: Global Dimension and Perspectives. Lancet, 382(9888): 260–272.
[4] Kosmadakis GC, Bevington A, Smith AC, et al., 2010, Physical Exercise in Patients with Severe Kidney Disease. Nephron Clinical Practice, 115(1): c7–c16.
[5] Painter P, 2009, Determinants of Exercise Capacity in CKD Patients Treated with Hemodialysis. Advances in Chronic Kidney Disease, 16(6): 437–448.
[6] Deng SY, Luo XJ, Liu YX, et al., 2023, Effects of Five Types of Exercises on Improving the Cardiorespiratory Endurance of Patients Undergoing Hemodialysis: A Network Meta-Analysis. Military Nursing, 40(6): 105–108 + 111.
[7] Chen J, Liu YX, Luo XJ, et al., 2022, Effects of Exercise on Physical Function in Maintenance Hemodialysis Patients: A Meta-Analysis. Chinese Journal of Blood Purification, 21(11): 850–857.
[8] Xu QJ, Hu YF, Hu HG, 2021, Effect of Different Types of Exercises in Improving the Walking Ability of Patients Undergoing Maintenance Hemodialysis: A Network Meta-Analysis. Military Nursing, 38(7): 1–5.
[9] Luo XJ, 2024, Association between Intradialytic Hypotension and Physical Function in Patients Undergoing Maintenance Hemodialysis: A Prospective Cohort Study, thesis, Soochow University.
[10] Hayes T, Sharma M, Shahbazi M, et al., 2019, The Evaluation of a Fourth-generation Multi-Theory Model (MTM) Based Intervention to Initiate and Sustain Physical Activity. Health Promotion Perspectives, 9(1): 13–23.
[11] Institute of Sports Medicine, General Administration of Sport of China, 2025, Expert Consensus on Clinical Exercise Prescription Practice (2025). Chinese Journal of Sports Medicine, 44(5): 341–357.
[12] Zhang F, Wang WQ, Zhang HC, 2022, Interpretation on the Clinical Practice Guidelines and Expert Consensus about Exercise Rehabilitation in Chronic Kidney Disease. Chinese Journal of Blood Purification, 21(2): 111–114.
[13] Deng JH, Tian X, Yang D, et al., 2022, Evidence-based Practice of Exercise Management in Maintenance Hemodialysis Patients. Chinese Journal of Nursing, 57(21): 2596–2603.
[14] Yang JH, 2022, Based on Multi-Theory Model the Study on Comprehensive Intervention of Behavior Changes for Elderly Patients with Hypertension, thesis, Hunan University of Chinese Medicine.
[15] Feng X, Sun J, Wang Z, et al., 2025, The Impact of Intradialytic Elastic Band Exercise on Physical and Cognitive Abilities in Patients on Maintenance Hemodialysis: A Randomized Controlled Trial. Renal Failure, 47(1): 2482124.
[16] Fang M, 2023, Application of Aerobic Combined Resistance Exercise on the Elderly Patients with MHD Obese Sarcopenia, thesis, Huzhou Normal University.
[17] Cho JH, Lee JY, Lee S, et al., 2018, Effect of Intradialytic Exercise on Daily Physical Activity and Sleep Quality in Maintenance Hemodialysis Patients. International Urology and Nephrology, 50(4): 745754.
[18] Hu H, Wu C, Kwok JYY, et al., 2023, Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis. American Journal of Nephrology, 54(9–10): 379–390.
[19] Zeng F, Wang XS, 2023, The Impact of Self-Management Based on WeChat Check-in Supervision on the Effect of Exercise Intervention for Maintenance Hemodialysis Patients. International Journal of Nursing Science, 42(24): 4596–4600.
[20] Bao LX, Li J, Zhang Y, et al., 2022, The Effects of a Home Rehabilitation Training through Stepwise Teaching in Patients after Total Hip Arthroplasty. Chinese Nursing Management, 22(1): 142–146.
[21] Ma YC, 2021, Expert consensus on Construction of the Renal Rehabilitation system in Hemodialysis Centers. Chinese Journal of Blood Purification, 20(12): 823–829.
[22] Sun JJ, Gu Q, Xue DG, et al., 2022, Evidence Summaries: Intradialytic Exercise for Maintenance Hemodialysis Patients. Journal of Nursing Science, 37(13): 9–12.
[23] Gao X, Mei CL, 2022, Interpretation of Guideline for Early Screening, Diagnosis, Prevention and Treatment of Chronic Kidney Disease (2022 edition). Chinese Journal of Practical Internal Medicine, 42(9): 735739.
[24] Borg G, 1970, Perceived Exertion as an Indicator of Somatic Stress. Scandinavian Journal of Rehabilitation Medicine, 2(2): 92–98.
[25] Liu CF, 2024, Application of Information Walking Exercise Intervention Based on ICF Framework to Maintenance Hemodialysis Patients, thesis, Yan’an University.
[26] Wang LX, 2022, The Six-minute Walking Test in the Rehabilitation Evaluation of Early Onset Scoliosis, thesis, Shanghai Institute of Physical Education.
[27] Van Cappellen, Van Maldegem SJM, Hoedjes M, et al., 2023, Self Performed Five Times Sit to Stand Test at Home as (Pre)Screening Tool for Frailty in Cancer Survivors: Reliability and Agreement Assessment. Journal of Clinical Nursing, 32(78): 13701380.
[28] Tung WC, Gillett P A, Pattillo RE, 2005, Applying the Trans Theoretical Model to Physical Activity in Family Caregivers in Taiwan Region. Public Health Nursing, 22(4): 299310.
[29] Li X, 2021, Effect of Empowerment Education on Exercise Rehabilitation of Patients with Coronary Heart Disease after Percutaneous Coronary Intervention, thesis, Qingdao University.
[30] Zelle DM, Klaassen G, van Adrichem E, et al., 2017, Physical Inactivity: A Risk Factor and Target for Intervention in Renal Care. Nature Reviews Nephrology, 13(3): 152–168.
[31] Jha V, Garcia G, Iseki K, et al., 2013, Chronic Kidney Disease: Global Dimension and Perspectives. Lancet, 382(9888): 260272.
[32] Jofré-Saldía E, Villalobos-Gorigoitía Á, Cofré-Bolados C, et al., 2023, Multicomponent Training in Progressive Phases Improves Functional Capacity, Physical Capacity, Quality of Life, and Exercise Motivation in Community-Dwelling Older Adults: A Randomized Clinical Trial. International Journal of Environmental Research and Public Health, 20(3): 2755.
[33] Bae YH, Lee SM, Jo JI, 2015, Aerobic Training During Hemodialysis Improves Body Composition, Muscle Function, Physical Performance, and Quality of Life in Chronic Kidney Disease Patients. Journal of Physical Therapy Science, 27(5): 1445–1449.
[34] Sakkas GK, Hadjigeorgiou GM, Karatzaferi C, et al., 2008, Intradialytic Aerobic Exercise Training Ameliorates Symptoms of Restless Legs Syndrome and Improves Functional Capacity in Patients on Hemodialysis: A Pilot Study. ASAIO Journal, 54(2): 185–190.
[35] Liu YB, Ding MM, Wang XY, et al., 2023, Application of an Exercise Intervention Based on the ADOPT Model in Hemodialysis Patients. Journal of Nursing Science, 38(13): 78–82 + 88.
[36] Xue GF, Zhang YJ, Yuan HH, et al., 2018, Study on the Influencing Factors of Exercise Self-efficacy in Maintenance Hemodialysis Patients. Chinese Journal of Blood Purification, 17(12): 814–817.
