Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients

Eun Jeong Ki; Hyang Sook So

doi:10.4040/jkan.2020.50.1.52

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Ki and So: Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients

Original Article

J Korean Acad Nurs 2020;50(1):52-65.

Published online: 17 January 2020

DOI: https://doi.org/10.4040/jkan.2020.50.1.52

Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients

Eun Jeong Ki¹, Hyang Sook So^2,

¹Department of Nursing, Seoyoung University, Gwangju

²College of Nursing, Chonnam National University, Gwangju, Korea

Address reprint requests to : So, Hyang Sook College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea, Tel: +82-62-530-4952 Fax: +82-62-220-4544 E-mail: hsso0075@jnu.ac.kr

Received 1 July 2019 Revised 4 December 2019 Accepted 19 January 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose:

To examine the effects of a smartphone application-based exercise program on self-efficacy expectations (SEE) and outcome expectations regarding exercise (OEE), physical fitness, activity level, physiological indices, and health-related quality of life in a sample of hemodialysis patients.

Methods:

A quasi-experimental control group pre-test post-test design was used. Subjects were recruited from two university hospitals in G city. The subjects were assigned randomly by coin toss: 33 participants to the experimental group and 30 to the control group. A literature review and the self-efficacy theory were used to develop the smartphone program. Experts designed and verified the program to be userfriendly and in consideration of user interaction. Data were collected through a self-report pre-test post-test questionnaire and online medical records.

Results:

In the experimental group, the levels of physical fitness and physical activity were significantly improved post-test, but the scores on health-related quality of life and the physical indices did not improve. In the experimental group, the SEE and OEE post-test scores were also significantly higher than the pre-test scores, but the control group’s scores did not change.

Conclusion

The smartphone application-based exercise program based on self-efficacy theory significantly improved the level of physical fitness and activity, SEE, and OEE for hemodialysis patients. The use of this application-based exercise program for hemodialysis patients might be an effective nursing intervention tool for improving SEE, OEE, level of physical fitness, and physical activity.

Keywords: Hemodialysis, Smartphone, Exercise, Self Efficacy, Physical Fitness

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Figure 1.

Theoretical framework and C·T·E structure for this study.

Figure 2.

Smart phone app-based exercise program applying self-efficacy resources for hemodialysis patients.

Figure 3.

Flow diagram of study participants.

Table 1.

Homogeneity Test of Characteristics and Research Variables (N=63)

Characteristics		Exp. (n=33)	Cont. (n=30)	χ² or t	p
Characteristics		n (%) M±SD	n (%) M±SD	χ² or t	p
Age (yr)	≤49	5 (15.2)	3 (10.0)	-	.559*
	50~59	11 (33.3)	10 (33.3)
	60~69	10 (30.3)	6 (20.0)
	≥70	7 (21.2)	11 (36.7)
Gender	Men	18 (54.5)	19 (63.3)	0.50	.610
	Women	15 (45.5)	11 (36.7)
Education	Elementary	3 (9.1)	3 (10.0)	-	.979*
	Middle school	4 (12.1)	4 (13.3)
	High school	15 (45.5)	12 (40.0)
	College	11 (33.3)	11 (36.7)
Marital status	Single	3 (9.1)	3 (10.0)	-	.193*
	Married	27 (81.8)	27 (90.0)
	Others	3 (9.1)	-
Economic condition	High	-	2 (6.7)	-	.434*
	Middle	20 (60.6)	18 (60.0)
	Low	13 (39.4)	10 (33.3)
Religion	Yes	20 (60.6)	15 (50.0)	5.71	.193
	No	13 (39.4)	15 (50.0)
Duration of hemodialysis (yr)	<3	3 (9.1)	6 (20.0)	-	.176*
	≥3	17 (51.5)	18 (60.0)
	≥10	13 (39.4)	6 (20.0)
Alcohol use	Drinking now	4 (12.1)	3 (10.0)	-	>.999*
	No drinking now	13 (39.4)	13 (43.3)
	Absolutely not	16 (48.5)	14 (46.7)
Smoking use	Smoking now	1 (3.1)	-	-	.890*
	No smoking now	12 (36.3)	9 (30.0)
	Absolutely not	20 (60.6)	21 (70.0)
Expectations for exercise	Self-efficacy (SEE)	54.10±15.78	42.96±30.37	1.80	.079
	Outcome (OEE)	4.10±0.70	3.93±0.90	0.84	.403
Physical fitness (kg)	Step test (times)	94.70±17.60	91.43±17.7	0.73	.467
	Sit to stand (times)	15.36±4.89	14.03±4.85	1.08	.284
	Grip strength Rt. arm	25.58±9.38	24.37±8.68	0.67	.599
	Lt. arm	23.97±9.08	24.23±8.70	0.57	.907
Physical activity (min/wk)	Vigorous (MET)	113.94±330.47	128.00±548.49	-0.12	.901
	Moderate (MET)	175.76±468.60	71.33±170.49	1.19	.239
	Walking (MET)	640.00±874.57	509.30±742.35	0.63	.527
	Total (MET)	929.70±1020.80	708.63±902.23	0.85	.395
Physical index	Systolic BP (mmHg)	144.76±26.64	139.50±23.30	0.83	.410
	Diastolic BP (mmHg)	77.27±16.20	72.97±14.61	1.10	.274
	sp Kt/V	1.65±0.24	1.57±0.27	1.16	.249
Quality of life	SF-12 physical	42.47±8.06	40.01±9.53	1.10	.272
	SF-12 mental	45.82±10.26	44.75±10.17	0.41	.679
	Symptom/problem	77.27±16.03	71.21±17.74	1.42	.159
	Renal effects	75.67±21.47	73.23±19.56	0.47	.640
	Renal burden	45.82±21.85	43.54±22.47	0.40	.684

Exp.=Experimental group; Cont.=Control group; SEE=Self-Efficacy Expectations for Exercise; OEE=Outcome Expectations for Exercise; BP=Blood Pressure; sp Kt/V=sing pool Kt/V; MET=metabolic equivalent of task.

^* Fisher’s exact test

Table 2.

Effects of Application-based Exercise Program on Research Variables (N=63)

Variables	Group	Pre-test	Post-test	t	p
Variables	Group	M±SD	M±SD	t	p
SEE		Exp. (n=33)	54.10±15.78	64.34±16.03	3.65	.001
		Cont. (n=30)	42.96±30.37	46.85±21.76
OEE		Exp. (n=33)	4.10±0.70	4.41±0.53	2.83	.006
		Cont. (n=30)	3.93±0.90	3.97±0.68
2 min. step test (times/2 min	n)	Exp. (n=33)	94.70±17.60	120.15±18.03	5.15	<.001
		Cont. (n=30)	91.43±17.75	95.43±20.02
Sit to stand test (times/30 se	c)	Exp. (n=33)	15.36±4.89	19.24±5.40	3.69	<.001
		Cont. (n=30)	14.03±4.85	14.37±5.02
Grip strength (kg)	Rt Arm	Exp. (n=33)	25.58±9.38	29.88±8.35	2.22	.030
		Cont. (n=30)	24.37±8.68	24.80±9.76
	Lt Arm	Exp. (n=33)	23.97±9.08	26.85±8.67	2.01	.048
		Cont. (n=30)	24.23±8.70	22.47±8.41
Physical activity (min/wk)	Vigorous (MET)	Exp. (n=33)	113.94±330.47	400.00±638.22	2.85	.007
		Cont. (n=30)	128.00±548.49	48.00±182.67
	Moderate (MET)	Exp. (n=33)	175.76±468.60	687.27±641.12	5.46	<.001
		Cont. (n=30)	71.33±170.49	55.33±167.88
	Walking (MET)	Exp. (n=33)	640.00±874.57	1462.00±2464.82	1.95	.059
		Cont. (n=30)	509.30±742.35	608.30±452.28
	Total (MET)	Exp. (n=33)	929.70±1120.80	2549.27±2664.28	3.88	<.001
		Cont. (n=30)	708.63±902.23	711.63±501.41
Blood pressure (mmHg)	Systolic	Exp. (n=33)	144.76±26.64	141.64±27.56	0.38	.702
		Cont. (n=30)	139.50±23.30	139.17±23.01
	Diastolic	Exp. (n=33)	77.27±16.20	74.70±15.01	1.10	.276
		Cont. (n=30)	72.97±14.61	70.33±16.47
sp Kt/V		Exp. (n=33)	1.65±0.24	1.61±0.33	0.20	.838
		Cont. (n=30)	1.57±0.27	1.52±0.28
Quality of life	Physical	Exp. (n=33)	42.47±8.06	43.06±9.80	0.66	.512
		Cont. (n=30)	40.01±9.53	41.55±8.13
	Mental	Exp. (n=33)	45.82±10.26	48.90±9.34	1.12	.264
		Cont. (n=30)	44.75±10.17	45.82±12.27
	Symptom/problem	Exp. (n=33)	77.27±16.03	73.89±15.32	1.01	.313
		Cont. (n=30)	71.21±17.74	69.24±20.83
	Renal effects	Exp. (n=33)	75.67±21.47	72.53±19.46	-0.13	.890
		Cont. (n=30)	73.23±19.56	73.23±20.18
	Renal burden	Exp. (n=33)	45.82±21.85	34.65±25.10	-0.78	.437

Exp.=experimental group; Cont.=control group; M=mean; SD=standard deviation; SEE=self-efficacy expectations for exercise; OEE=outcome expectations for exercise; MET=metabolic equivalent of task; BP=blood pressure; sp Kt/V=sing pool Kt/V.

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