Journal List > J Korean Acad Nurs > v.50(1) > 1143146

J Korean Acad Nurs. 2020 Feb;50(1):52-65. Korean.
Published online Feb 28, 2020.
© 2020 Korean Society of Nursing Science
Development and Effects of Smartphone App-Based Exercise Program for Hemodialysis Patients
Eun Jeong Ki,1 and Hyang Sook So2
1Department of Nursing, Seoyoung University, Gwangju, Korea.
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, Email:
Received Jul 01, 2019; Revised Dec 04, 2019; Accepted Jan 19, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. ( 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.



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.


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.


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.


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


Figure 1
Theoretical framework and C·T·E structure for this study.
Click for larger image

Figure 2
Smart phone app-based exercise program applying self-efficacy resources for hemodialysis patients.
Click for larger image

Figure 3
Flow diagram of study participants.
Click for larger image


Table 1
Homogeneity Test of Characteristics and Research Variables (N=63)
Click for larger image

Table 2
Effects of Application-based Exercise Program on Research Variables (N=63)
Click for larger image


This manuscript is a condensed form of the first author's doctoral dissertation from Chonnam National University.

CONFLICTS OF INTEREST:The authors declared no conflict of interest.


  • Conceptualization or/and Methodology: So HS.

  • Data curation or/and Analysis: Ki EJ.

  • Investigation: Ki EJ.

  • Project administration or/and Supervision: So HS.

  • Resources or/and Software: Ki EJ.

  • Validation: Ki EJ.

  • Visualization: So HS.

  • Writing original draft or/and Review & editing: So HS.

1. The Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: The Korean Society of Nephrology; 2018 [cited 2018 Sep 18].
2. de Lima MC, Cicotoste Cde L, Cardoso Kda S, Forgiarini LA Jr, Monteiro MB, Dias AS. Effect of exercise performed during hemodialysis: Strength versus aerobic. Renal Failure 2013;35(5):697–704. [doi: 10.3109/0886022X.2013.780977]
3. Jang EJ, Kim HS. Effects of exercise intervention on physical fitness and health-relalted quality of life in hemodialysis patients. Journal of Korean Academy of Nursing 2009;39(4):584–593. [doi: 10.4040/jkan.2009.39.4.584]
4. Lee JY. In: The empirical study of exercise prescription for end stage renal failure patients [dissertation]. Seoul: SungShin Women's University; 2016. pp. 1-103.
5. Gołębiowski T, Kusztal M, Weyde W, Dziubek W, Woźniewski M, Madziarska K, et al. A program of physical rehabilitation during hemodialysis sessions improves the fitness of dialysis patients. Kidney and Blood Pressure Research 2012;35(4):290–296. [doi: 10.1159/000335411]
6. Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T. Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: A randomized, controlled trial. Journal of the American Society of Nephrology 2006;17(8):2307–2314. [doi: 10.1681/ASN.2006010034]
7. Lee JY, Oh JE, Choi SW. The influence that the complex action program reaches on the strength and arteriosclerosis of the female end-stage renal failure. Korean Journal of Sports Science 2011;20(2):841–848.
8. Suh MR, Jung HH, Park JS. The effects of an exercise training in hemodialysis patients. Journal of Korean Biological Nursing Science 2001;3(1):29–40.
9. Levendoğlu F, Altintepe L, Okudan N, Uğurlu H, Gökbel H, Tonbul Z, et al. A twelve week exercise program improves the psychological status, quality of life and work capacity in hemodialysis patients. Journal of Nephrology 2004;17(6):826–832.
10. Resnick B, Zimmerman SI, Orwig D, Furstenberg AL, Magaziner J. Outcome expectations for exercise scale: Utility and psychometrics. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 2000;55(6):S352–S356. [doi: 10.1093/geronb/55.6.s352]
11. Kim AL. Effects of structured arm exercise on arteriovenous fistula stenosis in hemodialysis patient. Journal of Korean Biological Nursing Science 2012;14(4):300–307. [doi: 10.7586/jkbns.2012.14.4.300]
12. Lee SB, Jeong PY, Lee MH. ‘Daily oral motor exercise for 15 minutes’ for cerebral palsy: A case report for the mobile application development. AAA Research & Practice 2015;3(1):81–90. [doi: 10.14818/aac.2015.]
13. Estrin D, Sim I. Open mHealth architecture: An engine for health care innovation. Science 2010;330(6005):759–760. [doi: 10.1126/science.1196187]
14. Resnick B. Theory of self-efficacy. In: Smith M, Liehr PR, editors. Middle Range Theory for Nursing. 2nd ed. New York: Springer; 2008. pp. 183-204.
15. Bandura A. In: Self-efficacy: The exercise of control. New York: W.H. Freeman and Company; 1997. pp. 1-592.
16. Resnick B, Palmer MH, Jenkins LS, Spellbring AM. Path analysis of efficacy expectations and exercise behaviour in older adults. Journal of Advanced Nursing 2000;31(6):1309–1315. [doi: 10.1046/j.1365-2648.2000.01463.x]
17. Heyward VH. In: Kim JH, Kang IW, Kim WJ, Kim CH, Yoon BG, Lee DT, et al.Advanced fitness assessment and exercise prescription. 6th ed. Seoul: Hanmi Medical; 2011. pp. 98-151.
18. Dunbar CC, Robertson RJ, Baun R, Blandin MF, Metz K, Burdett R, et al. The validity of regulating exercise intensity by ratings of perceived exertion. Medicine and Science in Sports and Exercise 1992;24(1):94–99. [doi: 10.1249/00005768-199201000-00016]
19. Hoeger WWK, Hoeger SA. In: Go KJ, Go SK, Kim KJ, Park SK, Shin WT, Yang JO, et al.Fitness and wellness. 9th ed. Seoul: Hanmi Medical; 2008. pp. 69.pp. 98.pp. 111.pp. 151.
20. Duncan PW. In: Balance: Proceedings of the APTA Forum. Alexandria: American Physical Therapy Association; 1990. pp. 2.
21. Rus R, Ponikvar R, Kenda RB, Buturović-Ponikvar J. Effects of handgrip training and intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal failure. Therapeutic Apheresis and Dialysis 2005;9(3):241–244. [doi: 10.1111/j.1774-9987.2005.00263.x]
22. Jeon JH, Kim K. Consumer's needs for development of smartphone application for self care performance of patients with chronic hepatitis B. The Journal of the Korea Contents Association 2016;16(4):729–740. [doi: 10.5392/JKCA.2016.16.04.729]
23. Shin YH, Jang HJ, Pender NJ. Psychometric evaluation of the exercise self-efficacy scale among Korean adults with chronic diseases. Research in Nursing and Health 2001;24(1):68–76. [doi: 10.1002/1098-240x(200102)24:1<68::aidnur1008>;2-c]
24. Choi HY, Yang SJ. Effects of walking program based on social cognitive theory for office workers. Korean Journal of Adult Nursing 2013;25(6):712–724. [doi: 10.7475/kjan.2012.24.6.712]
25. Oh JY, Yang YJ, Kim BS, Kang JH. Validity and reliability of Korean version of international physical activity questionnaire (IPAQ) short form. Journal of the Korean Academy of Family Medicine 2007;28(7):532–541.
26. Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation 2006;48 Suppl 1:S2–S90. [doi: 10.1053/j.ajkd.2006.03.051]
27. Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the kidney disease quality of life (KDQOL™) instrument. Quality of Life Research 1994;3(5):329–338. [doi: 10.1007/bf00451725]
28. National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation 2015;66(5):884–930. [doi: 10.1053/j.ajkd.2015.07.015]
29. Park HJ, Kim S, Yong JS, Han SS, Yang DH, Meguro M, et al. Reliability and validity of the Korean version of kidney disease quality of life instrument (KDQOL-SF™). The Tohoku Journal of Experimental Medicine 2007;211(4):321–329. [doi: 10.1620/tjem.211.321]
30. Irvine AB, Russell H, Manocchia M, Mino DE, Cox Glassen T, Morgan R, et al. Mobile-Web app to self-manage low back pain: Randomized controlled trial. Journal of Medical Internet Research 2015;17(1):e1 [doi: 10.2196/jmir.3130]
31. Kim TU, Kim SC, Cho EH. The effects of using m-Health app to the body composition, blood and related variable of exercise adherence of middle-aged obese female. The Korean Journal of Physical Education 2015;54(2):407–419.
32. Choi YH. In: Effects of smart phone app-based walking exercise program for taxi drivers [dissertation]. Gwangju: Chonnam National University; 2015. pp. 1-86.
33. Cho HY. Effects of self-motivated virtual reality exercise program on heart rate variability and quality of life in the hemodialysis patients. Journal of the Korea Academia-Industrial Cooperation Society 2014;15(9):5578–5584. [doi: 10.5762/KAIS.2014.15.9.5578]