Background/Aims: Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients. Methods: We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient’s home ZIP code (www.walkscore.com; 0 = poorest walkability; 100 = greatest walkability). Results: HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46). Median WS of the neighborhood where they resided was 28. Patients in an above-median WS (n = 27) neighborhood took significantly more daily steps compared to those (n = 19) in a below-median WS neighborhood (7,514 ± 3,900 vs. 4,800 ± 2,228 steps/day; p < 0.001, t test). Daily steps and WS were directly correlated (R = 0.425; p = 0.0032, parametric test; R = 0.359, p = 0.0143, non-parametric test). Conclusion: This is the first study conducted among HD patients to indicate a direct relationship between neighborhood walkability and the actual steps taken. These results should be considered when designing initiatives to increase and improvise exercise routines in HD populations.

Keywords:
End-stage renal disease, Chronic kidney disease, Hemodialysis, Walkability, Physical activity, Activities of daily living
1.
Physical Activity Guidelines Advisory Committee: Physical Activity Guidelines Advisory Committee Report. Washington, US Department of Health and Human Services, 2008.
2.
Tudor-Locke C, Craig CL, Aoyagi Y, Bell RC, Croteau KA, De Bourdeaudhuij I, Ewald B, Gardner AW, Hatano Y, Lutes LD, Matsudo SM, Ramirez-Marrero FA, Rogers LQ, Rowe DA, Schmidt MD, Tully MA, Blair SN: How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act 2011; 8: 80.
3.
Saran R, Robinson B, Abbott KC, Agodoa LY, Albertus P, Ayanian J, Balkrishnan R, Bragg-Gresham J, Cao J, Chen JL, Cope E, Dharmarajan S, Dietrich X, Eckard A, Eggers PW, Gaber C, Gillen D, Gipson D, Gu H, Hailpern SM, Hall YN, Han Y, He K, Hebert H, Helmuth M, Herman W, Heung M, Hutton D, Jacobsen SJ, Ji N, Jin Y, Kalantar-Zadeh K, Kapke A, Katz R, Kovesdy CP, Kurtz V, Lavalee D, Li Y, Lu Y, McCullough K, Molnar MZ, Montez-Rath M, Morgenstern H, Mu Q, Mukhopadhyay P, Nallamothu B, Nguyen DV, Norris KC, O'Hare AM, Obi Y, Pearson J, Pisoni R, Plattner B, Port FK, Potukuchi P, Rao P, Ratkowiak K, Ravel V, Ray D, Rhee CM, Schaubel DE, Selewski DT, Shaw S, Shi J, Shieu M, Sim JJ, Song P, Soohoo M, Steffick D, Streja E, Tamura MK, Tentori F, Tilea A, Tong L, Turf M, Wang D, Wang M, Woodside K, Wyncott A, Xin X, Zang W, Zepel L, Zhang S, Zho H, Hirth RA, Shahinian V: US renal data system 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2017; 69(3 suppl 1):A7–A8.
4.
Lopes AA, Lantz B, Morgenstern H, Wang M, Bieber BA, Gillespie BW, Li Y, Painter P, Jacobson SH, Rayner HC, Mapes DL, Vanholder RC, Hasegawa T, Robinson BM, Pisoni RL: Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: the DOPPS. Clin J Am Soc Nephrol 2014; 9: 1702–1712.
5.
Morishita S, Tsubaki A, Shirai N: Physical function was related to mortality in patients with chronic kidney disease and dialysis. Hemodial Int 2017; 21: 483–489.
6.
Johansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, Schoenfeld PY, Kent-Braun JA: Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int 2000; 57: 2564–2570.
7.
Panaye M, Kolko-Labadens A, Lasseur C, Paillasseur JL, Guillodo MP, Levannier M, Teta D, Fouque D: Phenotypes influencing low physical activity in maintenance dialysis. J Ren Nutr 2015; 25: 31–39.
8.
Afsar B: The relationship between intact parathyroid hormone levels and daily physical activity in hemodialysis patients. Int J Artif Organs 2014; 37: 350–357.
9.
Zamojska S, Szklarek M, Niewodniczy M, Nowicki M: Correlates of habitual physical activity in chronic haemodialysis patients. Nephrol Dial Transplant 2006; 21: 1323–1327.
10.
Sallis JF, Cerin E, Conway TL, Adams MA, Frank LD, Pratt M, Salvo D, Schipperijn J, Smith G, Cain KL, Davey R, Kerr J, Lai PC, Mitas J, Reis R, Sarmiento OL, Schofield G, Troelsen J, Van Dyck D, De Bourdeaudhuij I, Owen N: Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet 2016; 387: 2207–2217.
11.
Christian H, Knuiman M, Divitini M, Foster S, Hooper P, Boruff B, Bull F, Giles-Corti B: A Longitudinal analysis of the influence of the neighborhood environment on recreational walking within the neighborhood: results from RESIDE. Environ Health Perspect 2017; 125: 077009.
12.
Siqueira Reis R, Hino AA, Ricardo Rech C, Kerr J, Curi Hallal P: Walkability and physical activity: findings from Curitiba, Brazil. Am J Prev Med 2013; 45: 269–275.
13.
Althoff T, Sosic R, Hicks JL, King AC, Delp SL, Leskovec J: Large-scale physical activity data reveal worldwide activity inequality. Nature 2017; 547: 336–339.
14.
Williams S, Han M, Ye X, Zhang H, Meyring-Wosten A, Bonner M, Young C, Thijssen S, Marsh D, Kotanko P: Physical activity and sleep patterns in hemodialysis patients in a suburban environment. Blood Purif 2017; 43: 235–243.
15.
King AC, Salvo D, Banda JA, Ahn DK, Chapman JE, Gill TM, Fielding RA, Demons J, Tudor-Locke C, Rosso A, Pahor M, Frank LD: Preserving older adults' routine outdoor activities in contrasting neighborhood environments through a physical activity intervention. Prev Med 2017; 96: 87–93.
16.
King AC, Sallis JF, Frank LD, Saelens BE, Cain K, Conway TL, Chapman JE, Ahn DK, Kerr J: Aging in neighborhoods differing in walkability and income: associations with physical activity and obesity in older adults. Soc Sci Med 2011; 73: 1525–1533.
17.
Barnett A, Cerin E, Zhang CJP, Sit CHP, Johnston JM, Cheung MMC, Lee RSY: Associations between the neighbourhood environment characteristics and physical activity in older adults with specific types of chronic conditions: the ALECS cross-sectional study. Int J Behav Nutr Phys Act 2016; 13: 53.
18.
Creatore MI, Glazier RH, Moineddin R, Fazli GS, Johns A, Gozdyra P, Matheson FI, Kaufman-Shriqui V, Rosella LC, Manuel DG, Booth GL: Association of neighborhood walkability with change in overweight, obesity, and diabetes. JAMA 2016; 315: 2211–2220.
19.
Brown SC, Pantin H, Lombard J, Toro M, Huang S, Plater-Zyberk E, Perrino T, Perez-Gomez G, Barrera-Allen L, Szapocznik J: Walk score ®: associations with purposive walking in recent Cuban immigrants. Am J Prev Med 2013; 45: 202–206.
20.
Duncan DT, Aldstadt J, Whalen J, Melly SJ, Gortmaker SL: Validation of walk score for estimating neighborhood walkability: an analysis of four US metropolitan areas. Int J Environ Res Public Health 2011; 8: 4160–4179.
21.
Towne SD Jr, Lopez ML, Li Y, Smith ML, Warren JL, Evans AE, Ory MG: Examining the role of income inequality and neighborhood walkability on obesity and physical activity among low-income hispanic adults. J Immigr Minor Health 2017, Epub ahead of print.
22.
Mazumdar S, Learnihan V, Cochrane T, Phung H, O'Connor B, Davey R: Is walk score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state. BMJ Open 2016; 6: e012548.
23.
Han M, Williams S, Mendoza M, Ye X, Zhang H, Calice-Silva V, Thijssen S, Kotanko P, Meyring-Wosten A: Quantifying physical activity levels and sleep in hemodialysis patients using a commercially available activity tracker. Blood Purif 2016; 41: 194–204.
24.
Kutner NG, Zhang R, Allman RM, Bowling CB: Correlates of ADL difficulty in a large hemodialysis cohort. Hemodial Int 2014; 18: 70–77.
25.
Tudor-Locke C, Washington TL, Hart TL: Expected values for steps/day in special populations. Prev Med 2009; 49: 3–11.
26.
Locatelli F, Marcelli D, Conte F, D’Amico M, Del Vecchio L, Limido A, Malberti F, Spotti D: Cardiovascular disease in chronic renal failure: the challenge continues. Registro Lombardo Dialisi e Trapianto. Nephrol Dial Transplant 2000; 15(suppl 5):69–80.
27.
O'Hare AM, Tawney K, Bacchetti P, Johansen KL: Decreased survival among sedentary patients undergoing dialysis: results from the dialysis morbidity and mortality study wave 2. Am J Kidney Dis 2003; 41: 447–454.
28.
Anand S, Chertow GM, Johansen KL, Grimes B, Kurella Tamura M, Dalrymple LS, Kaysen GA: Association of self-reported physical activity with laboratory markers of nutrition and inflammation: the Comprehensive Dialysis Study. J Ren Nutr 2011; 21: 429–437.
29.
Majchrzak KM, Pupim LB, Chen K, Martin CJ, Gaffney S, Greene JH, Ikizler TA: Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days. J Ren Nutr 2005; 15: 217–224.
30.
Katayama A, Miyatake N, Nishi H, Ujike K, Hashimoto H, Kurato R, Koumoto K: Relationship between changes in physical activity and changes in health-related quality of life in patients on chronic hemodialysis with 1-year follow-up. Acta Med Okayama 2016; 70: 353–361.
31.
Gomes EP, Reboredo MM, Carvalho EV, Teixeira DR, Carvalho LF, Filho GF, de Oliveira JC, Sanders-Pinheiro H, Chebli JM, de Paula RB, Pinheiro Bdo V: Physical activity in hemodialysis patients measured by triaxial accelerometer. Biomed Res Int 2015; 2015: 645645.
32.
Carvalho EV, Reboredo MM, Gomes EP, Teixeira DR, Roberti NC, Mendes JO, Oliveira JC, Sanders-Pinheiro H, Pinheiro BV: Physical activity in daily life assessed by an accelerometer in kidney transplant recipients and hemodialysis patients. Transplant Proc 2014; 46: 1713–1717.
33.
Shibata S, Tsutou A, Shiotani H: Relation between sleep quality and daily physical activity in hemodialysis outpatients. Kobe J Med Sci 2014; 59:E161–E166.
34.
Matsuzawa R, Matsunaga A, Kutsuna T, Ishii A, Abe Y, Yoneki K, Harada M, Ishibashi M, Takeuchi Y, Yoshida A, Takahira N: Association of habitual physical activity measured by an accelerometer with high-density lipoprotein cholesterol levels in maintenance hemodialysis patients. ScientificWorldJournal 2013; 2013: 780783.
35.
Avesani CM, Trolonge S, Deleaval P, Baria F, Mafra D, Faxen-Irving G, Chauveau P, Teta D, Kamimura MA, Cuppari L, Chan M, Heimburger O, Fouque D: Physical activity and energy expenditure in haemodialysis patients: an international survey. Nephrol Dial Transplant 2012; 27: 2430–2434.
36.
Shimoda T, Matsuzawa R, Yoneki K, Harada M, Watanabe T, Matsumoto M, Yoshida A, Takeuchi Y, Matsunaga A: Changes in physical activity and risk of all-cause mortality in patients on maintence hemodialysis: a retrospective cohort study. BMC Nephrol 2017; 18: 154.
37.
Cupisti A, Capitanini A, Betti G, D’Alessandro C, Barsotti G: Assessment of habitual physical activity and energy expenditure in dialysis patients and relationships to nutritional parameters. Clin Nephrol 2011; 75: 218–225.
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2018
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