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慢性血液透析患者を対象とした身体活動量評価におけるデータ採用基準充足の特性
菱井修平、宮武
氏家伸行、西一尋、河本宏行、近藤紀一、鈴木隆司、片山裕美、橋本昭彦、洋夫

Factors Related to Meeting Data Recruitment Criteria for PhysicalActivity Measurements in Patients on Chronic Hemodialysis
Shuhei HISHII １, ２，Nobuyuki MIYATAKE １，Hiroyuki NISHI ３，Takashi KONDO ３，Akihiko KATAYAMA ４，Kazuhiro UJIKE ３，Kiichi KOUMOTO ３，Hiromi SUZUKI １，Hiroo HASHIMOTO ３
要旨【はじめに】
我が国における透析患者数は年々増加し、患者の高齢化も進んでいる。そのため、透析導入後の QOL および生存率の改善が課題である。
我々は、これまで、慢性血液透析（Chronic Hemodialysis、CHD）患者を対象として、身体活動量や座位行動が健康関連 QOL の重要な規定要因であることを報告してきた。また、健康づくりのために身体活動量を増加させることが有意義であることが広く知られている。身体活動量の評価方法として、妥当性や信頼性が証明されている３軸加速度計が用いられている。
CHD 患者は、血液透析治療を行う透析日と治療を行わない非透析日があり、活動量計の装着日数や１日あたりの装着時間が十分ではない場合が多く、習慣的な身体活動量を評価することが困難である。
【目的】
本研究では、慢性血液透析患者を対象に、３軸加速度計を用いた身体活動量測定の採用基準を満たす患者特性について検討した。
【対象】
対象は、2013 年から 2018 年に因島総合病院の透析センターに通院する慢性血液透析患者 196 名の血液透析患者のうち、採用基準を満たした 132 名（男性 77 名、女性 55 名、平均年齢 71.1 ± 10.0 歳）を解析対象とした。
【方法】
評価項目は、性別、年齢（歳）、身長（㎝）、体重（㎏）、BMI（㎏ /m2）、透析歴（年）、透析原因（糖尿病腎症 / その他）、血液透析導入年齢（歳）、血液データとして、アルブミン（g/mL）、空腹時血糖（mg/dL）、中性脂肪（mg/dL）、HDL コレステロール（mg/dL）および慢性疾患（糖尿病、高血圧症、脂質異常症、腰痛、膝痛）を身体活動量測定の初回参加時の最新の情報を個人カルテより収集した。
身体活動量は、３軸加速度計内蔵身体活動量計（Active style Pro HJA-350IT、オムロン社）を用いて評価した。採用
基準は、連続した 14 日のうち、１）１日あたり 600 分以上の装着、２）３日の透析日と日曜日を含めた４日の非透析日を合わせた７日間のデータが揃っている、とした。また、採用基準を満たした群（SG 群）と満たせなかった群（USG）に分類し、２群間における評価項目について、χ二乗検定を用いた。また、多重ロジスティック回帰分析を用いて、身体活動量評価の採用基準充足の有無に関連する因子について、性別、年齢、体格指数、透析歴、透析原因疾患を調整因子と167

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して検討した。
参加者には、紙面にてインフォームドコンセントを得ており、本研究は、因島総合病院研究倫理委員会の承認を得て実施した。
【結果および考察】
性別、脂質異常症、膝痛において、SG 群と USG 群間に有意差を認めた。ロジスティック回帰において、性別が身体活動評価の採用基準充足に関与しており、男性が女性よりも有意にオッズ比が低値を示した（オッズ比：0.39、95%CI：0.18-0.84）。本研究結果より、CHD 患者の身体活動量調査では、充足者の特性として性別が関連しており、男性への働きかけに配慮することで充足率が改善する可能性が示唆された。
【結論】
慢性血液透析患者において、身体活動量評価基準の充足には、性別が関与す可能性が示唆された。

１）Department of Hygiene, Faculty of Medicine, Kagawa University, Miki 761-0793, Japan
〒761-0793 香川県木田郡三木町池戸1750-1
香川大学医学部衛生学教室
代表著者の通信先：Shuhei Hishii、Department of Hygiene, Faculty of Medicine, Kagawa University
菱井修平、香川大学医学部衛生学
Phone：087-891-2465 Fax：087-891-2134 E-mail：duratech117@gmail.com
２）Medifit-plus Co.,Ltd, Takamatsu 760-0029, Japan
〒760-0029 香川県高松市丸亀町3-13
株式会社メディフィットプラス
３）Innoshima General Hospital, Onomichi, Hiroshima 722-2323, Japan
〒722-2323 広島県尾道市因島土生町2561
因島総合病院
４）Faculty of Social Studies, Shikokugakuin University, Zentsuuji, Kagawa 765-8505, Japan
〒765-8505 香川県善通寺市文京町3-2-1
四国学院大学社会学部
受付日：2019.12.20，採択日：2020.5.17

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Introduction

Subjects and Methods

The number and age of patients on chronic

Subjects

hemodialysis（CHD）are increasing in Japan. Therefore,

Among 196 outpatients on CHD in Innoshima Generaleffective prevention and maintenance strategies for

hospital between 2013 and 2018 , 64 subjects werepatients on CHD have become a public health challenge,

excluded due to disagreement（n= 43）, not implementedand increases in lifespan with better health-related（n = 11）, and lack of data（n = 10）, and finally 132

quality of life（QOL）are expected.

subjects（77 men, 71 . 1±10 . 0 years）were recruited foranalysis in this cross-sectional study（Figure 1）.

We previously reported that daily physicalactivity ［1 , 2］ and sedentary behavior ［3］ were important

All subjects provided written informed consent.

factors affecting health-related QOL in patients on

Ethical approval for the present study was obtained

CHD. A tri-accelerometer, which has high reliability

from the Ethics Committee at Innoshima General, has recently been used to evaluate

Hospital, Onomichi, Japan （H 2 5 . 2 . 2 7 , H 2 6 . 1 . 2 3 ,and validity［4 , 5］

physical activity, including sedentary behavior. The

H 26 . 12 . 16 , H 27 . 12 . 25 , H 28 . 12 . 9 , and H 29 . 12 . 4）.

［6 - 8］evaluation of physical activity using a tri-accelerometer
Clinical parameters and measurements

is generally performed over 7 continuous days, and［9］.

The following clinical parameters were obtained from

Therefore, this evaluation is affected by the number of

medical clinical records: sex, age（years）, height（cm）,days as well as time per day that the device is worn,

body weight（dry weight）（kg）, body mass index（kg/average physical activity per day is analyzed

which may induce biasm 2）, the duration of HD（years）, cause of HD（diabetic.

［10］

Patients on CHD have to lie in a supine position

nephropathy or others）, age at the initiation of HD

for at least 4 hours per day and 3 times per week to（years）, albumin（g/mL）, fasting blood glucose（mg/undergoing HD treatment. Physical activity is usuallydL）, triglyceride（mg/dL）, HDL-cholesterol（mg/evaluated in patients on CHD as follows: 1）days withdL）, and the presence of chronic disease（diabetes

at least 600 minutes of wearing time are consideredmellitus, hypertension, dyslipidemia, low back pain,valid, and 2）patients with at least 7 valid days（moreand knee pain）, as described previously ［3］. The

specifically, 3 HD days and 4 non-HD days
including Sunday）are included in the evaluation. However, difficulties are associated with［3］physical activity measurements in patients onCHD because HD days, non-HD days, and totaldays（7 days）need to be considered ［11］. We
previously reported that the adoption rate of a
7 -day physical activity evaluation on HD days（3 days）, non-HD days, including Sunday（4days）, and total days was low（48 . 4 %）［3］. To
accurately and effectively evaluate physicalactivity including sedentary behavior in patientson CHD, clinical characteristics need to becompared between those who do and do notmeet data recruitment criteria using a triaccelerometer.
In the present study, we investigatedclinical characteristics related to meetingdata recruitment criteria for physical activity
measurements using a tri-accelerometer inpatient on CHD.

Table
patients
onon
chronic
hemodialysis
Table 1.1. Clinical
Clinicalcharacteristics
characteristicsofof
patients
chronic
hemodialysis
Clinical parameters
55 (41.7)
Women
Age (years)
71.1 ± 10.0
100 (75.8)
Older than 65 years
Height (cm)156.2 ± 9.3
Body weight (dry weight) (kg)54.6 ± 11.9
22.3 ± 3.7
Body mass index (kg/m2)
Duration of HD (years)
5.4 ± 7.3
47 (35.6)
Diabetic nephropathy
Age at the initiation of HD （years）
66.1 ± 14.0
Blood samples
Albumin (g/mL)
3.7 ± 0.4
Fasting blood glucose (mg/dL)
134.3 ± 40.4
Triglyceride (mg/dL)
114.3 ± 73.3
HDL-cholesterol (mg/dL)
53.9 ± 16.5
Chronic Diseases
60 (45.5)
Diabetes mellitus
117 (88.6)
Hypertension
54 (40.9)
Dyslipidemia
43 (32.6)
Low back pain
20 (15.2)
Knee pain
Values are shown as the mean ± SD or n (%)
HD: hemodialysis

169健康支援第22巻2号

167-172，2020presence of chronic disease was established based on

regression analysis was used to identify factors related

medical records. Clinical parameters were collected

to meeting data recruitment criteria in the evaluation of

from the most recent medical records during the firstphysical activity using the tri-accelerometer in patients

participation of respective subjects in physical activity

on CHD. We used the group type as a dependentmeasurements using a tri-accelerometer.

variable, and sex, age, body mass index, the duration ofA tri-accelerometer（Active style Pro HJA- 350 IT,

HD, and cause of HD as independent variable that wereOMRON HEALTH CARE Co., Ltd., Kyoto, Japan）,

considered to be clinically important.

which has been widely used in assessments of physicalStatistical analyses were performed using JMP

activity with high reliability and validity ［4 , 5］, was used

13 . 0 software（SA, Cary, NC, USA）.

to objectively evaluate physical activity in the present
Resultsstudy. The adoption criteria for evaluating physicalactivity were as follows and described previously: 1）

Clinical characteristics are summarized in Table 1 .

［3］days with at least 600 minutes of wearing time wereFifty-five（41 . 7 %）patients were women and 100

considered valid, and 2）patients with at least 7 valid（75 . 8 %）were older than 65 years. Age at the initiationdays（more specifically, 3 HD days and 4 non-HD daysof HD was 66 . 1±14 . 0 years（Table 1）.

including Sunday）were included in the evaluation.

Table 2 shows a comparison of clinical parameters

Patients who satisfied adoption data recruitment criteria

between SG （n = 5 7） and USG （n = 7 5）. The

were allocated to the satisfied group（SG）, while thoseprevalence of women was significantly higher in SG

who did not were allocated to the unsatisfied groupthan in USG. The prevalence of dyslipidemia and knee

（USG）. We compared clinical parameters between thepain was also significantly higher in SG than in USG2 groups.

（Table 2）. No significant differences were observed inother clinical parameters between the 2 groups.

Statistical analysis

We used a multiple logistic regression analysis toData were expressed as means ± standard deviation

identify factors related to meeting data recruitment（SD）. Comparisons between the 2 groups werecriteria in the evaluation of physical activity using theperformed using the chi-squared test. A multiple logistic

tri-accelerometer in patients on CHD. Sex was found to

Total outpatients
n=196
Disagreement
n=43
Participant
n=153

Not implemented
n=11

Accelerometryn=142
Lack of data
n=10
Satisfied groupn=57

Unsatisfied groupn=75

Figure 1. Flowchart of patients
Figure 1. Flowchart of patients
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be associated with meeting data recruitment criteria

be generalized to patients on CHD. Furthermore, weafter adjustments for confounding factors［odds ratio:

did not conduct a stratified analysis using detailed

0 . 39（reference: women）, 95 % confidence interval: 0 . 18 -data, i.e. the time per day and days per week that the0 . 84］（Table 3）.

device was worn by subjects who did not meet the data
recruitment criteria for physical activity measurements

Discussion

using the tri-accelerometer.

In the present study, we investigated clinical

In conclusion, sex was an important factor

characteristics related to meeting data recruitment

related to meeting data recruitment criteria for

criteria for physical activity measurements using a tri-the tri-accelerometer in patients on CHD. Althoughaccelerometer in patients on CHD. Sex was identified as

we currently cannot clarify the reason for thea clinically important factor in meeting data recruitment

sex difference in the present study, it needs to be

criteria for physical activity measurements, and men

considered when evaluating physical activity using ashowed a significantly lower odds ratio than women.

tri-accelerometer in patients on CHD. Furthermore, weSeveral limitations remain in the present study.

need to strongly encourage patients to attach the tri-Subjects were older and patients in a single clinic inaccelerometer in order to accurately evaluate physical

Onomichi, Japan; therefore, the results obtained cannot

activity, including sedentary behavior, particularly

Table 2. Comparison of clinical parameters in chronic
Table 2. Comparison of clinical parameters in chronic
hemodialysis
patientsininsatisfied
satisfiedandunsatisfied
groupshemodialysis patients
andunsatisfied
groupsNumberSex
MenWomenAge (years)< 65
65 - 74≥ 75
Body mass index (kg/m2)< 25≥ 25
Duration of HD (years)<55 - 10≥ 11
Cause of HD
Diabetic nephropathy
OthersHypertension
Yes
No
Diabetes mellitus
Yes
No
Dyslipidemia
YesNo
Low back pain
Yes
NoKnee pain
Yes
No

Table
3. Odds
Oddsratios
ratiosinin
satisfiedunsatisfied
groupsTable 3.
satisfiedandandunsatisfied
groupsSatisfiedgroup
57 (43.1)

Unsatisfiedgroup
75 (56.8)

26 (45.6)
31 (54.4)

51 (68.0)
24 (32.0)

0.010

11 (19.3)
18 (31.6)
28 (49.1)

21 (28.0)
23 (30.7)
31 (41.3)

0.482

44 (77.2)
13 (22.8)

59 (78.7)
16 (21.3)

0.840

36 (63.2)
7 (12.3)
14 (24.6)

56 (74.7)
9 (12.0)
10 (13.3)

0.239

20 (35.1)
37 (64.9)

27 (36.0)
48 (64.0)

0.914

52 (91.2)
5 (8.8)65 (86.7)
10 (13.3)

0.413

25 (43.9)
32 (56.1)

35 (46.7)
40 (53.3)

0.748

33 (57.9)
24 (42.1)

21 (28.0)
54 (72.0)0.001

19 (33.3)
38 (66.7)

24 (32.0)
51 (68.0)

0.871

13 (22.8)
44 (77.2)

7 (9.3)68 (90.7)

0.033

Values are shown as n (%)
Bold values indicate a significant difference (p < 0.05)
HD: hemodialysis

p value

171

Sex
MenWomenAge (years)< 65
65 - 74≥ 75
Body mass index (kg/m2)
< 25
≥ 25
Duration of HD (years)<55 - 10
≥11
Cause of HD
Diabetic nephropathy
Others

OR95% CIp value

0.39
1.00

0.18 - 0.84

0.015

2.02
1.43
1.00

0.79 - 5.13
0.61 - 3.34

0.140
0.414

0.95
1.00

0.38 - 2.35

0.912

2.11
1.39
1.00

0.79 - 5.64
0.36 - 5.33

0.135
0.629

0.89
1.00

0.41 - 1.92

0.761

OR: odds ratio.
Odds ratios were adjusted for all other variables shown in the table.
95% CI: 95% confidence interval
Bold values indicate a significant difference (p < 0.05)
HD: hemodialysis

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among male patients on CHD. Further studies are

determined sedentary behavior and physical activity

needed to accurately and effectively evaluate physicalin community-dwelling older adults. Res Exer

activity using a tri-accelerometer in patients on CHD.

Epidemiol, 2018 ; 20 : 5 - 15（in Japanese）.
９）M atthews CE, Ockene IS, Freedson PS, Rosal MC,Acknowledgments and conflicts of interest

Merriam PA, Hebert JR.: Moderate to vigorous

This research was supported in part by a researchphysical activity and risk of upper-respiratory tract

grant from the Ministry of Education, Culture, Sports,

infection. Med Sci Sports Exerc, 2002 ; 34 : 1242 -Science and Technology, Japan（JSPS KAKENHI grant

1248 .

no. 17 K 01851，20 K 11557）.

10）I noue S, Ohya Y, Odagiri Y, et al.: Characteristics

The authors have no conflicts of interest to report.

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