The effect of social support on physical activity of hemodialysis patients : the chain mediating role of exercise self-efficacy and barriers to exercise benefits

Abstract

Abstract Background Maintenance hemodialysis patients exhibit low physical activity, which is associated with sarcopenia, increased risk of cardiovascular events, and elevated all-cause mortality. Social support is an important resource for promoting healthy behaviors. But the mechanisms of influencing these patients’ intrinsic psychological processes to raise physical activity levels are unclear. Methods This study was a cross-sectional observational study from September 2021 to February 2022, enrolling 460 hemodialysis patients from four tertiary hospitals in Xi’an City. We assessed social support, exercise self-efficacy, and exercise benefits and barriers perceptions with the Social Support Rating Scale (SSRS), the Self-Efficacy for Exercise Scale (SEE), and the Dialysis Patient-perceived Exercise Benefits and Barriers Scale (DPEBBS) respectively. Daily total step count was measured using an Omron electronic pedometer (model HJ-321) worn continuously for seven days. Descriptive statistics, Pearson correlation analysis, and chain mediation analysis using the PROCESS macro developed by Hayes (Model 6) were performed; the significance of mediation effects was tested via bootstrapping. Results Pearson correlation analysis revealed significant positive correlations among social support, exercise self-efficacy, perceived exercise benefits and barriers, and total daily steps ( r = 0.289–0.507; all P < 0.01). Chain mediation model analysis indicated social support’s total effect on daily steps was 0.289. Specific mediation pathways included: (1) social support → exercise self-efficacy → total daily steps; (2) social support → perceived barriers to exercise benefits → total daily steps; (3) social support → exercise self-efficacy → perceived barriers to exercise benefits → total daily steps. Significant positive correlations were observed among social support, exercise self-efficacy, perceived exercise benefits and barriers, and total daily steps (all P < 0.01). Chain mediation analysis revealed that social support’s total effect on daily steps was 0.289 (95% CI: 0.201–0.377). Three significant mediation pathways were identified: social support → exercise self-efficacy → daily steps; social support → perceived barriers to exercise benefits → daily steps; and the chain mediation pathway social support → exercise self-efficacy → perceived barriers to exercise benefits → daily steps. Conclusion Social support not only directly and positively influences physical activity levels among patients undergoing hemodialysis but also indirectly promotes physical activity by enhancing exercise self-efficacy and improving perceptions of barriers to exercise benefits. A chain mediation pathway "social support → exercise self-efficacy → perception of barriers to exercise benefits → physical activity "was identified. Trial registration The study protocol was approved by the Ethics Committee of Xi’an Jiaotong University (approval number: 20211575).