Rehabilitation Exercise Behaviors in Patients Undergoing Peritoneal Dialysis: A Mixed-Methods Study on Multidimensional Determinants

Objectives To identify factors influencing rehabilitation exercise behaviors in patients undergoing peritoneal dialysis (PD), analyze correlations between exercise intention and physical function, and explore unmet needs via qualitative interviews to inform evidence-based PD exercise rehabilitation management. Design Cross-sectional survey and qualitative study. Setting A tertiary comprehensive hospital in China. Participants Cross-sectional survey: 144 patients on maintenance PD (N=144) were consecutively recruited between 2024 and 2025. The cohort had a mean age of 57.2±12.4 years (54.9% men), with chronic glomerulonephritis (71.5%) as the primary renal disease. Qualitative study: 16 patients undergoing PD (N=16) were selected via purposive maximum variation sampling from this cohort, with sampling stratified to ensure heterogeneity in age, disease severity, and education level. Interventions Not applicable. Main Outcome Measures For the cross-sectional survey, baseline demographic and clinical data were collected; Spearman correlation was used to analyze the association between Exercise Benefits/Barriers Scale scores and physical function indicators. For the qualitative study, semistructured interviews on home exercise barriers and support needs were performed, with data analyzed using the conventional content analysis approach. Results Exercise Benefits/Barriers Scale scores showed significant positive correlations with bilateral handgrip strength and skeletal muscle mass. In contrast, a negative correlation was observed with timed Up and Go test, indicating that higher exercise intention predicts better muscle function and mobility. Qualitative analysis identified 6 core barriers: cognitive misconceptions on exercise safety, fear of exercise-induced complications, limited tailored rehabilitation information, demand for sustained professional guidance, insufficient family understanding, and inadequate specialized rehabilitation services. Conclusions Exercise intention is positively correlated with muscle function in patients undergoing PD, but exercise adherence remains suboptimal because of interlinked cognitive, socially reinforced bodily fragility, safety-related, and systemic barriers. Multidimensional targeted strategies addressing these barriers are critical to improve exercise adherence and patients' quality of life.