Adherence to a healthy lifestyle is an important requirement for patients with chronic kidney disease, as it can prevent disease progression and mortality. However, many patients find this...Show moreAdherence to a healthy lifestyle is an important requirement for patients with chronic kidney disease, as it can prevent disease progression and mortality. However, many patients find this difficult. In addition, people living with chronic kidney disease also experience various symptoms, of which fatigue is the most common and also the most impeding when it comes to carrying out daily activities. To increase adherence to a healthy lifestyle it is necessary to investigate which factors hinder or facilitate this adherence to a healthy lifestyle. Therefore, this study examined (1) whether fatigue may be a barrier for adhering to a healthy lifestyle, defined as adhering to guidelines regarding a healthy diet and taking physical activity, and adherence to an intervention to support a healthy lifestyle. This study also examined (2) whether actively participating in a lifestyle intervention is indeed related to improving lifestyle over time, and (3) whether the relation between fatigue and a change in healthy lifestyle adherence over time is mediated by the level of intervention adherence. To answer these research questions, an observational study was conducted. This study was a sub-project of the E-GOAL study, which comprised a multicenter randomized controlled trial (RCT) among patients with chronic kidney disease (N = 121) to assess the effectiveness of lifestyle intervention. The participants who were randomly assigned to the intervention group (N = 60) received an online intervention program including tailored e-coach modules with home assignments and e-coaching of a psychologist. This study distinguished two measures of intervention adherence: objective and subjective intervention adherence. Questionnaires were used to measure fatigue (SFQ), diet adherence, physical activity adherence (SQUASH), and subjective intervention adherence, which participants had to complete at baseline (t = 0) and after the 3-month during intervention (t = 3). To measure objective intervention adherence, the psychologist's records were used to calculate the average number of modules completed per week. To test the hypotheses, hierarchical multiple regression analyses and mediation analyses with Hayes' PROCESS macro model were performed. During the analyses, adjustments were made for baseline values, age, gender, and employment situation. The analyses revealed that, contrary to expectations (1) fatigue was not related to a change in physical activity adherence over time, and (2) fatigue was positive instead of negative related to a change in diet adherence over time, (3) and this effect between fatigue and a change in diet adherence overtime was fully mediated by patients' selfreported level of intervention adherence. In conclusion, more fatigued patients reported better adherence to the intervention and were, therefore, more adherent to a healthy diet over time. A suggestion for clinical practice is therefore to incorporate interventions such as the E-GOAL intervention into the standard treatment of chronic kidney disease. Further research is needed on fatigue as a barrier and what interventions need to improve physical activity adherence as well.Show less
