The effect of social support on physical activity of hemodialysis patients : the chain mediating role of exercise self-efficacy and barriers to exercise benefits
- 1School of Nursing, Air Force Medical University, Xi’an, Shaanxi China
- 2Department of Nephrology, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi China
- 3Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi China
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).
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BibTeX
@article{huang2026effect,
title = {{The effect of social support on physical activity of hemodialysis patients : the chain mediating role of exercise self-efficacy and barriers to exercise benefits}},
author = {Mei Huang and Siran Zhao and Jie Gao and Honghong Lv and Ya Zhang and Yanqing Kang and Xinyue Xu and Aili Lv and Chunping Ni},
journal = {BMC Psychology},
year = {2026},
month = aug,
doi = {10.1186/s40359-026-05261-3},
url = {https://doi.org/10.1186/s40359-026-05261-3},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The effect of social support on physical activity of hemodialysis patients : the chain mediating role of exercise self-efficacy and barriers to exercise benefits
AU - Mei Huang
AU - Siran Zhao
AU - Jie Gao
AU - Honghong Lv
AU - Ya Zhang
AU - Yanqing Kang
AU - Xinyue Xu
AU - Aili Lv
AU - Chunping Ni
PY - 2026
DA - 2026/08/11
JO - BMC Psychology
DO - 10.1186/s40359-026-05261-3
UR - https://doi.org/10.1186/s40359-026-05261-3
AB - 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).
SN - 2050-7283
ER -