The Effect of Self-Efficacy Perception Enhancing Program toward Square Stepping Exercise among Patients with Chronic Kidney Disease Stage 1-2
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Abstract
This quasi-experimental study aimed to examine the effects of an exercise self-efficacy enhancement program using a square stepping exercise approach among patients with early-stage chronic kidney disease (CKD stages 1–2). A two-group pretest–posttest design was employed. Fifty-three patients with CKD stages 1–2 were recruited through purposive sampling and assigned to either an experimental group (n = 26) or a comparison group (n = 27). Data were collected between September 2024 and April 2025. The intervention program was developed based on Bandura’s self-efficacy theory and included mastery experiences, role modeling through actual and symbolic models, verbal persuasion, motivational support, group learning activities, and outcome feedback to encourage continuous engagement in a square stepping exercise regimen over a 12-week period. Data were collected using the Exercise Self-Efficacy Questionnaire and the Exercise Behavior Questionnaire. Content validity indices of the instruments were .89 and 1.00, respectively, while Cronbach’s alpha coefficients were .94 and .93, respectively. Descriptive statistics and t-tests were used for data analysis.
The findings revealed that, following the intervention, participants in the experimental group demonstrated significantly higher mean scores for exercise self-efficacy and exercise behavior compared with their baseline scores (p<.05). Furthermore, the experimental group showed significantly higher exercise behavior scores than the comparison group after the intervention (p<.05). However, no statistically significant difference in exercise self-efficacy was observed between the two groups at posttest.
These findings suggest that the program was effective in enhancing exercise self-efficacy and promoting exercise behavior among patients with early-stage chronic kidney disease. The program may therefore be adopted by nurses and healthcare professionals as a practical strategy to encourage regular physical activity among individuals at risk of chronic kidney disease and those in the early stages of the disease.
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References
American College of Sports Medicine. (2018). ACSM’s Guidelines for exercise testing and prescription. 10thed. Philadelphia: Wolters Kluwer.
Arooj, H., Aman, M., Hashmi, M.U., Nasir, Z., Zahid, M., Abbas, J., Amjad, N., Maryam, S. & Farhan, K. (2025). The impact of nurse-led care in chronic kidney disease management: a systematic review and meta-analysis. BioMed Central Nursing, 24(188), 1-24.
Baker, L. A., March, D. S., Wilkinson, T. J., Billany, R. E., Bishop, N. C., Castle, E. M. & et al. (2022). Clinical practice guideline exercise and lifestyle in chronic kidney disease. BioMed Central Nephrology, 23(75), 1-36.
Cha, H. J., Kim, K. B. & Baek, S. Y. (2022). Square-stepping exercise program effects on fall-related fitness and BDNF levels in older adults in Korea: A randomized controlled trial. International Journal of Environmental Research and Public Health, 19 (7033), 1-14.
Chopsiang, L. (2018). Exercise for delaying progression in chronic kidney disease. Nursing, Health and Education Journal, 19(3), 25-35. (in Thai).
Chouwai, S., Suebsoontorn, W., Ruanphet, K. & Nimit-arnun, N. (2024). The effect of self- efficacy perception enhancing program towards square stepping exercise on exercise behaviors with pre-diabetes mellitus. Christian University Journal, 30(1), 123-136. (in Thai).
Defossez, K., Naetpakdee, N., Wongken, I. & Pangmueangcook, N. (2023). The development of a motivation model for modifying exercise behavior for delaying deterioration in chronic kidney disease stage 3 patients. Journal of environmental and community health, 8(2), 260-268. (in Thai).
Gill, D. P., Gregory, M. A., Zou, G., Liu-Ambrose, T., Shigematsu, R. & Hachinski, V. (2015). The healthy mind, Healthy mobility trial: A novel exercise program for older adults. Medicine & Science in Sports & Exercise, 48(2), 297-306.
Giannouli, E. Morat, T. & Zijlstra, W. (2020). A novel square-stepping exercise program for older adults (Steplt): rationale and implications for falls prevention. Frontiers in Medicine, 6(318), 1-10.
Hayden, J. (2009). Introduction to health behavior theory. United States of America: Jones and Bartlett Publishers.
Junque-Jimenez, A., Morera-Mas, A., Perez-Ventana-Ortiz, C., Andreu-Periz, L. & Segura-Orti, E. (2022). Home-based exercise programs in patients with chronic kidney disease: A systematic review and META-analysis. Worldviews on Evidence-Based Nursing, 19(4), 322-337.
Kidney Disease-Improving Global Outcomes (KDIGO). (2021). Clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney International, 99(3), 1-92.
Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements,12(1), 7–11.
Lopez-Vargas, P. A., Tong, A., Howell, M. & Craig, J. C. (2016). Educational interventions for patients with CKD: A systematic review. American Journal of Kidney Diseases, 68(3), 353-370.
Ma, Q., Gao, Y., Lu, J., Liu, X., Wang, R., Shi, Y. & et al. (2022). The effect of regular aerobic exercise on renal function in patients with CKD: A systematic review and meta- analysis. Frontiers in Physiology, 13(901164), 1-13.
Nimit-arnun, N., Chouwai, S. & Suebsoontorn, W. (2021). Square-stepping exercise for fall prevention in community-dwelling elderly persons: A literature analysis. Royal Thai Navy Medical Journal, 48(1), 23-36. (in Thai).
Sakorn, P. & Nunthaitaweekul, P. (2020). The effect of self-efficacy promoting and resistance training program on functional status in end stage renal disease (ESRD) patients receiving hemodialysis. Journal of Health and Nursing Research, 37(1), 168-179. (in Thai).
Sarinukul, C., Janyacharoen, T., Donpunha, W., Nakmareong, S., Ruksapukdee, W. & Sawanyawisuth, K. (2023). Pressure, physical performance, and quality of life in female older adults with stage1 hypertension: a randomized controlled trial. Canadian Geriatrics Journal, 26(1), 144-149.
Sermsinsiri, K., Semsri, S. & Nonakaravathin, S. (2019). The effect of square-stepping exercise on balance of elderly adults at risk of falls. Journal of The Royal Thai Army Nurses, 20(1), 359-370. (in Thai).
Shigematsu, R., Okura, T., Nakagaichi, M., Tanaka, K., Sakai, T., Kitazumi, S. et al. (2008). Square- stepping exercise and fall risk factors in older adults: A single-blind, randomized controlled trial. Journal of Gerontology and Geriatrics: Series A, 63(1), 76–82.
Siqueira,V. A. A. A., Shigematsu, R. & Sebastiao, E. (2024). Stepping towards health: a scoping review of square-stepping exercise protocols and outcomes in older adults. BMC Geriatrics, 24(590), 1-14.
The Nephrology Society of Thailand, Subcommittee for Chronic Kidney Disease Prevention . (2022). Clinical practice recommendation for the evaluation and management of chronic kidney disease in adults 2022 (Revised edition). Bangkok: Srimuang Printing Co., Ltd.
Vijitsoonthornkul, K. (Editor). (2022). Epidemiology and review of preventive measures for chronic kidney disease. Department of Disease Control, Ministry of Public Health. Retrieved (2024, August 22). from
https://ddc.moph.go.th/uploads/publish/1308820220905025852.pdf.
