EXERCISE

[swramsay]

One of my questions as well! Thanks for asking. I am trying to get back to the gym after 4 -5 months off (7 surgeries with recovery, dialysis etc) Exercise has been part of my life for all my life....running for 35 years and then other cardio with light weights the last few years. I have missed it a lot but have not felt good enough to go. Plus I am concerned about my high potassium/phosphorus and my heart. I went yesterday to the gym. I am so out of shape but very happy to be there. I felt faint during the cardio so kept it easy. I am looking forward to home hemo because I know I will feel better and stronger.

I wonder if excercising before dialysis may be beneficial so that any lactic acid buildup from exercis can be removed. Just a thought. I know when I exercised before scans of appts where my creatinine was being checked, I had elevated creatinine (I assumed due to exercise). Right now I am going when I feel good enough to go. I love being back to the gym - mentally especially right now.

[jbeany]

swramsay - there's another thread on here somewhere about how beneficial exercise is supposed to be while you are actually hooked to the machine.  Hmmm - I can't remember where, maybe in the news articles?  I remember something about the patients using bike pedals while they sat in their chairs.  From personal experience, I think exercise at any time helps with fluid removal.  The more you sweat off, the easier the time in the chair is.

[swramsay]

Thank you. I'll look for it. I have read about some dialysis centers offering bikes while people are dialyzing. I personally think it's a great idea.

[RichardMEL]

Well much respect and kudos to those of you spending time at the gym with trainers doing workouts and all that. I have upped my general exercise a bit in the past month or so. Every week I usually do:

Monday-Friday: I walk around 20 minutes - half way to work
Sunday: I walk around 7km's round trip (around 4-5 miles) around my area (through parks etc). it is very relaxing but I find walking a REALLY good way to keep the exercise up. It's free and easy to do but I am certain it is good for the heart and legs etc... and heck I even sweat out a bit so a bit of a bonus fluid wise.

I may not be doing the gym work but I do feel like I am keeping active and doing something positive for my health.

[monrein]

Regular walking is an excellent form of exercise.  Keep it up RM, we need you around for a long long time.   

[Zach]

Monday-Friday: I walk around 20 minutes - half way to work
Sunday: I walk around 7km's round trip (around 4-5 miles) around my area (through parks etc). it is very relaxing but I find walking a REALLY good way to keep the exercise up. It's free and easy to do but I am certain it is good for the heart and legs etc... and heck I even sweat out a bit so a bit of a bonus fluid wise.

Walking is great exercise.  And doing it six times a week is very important.  Not only does it help the heart and legs, some studies show that it even helps the brain.

[Lucinda]

The closest thing I have been to the gym since my husband's family arrived is to buy new gym gear at the sales.  I am going back today.  I really miss it and it is my sanity break from all the bedlam.  My time and the only time I have my phone turned off is the hour I spend there.  That said, I have still walked most days over Christmas and the Wii is great Graeme.  I have the Wii fit board but I still haven't used it because I bought it just before Christmas but I have done the bowling and tennis etc and it gives you a great workout.  I noticed my blood pressure has gone up again since I haven't been going to the gym every day so I am back on higher doses of medication but hoping I will be able to drop down again when I am back into the real swing of things.  The worst thing about not going to the gym is that I have been sleeping really, really badly and then I get up feeling like crap and not wanting to go to the gym.  Not good to break the routine for body, mind or brain!

[RichardMEL]

Zach - ha! I'd have to walk from here to China to have any affect on my brain. It's long gone.

My "other brain" however is well and truly fit... to wit...

Lucinda.. stuff the gym... just what manner of body hugging gym gear did you get exactly??? 

Actually, I totally get the point that if you get out of the swing of doing any sort of exercise it's much harder to get back in. If I *don't* walk for a bit it is much easier to think oh yeah I'd much rather lie in bed with the cat or whatever than get up and moving.. but once I'm out there walking it feels good and I know I'm doing something positive...

hmm so only 5,000 miles to China. Well, best try with around 5 today.....

[kitkatz]

I worked out with the trainer in the pool today then swam ten laps in the pool afterwards. I change trainers Tuesday next week.  From lady to a man. We shall see how it goes. Stacy was very patient with me.   I am not the most coordinated person in the world. 

[kitkatz]

I am off to lunch and then to the gym to exercise.  Maybe bike, elliptical and pool work.

[dkerr]

My question is about the fistula with exercise.  I'm told I'm not supposed to carry anything heavier than 5 lbs. on my fistula arm.  What about upper body weights?  Does that mean I can't lift anything heavier than 5 lbs.?

[okarol]

I came across this article from 2003 - good info, I did not call all the numbers to see if they still work. Web links still seem ok:

As a Dialysis Patient, How Can I Get in Better Shape?

By Maria Karalis, RD, LD, CSR

Like most Americans, you probably made several new year's resolutions such as to eat better, lose weight or start an exercise program. How are you doing?

Studies have shown that no matter how old you are exercise can make you stronger and give you more energy. People on dialysis that exercise do more, feel better and have a greater sense of control over their lives. There are numerous other benefits too.

Exercise:

    * Helps to maintain or decrease your body weight
    * Increases strength, endurance and flexibility
    * Keeps your heart healthy
    * Improves your sense of well-being
    * Lifts your mood and helps fight depression
    * Helps control blood pressure (you may even be able to cut down on blood pressure medication)
    * Lowers blood sugar (if you are diabetic)
    * Reduces your risk of having a heart attack
    * Helps you sleep better
    * Keeps your bones healthy

Recent studies have shown that senior citizens who exercise can be in better shape than a couch potato in their twenties. How old you are does not determine how fit you are. What counts is what you are doing to improve your fitness level. So how do you "just do it?"

Consult your doctor and start out slowly.

First, talk to your doctor to see what types of exercises are best for you. Questions to ask are "what exercises are best to improve my strength and endurance?" or "what exercises are best to improve my heart health?" When you start, start slowly. Don't try to do too much too fast. If you have mobility problems, your doctor may refer you to a physical therapist. Physical therapists can help you with stretching and strengthening exercises. In addition, a registered dietitian can help you plan a healthy diet. No matter what your physical condition, your healthcare team can help design a fitness program to work for you.

If you are on dialysis, ask if specially designed exercise bikes are available so that you can exercise while you are dialyzing. If your dialysis center doesn't have a specialized exercise bike, contact Champion Manufacturing LLC at 800-998-5018 or visit their website at www.championchair.com. They have a bike called "Champ-Cycle" that you can secure to any chair, including your dialysis chair. (Or use it in front of your favorite couch or recliner.) The newest way for dialysis patients to exercise is the Stider excercise combination cycle/stepper made by Osborn Medical in Minnesota. While you are sitting, you can walk or stride at your own pace. Even if you have a limited range of motion, this machine works great. The Strider can be adjusted for each leg for maximal comfort and flexibility. To obtain more information about the Strider call 1-800-535-5865 or check their website at www.osbornmedical.com.

Make it fun.

Choose something that is easy and that you will enjoy. Most people quit exercising because they are bored. If you are a very social person, consider recruiting a buddy to exercise with you. Or find an exercise group in your neighborhood. You may want to start a mall walking group or some other activity. Build variety in your exercise plan. Change the activities and where you engage in these activities. If you'd rather exercise on your own, try walking, yoga or tai chi. You don't have to run a marathon to improve your health. Simply folding the laundry or doing a few stretching exercises or arm lifts counts.

Keep at it and add some variety.

Get moving and stick with it! No matter how small you start out (even if it's only waving your arms or swinging your legs for a few minutes, resting and doing it again), whatever you are doing is more than you were doing before and that is great! Be sure to set some small goals for yourself and celebrate your successes!

Make it a lifetime.

Seeing you get fit will help inspire others to follow in your footsteps. A journey of a thousand miles starts with just one step. Remember it's the long run that counts. You don't have to race to the finish line first, you just have to show up to the starting line and do the best you can.

Work closely with a registered dietitian.

If your goal is to lose some weight, work closely with the registered dietitian at the dialysis center. It is well known that extra weight worsens diabetic control, blood pressure and is a major risk factor for heart disease. The formula for weight control seems easy but actually trying to cut back on calories and including exercise in a busy lifestyle can be a real challenge. The dietitian can give you some general guidelines on where to cut back without compromising the overall quality of your diet. Here are some general tips to get you started:

    * Think "healthy" eating instead of "dieting." Dieting is an on again-off again thing; healthy eating is a life- long process.
    * Make sure to select a wide variety of foods from each food group depending on your calorie needs.
    * Eat the suggested serving size. Weigh or measure what you eat until you can estimate a serving.
    * Choose high fiber foods; this helps to create a feeling of fullness.
    * Eat three meals per day; don't skip any meals. Skipping meals leaves you famished and then you tend to overeat.
    * Be sure to eat all your allowed fruits and vegetables every day.
    * Choose lean cuts of meat, poultry and fish. Trim away any visible fats; broil, roast or boil, instead of frying. Remove skin from poultry.
    * Be aware of your eating habits. Keep a food diary and jot down what you are eating and drinking for several days. Include what you are doing, where and how you were feeling. Do you see any patterns?
    * Limit foods that are high in fat, such as butter, mayonnaise, oils (even olive oil), desserts/pastries, and fried foods. These are often not limited on a renal diet because they tend to be low in sodium, potassium and phosphorus. But these foods are high in calories and if eaten in excess can lead to weight gain. Your dietitian can give you a list of high fat foods and help you identify ways to cut back.
    * Limit sugars and concentrated sweets. Like fats, these are "empty" calories that provide very little nutritional value but can add a lot of calories. For those of you on peritoneal dialysis, you are already receiving extra calories from the dextrose in the dialysate. Watching simple sugars in your diet becomes even more important to help manage your weight.

There are many excellent resources out there to help you get started. Here are just a few:

An Exercise Program for the Person with Chronic Renal Disease -- Published by the NKF of Eastern Missouri & Metro East, Inc. Call 314-961-2828 or write to: the National Kidney Foundation of Eastern Missouri and Metro East 1423 Hanley Industrial Court St. Louis, MO 63144.

Exercise: A Guide for People on Dialysis - Booklet, Life Options Rehabilitation Program. To request a free copy, call 1-800-468-7777.

Exercise Lite Brochure -- Booklet, American College of Sports Medicine. For a free copy, send a self-addressed business sized envelope to: American College of Sports Medicine, Public Information Department, PO Box 1440, Indianapolis, IN 46206-1440. Call 317-637-9200 for more information.

Staying Fit with Kidney Disease- Brochure, National Kidney Foundation. To request a free copy, call 1-800-622-9010.

Maria Karalis is a Registered Dietitian and Staff Developer in Staff Development with Fresenius Medical Care. She is a Board Certified Specialist in Renal Nutrition (CSR) and has been working in the renal industry for over 11 years.

The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.

This article originally appeared in the January 2003 issue of aakpRENALIFE, Vol. 18, No. 4.

[swramsay]

Thanks for the article. I called one of the numbers. They are on eastern time so I will call again tomorrow to receive some info.

I just started back at the gym after at least 4 months off (7 surgeries put a damper on things  ) It feels very good to begin again   . I don't expect to be in the shape I was in when I stopped but I am concerned a little by how I feel. I'm not pushing it - just enough to break a sweat and feel as though I'm on the right track. However, I get really lightheaded. When I was done today,  I squatted down to put my things in my bag. When I stood up, I almost blacked out. The other day while on the elliptical, I got very light-headed and felt strange. I wondered for a moment if I was going to faint.  Had to stop for a minute. I'm not used to this at all and have no idea how important any of it is. I have exercised all my life and have never been unsure about it. I know my potassium is high (over 6) and that worries me a bit. Yesterday at dialysis I was questioning the nurse about my potassium and he noticed I was getting a high potassium (3K) 'bath?' and had it lowered to a 1K. They have known about my high potassium for weeks. I wish I knew all I needed to know by now. I would have caught that myself.

I still have yet to meet with my nephrologist and have been trying to meet with her since the end of November. I've had a few (growing) pages of questions, concerns and information to talk to her about. I am looking for a different doc and have 2 meetings set up with 2 new docs. I'll will most likely have met with and found a new doc before being able to meet with the one I have now (hopefully)!

take good care everyone,
Wendy

[kitkatz]

I swam 36 laps today which is the equivalent of half of a mile!    I ran some of them in the water and swam some of them.

The guy trainer sat me down and interviewed me today. Like he could not have gotten the info from my other trainer and worked out today with me! Sigh!
Oh well start with him on Thursday!

[st789]

 

Walking is a simple exercise to stay fit.  Keep it up everyone.

[Lucinda]

I started back at the gym three months ago and my goal was to lose centimetres rather than base it on weight.  So close to dialysis my weight fluctuates greatly with fluid retention so I told my trainer that I wanted to work on centimetres rather than scales.  I've lost 47 centimetres so far.  My thighs and upper arms are being a bit stubborn but I lost 20 off my hips so I am happy about that.  Scales are good for some things but when it comes down to weight loss, measurements are probably a little more accurate. 
 

[Tinah1968]

I must agree, if we think about the pounds that we lose it may be discouraging becasue we think we are working hard and we did not drop any weight, But that doesn't mean that you are not getting fit.. I am sure you have all seen/heard of the Biggest loser on NBC. I became a fan of the show and then I realized that as I sit an watch it hummm If they can do it I can do it. So I bought the Biggest loser work out and have been doing it now for 3 weeks lost a total of 4 inches around my waist. But, I also changed my Eating habits, No more fried foods and I have a Vegetable with Lunch and dinner no Exceptions.  I have a fistula so I can't do the weights but I do everything else.... And I love it, It took me a long time to quit thinking about it and do something.

[kitkatz]

It happens with me right now. Dialysis scales says pounds are still there, clothing says differently.   The gym lost the last two measurements of me they took. Darn it!

[monrein]

I must agree, if we think about the pounds that we lose it may be discouraging becasue we think we are working hard and we did not drop any weight, But that doesn't mean that you are not getting fit.. I am sure you have all seen/heard of the Biggest loser on NBC. I became a fan of the show and then I realized that as I sit an watch it hummm If they can do it I can do it. So I bought the Biggest loser work out and have been doing it now for 3 weeks lost a total of 4 inches around my waist. But, I also changed my Eating habits, No more fried foods and I have a Vegetable with Lunch and dinner no Exceptions.  I have a fistula so I can't do the weights but I do everything else.... And I love it, It took me a long time to quit thinking about it and do something.

Good for you Tina.  Keep it up, this is one of the best and most important things you can do for yourself.  Feeling fit beats food cravings any day.   

[swramsay]

Is it true we can't use weights with a fistula? I do some light weights for biceps and also for triceps. It doesn't look like my fistula is being affected in any way but then again, I haven't started using it yet.

What have others been told?

[Tinah1968]

I think you can do 2 pound weights but, Of course that is just something i read. It is supposed to make yuor veins stronger if you do. But the Dr. "advised" me not to do anything that would put to much weight on my arm becasue when they did my Fistula they had problems and instead of 1 Incision I have 7 up and down my arm.

[Zach]

Sounds really great everyone!

And remember, muscle weighs more than fat.

[monrein]

Is it true we can't use weights with a fistula? I do some light weights for biceps and also for triceps. It doesn't look like my fistula is being affected in any way but then again, I haven't started using it yet.

What have others been told?

I do 10 or 12 pound free weights and I also do heavier on some cybex machines.  All my doctors know what I do and tell me to keep going.  It could very well depend on the individual fistula and if there are any issues, like in Tina's case, I'd listen to my doctor.  How about some of the tensor exercises done with heavy elastic tubes that have gripping handles.  I use those when I travel.

[Tinah1968]

I found this Article on exercising your fistula.. Hope it helps
Exercising your Fistula
“Take Five”
Patient Instruction Sheet


 

A Fistula is a connection of an artery and vein.





About 10 - 14 days after surgery it is very important to start exercising your fistula arm.  By exercising your fistula arm, you increase the blood supply to the fistula.  This causes the vein in the fistula to enlarge.  This helps to get the fistula large enough to insert dialysis needles.  Taking 5 minutes and completing this exercise at least 5 times per day is very important!  (Do it when you wake up, at meals, and at bedtime.)

It will save you from lots of problems when your access is used.


TAKE CHARGE AND TAKE “FIVE”



1.   Squeeze arm using opposite hand, approximately 6 inches above suture line.

2.   Check for a thrill or pulse.  Do this by placing two fingers on your fistula.

3.   Open and close your fist or squeeze a ball or sock while squeezing your arm.

4.   Do this for 5 minutes, at least 5 times per day.

5.   If you are in doubt about this exercise, ask your Dialysis Team to show you.

6.   If your fistula is being used for dialysis, do not exercise it for 24 hours after dialysis.

7.   Your Dialysis Team will tell you when you no longer need to exercise your fistula

[monrein]

I just want to make sure we're talking about the same things here.

A new fistula can benefit from exercises to help it develop and mature so it is ready to be used.  These are specific exercises  like the ones Tina described above.  (Some doctors feel that these are unnecessary and don't do much that the fistula won't do by itself while others swear by them and insist on patients doing them.  I have personally had both of these types of doctors.) 

If you have a developed, functioning fistula you must be careful about lifting things that are too heavy or doing weight lifting exercises that could harm the fistula.  You should consult with your doctor about your exercise routine and lifting free weights or using weight lifting machines.