Exercise Program Tips for Dialysis PatientsRenal Support Network
www.rsnhope.orgBy Jamie Shish, RD, LDN, ATC/L
Studies show that traditional risk factors for heart disease--such as high blood pressure (BP), high blood glucose, and decreased physical activity--are more strongly associated with a mortality risk from cardiovascular disease in people with chronic kidney disease (CKD), particularly older people. These results are from the Cardiovascular Health Study, which is funded by the National Heart, Lung, and Blood Institute.
Although you see your physician regularly to control your blood sugar and your BP, what are you doing to increase your physical activity? It is equally as important--and maybe even easier to control--than BP and blood sugar. You can be more physically active, and it may just save your life.
Common Misunderstandings
Let us start with some common misunderstandings about exercise, such as "no pain, no gain." Pain is there for a reason: it is our body's way of telling us something important. If you ever feel pain during exercise, stop what you are doing and consult your physician.
The thought that exercise can be dangerous is another common misunderstanding� if it�s done correctly. Actually, people who never exercise are more likely to be injured than those who do regularly exercise. Those "weekend warriors" who head out for a long bike ride on a beautiful spring day after being a couch potato all winter are much more likely to be injured during exercise than someone who has been biking regularly.
Although there are probably many more misunderstandings and myths, the last one to review here is that people with high BP should not do resistance or weight training. Resistance training can be a wonderful exercise for anyone as long as the exercise is done by using the appropriate weight, breathing techniques, and form. For instance, never hold your breath when performing any type of exercise.
It may be worth consulting a personal trainer to set up an exercise regimen that is specific for you, and to instruct you on proper technique before starting a new program. It is important for everyone to consult their primary healthcare provider before starting any exercise regimen and to be specific and honest by telling him/her exactly what type of regimen you plan to start.
"A Priority in Our Lives"
Physical activity should be a priority in our lives, and it is recommended that all adults get at least 30 minutes or more of moderate-intensity physical activity daily. Take a look at your daily schedule and responsibilities and find the best time of day to fit in exercise on a regular basis. You will benefit from adding exercise at any time of the day, but for consistency you may want to make it the same time daily. Think about when you have the most energy or when you typically are sedentary, then make that your time for exercise.
For most, physical activity should be started slowly and increased gradually, with the goal of 30 minutes daily. For example, you may want to begin a walking program three days per week for 10-15 minutes, and then increase to 30 minutes of brisk walking daily by week 8-12 of the program.
"Examples of Moderate Activity"
Some examples of moderate activity are the following:
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Gardening for 30-45 minutes;
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Pushing a stroller 1.5 miles in 30 minutes;
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Raking leaves for 30 minutes;
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Climbing stairs for 15 minutes;
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Walking 1.75 miles in 35 minutes;
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Bicycling 5 miles in 30 minutes; and
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Water aerobics for 30 minutes, or swimming laps for 20 minutes.
These are just a few ways you can choose to get in your 30 minutes of moderate-intensity activity each day, and all are approximately equal to burning 150 calories. When you reach your goal of 30 minutes of moderate physical activity daily, you will be burning an extra 1,050 calories per week! This is the equivalent of losing one pound in a little over three weeks just by adding a moderate exercise regimen.
It is recommended that you refrain from lifting heavy objects with the arm in which your permanent hemodialysis (HD) vascular access has been placed. If you are using a catheter for HD you should not participate in swimming activities because the catheter must not get wet.
Seek Professional Assistance
As a beginner to exercise or as a senior citizen with or without kidney disease, seeking professional assistance is strongly recommended. Start with a �history and physical� from your physician, then seek the assistance of a professional personal trainer with experience in training senior citizens or persons with chronic health conditions. Most cities have a local gym or YMCA where you can start looking for a qualified personal trainer. This professional will use the history and physical charts provided by your doctor, along with your personal goals, to design the best exercise routine for you.
You will also be shown proper form, technique, and intensity so that you are not injured during exercise. If hiring a personal trainer is not an option for you, there are other beginner exercises that you may start on your own. Walking on a treadmill or at a local indoor shopping mall three to five times per week for 20-60 minutes would be an effective exercise. Start this program slowly at a comfortable pace, then increase your pace and distance gradually by five minutes every week until your goal distance or time is achieved.
Exercise Bike
Many dialysis clinics offer a team rehabilitation program where patients ride special stationary exercise bikes during their dialysis treatments. Your nephrologist will clear you for exercise, and then you will be trained to use these very "user-friendly" exercise bikes. Again, the exercise program should start slowly at an easy pace, increasing the time and resistance gradually until you reach a goal of 30 minutes. Many patients think this is a very good way to use their time on dialysis.
One of these individuals is John Cossarek, a hemodialysis patient at the author's dialysis unit in Skokie, IL. In his early years, he was an active young man. Now he uses a wheelchair or walker and finds the stationary bicycle a great way to stay active.
"I try to ride the bike three times a week for 30 to 40 minutes each time," John remarked. "It is a good way to get my legs moving and pass the time at dialysis."
Riding a stationary bike while on the dialysis machine really is a wonderful opportunity for patients to fit exercise into a schedule that has become a little busier since they began their hemodialysis treatments. Ask your clinic manager, social worker, or nurse today whether they offer a team rehabilitation program!
Lose the Extra Weight!
If you are overweight, an initial weight-loss goal of only 10% of your current body weight can reduce disease risk factors. The weight should be lost at a rate of 1-2 pounds per week using a healthy diet and exercise regimen. A 10% weight loss reduction in a 200-pound individual would be 20 pounds and would take approximately 10-20 weeks to accomplish at the recommended rate.
Be sure to consult your primary care provider, registered dietitian, and personal trainer for specific meal and exercise weight-loss plans.
Keeping on Track
To be successful with a lifestyle change such as adding daily physical activity, you may find it helpful to enlist a health professional to keep you on track and accountable to your plan. Consider setting up monthly appointments with your registered dietitian or weekly appointments with your personal trainer when you can bring diet and activity logs for review as well as receive encouragement to stay with your goal.
You may also choose to self-monitor your physical activity goal. Keeping a journal of your daily activity with specific goals can produce real records and milestones of your success.
Three Specific Goals
To begin your program, list three specific goals such as:
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Start physical activity regimen on (place your chosen date here);
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Do some form of moderate physical activity three days per week; and
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Get at least 30 minutes of moderate physical activity five days per week by week 12 of the program.
Conclusion
Self-monitoring will usually get the lifestyle change going in the desired direction. Rewards are another very important part of achieving success with any lifestyle change. Just make sure the rewards are not pushing you in the opposite direction of your goal, such as treating yourself to a week off from activity. Instead, when you reach one of your goals, try treating yourself to a new pair of gym shoes, a new exercise outfit, or even a day at the ballpark!
As with any lifestyle change, it is not a sprint or a destination to reach. Adding physical activity to your regimen is a lifetime journey. The health benefits--physically and mentally--are countless if you decide to accept the challenge of this journey. You may see weight loss, lower blood pressure, lower blood sugar, and a lowering of the other risk factors associated with early mortality. Adding moderate-intensity physical activity to your life on a regular basis just may save your life! You can get started today by making an appointment with your primary healthcare provider to be cleared for an exercise program.
About the Author
Jamie Shish, RD, LDN ATC/L, is a registered dietitian working as a Case Manager for Fresenius Medical Care, Villa Park, IL, and as a Consultant Dietitian for Advocate Health Care. She holds a Bachelor's of Science in Kinesiology with an Athletic Training major. She is also a personal trainer and is certified by the American Dietetic Association in Adult Weight Loss Management.
Last Updated February 2007
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