Exercise Coaching and Rehabilitation Counseling Improve Quality of Life for Predialysis and Dialysis Patients

Abstract

Advances in medical treatment have improved the rehabilitation potential of predialysis (P) and dialysis (D) patients, but deficits remain in their physical and vocational functioning. We studied 18 P (expected to begin dialysis in 6–12 months) and 18 D patients (on dialysis 1–5 years) for 1 year. Exercise coaching and rehabilitation counseling were provided at no cost for the first 6 months to half of each patient group (rehabilitation group = R); the other half were assigned randomly to controls (C). No R services were provided during 6 months of follow-up. PR walked further in 6 min at 6 months (+3.9 m) and 12 months (+4.1 m) than initially (p < 0.01). Hematocrit increased in R (p < 0.05), but not in C. Symptom scores were stable in D, worsened 21% in PC, and improved 15% in PR. Sickness impact profile scores were better in PR than PC at 6 months (p < 0.05) and 12 months (NS). Comorbidity correlated with symptoms (r = +0.34, p < 0.05), self-rated affect (r = –0.35, p < 0.05), and self-rated Karnofsky index of disability (r = –0.37, p < 0.05), but not with physician-rated affect or physician-rated Karnofsky index of disability. Thus, quality of life was stable or improved in PR, but declined in PC; PR benefited more than DR. Rehabilitation services are more beneficial before than after patients stabilize on dialysis, and quality of life monitoring should continue indefinitely.

Physical and Psychological Burden of Chronic Kidney Disease among Older Adults

“…Clinicians should be aware that declining physical function is not necessarily an inevitable consequence of advancing kidney disease and that there is evidence that exercise training is associated with improved QoL [46][47][48] . There is also evidence that correction of anemia may improve QoL in CKD patients [49,50] .…”

Assessment and Clinical Aspects of Health-Related Quality of Life in Dialysis Patients and Patients with Chronic Kidney Disease

“…Physical inactivity is one reason for a reduction in physical capacity and interventions to increase physical activity in CKD patients may be relevant. The effects of physical exercise in CKD patients have been intensively studied and physical capacity can be significantly improved by exercising [17,18,19,20]. Information of the benefit of physical activity should be a part of the treatment program delivered to CKD patients.…”

A Program of Physical Rehabilitation during Hemodialysis Sessions Improves the Fitness of Dialysis Patients

“…This has been shown in several studies which assessed walking speed [1], strength [2] and quality of life [3]. Many factors may contribute to this disturbance: anemia [4], the uremic milieu itself, inflammatory state and malnutrition [5].…”