Physical activity and exercise training: a relevant aspect of the dialysis patient’s care

Abstract

Sedentary lifestyle is frequent in hemodialysis patients whose physical capabilities are largely reduced when compared with healthy subjects, and evidence exists that sedentary dialysis patients are at higher risk of death as compared to non-sedentary ones. Dialysis patients may suffer from cardiovascular disease, diabetes, malnutrition, depression, which limits their exercise capacity; conversely, regular physical exercise may favor rehabilitation and correction of several cardiovascular, metabolic and nutritional abnormalities. Many observational, population-based studies show that the level of physical activity is related to quality of life and nutritional status, as well as to the survival probability. Intervention studies are instead lacking; a randomized controlled multicenter trial is in progress in Italy to assess the effect of home-based exercise programs on survival and hospitalization rate in stable dialysis patients. Implementation of physical activity should be one of the goals of dialysis care management, but several barriers prevent a widespread implementation of physical exercise programs in the dialysis units. A lack of patients' or care-givers' motivation or willingness, and structural or functional resources are the most frequent obstacles to exercise implementation. Since the hemodialysis population is quite heterogeneous for physical abilities and comorbidities, exercise in not for everyone and individual prescription is required for a correct and safe implementation of physical activity.

Nutrition and Physical Activity in CKD patients

“…Kouidie et al evaluated the effects of long-term physical training (4 years) on HD patients' fitness, perception of health and overall life situation [23]. They found that HD patients are able to adhere to long-term physical training programs both on dialysis- and non-dialysis days, with significant increase in exercise capacity especially after the first year.…”

“…They found that HD patients are able to adhere to long-term physical training programs both on dialysis- and non-dialysis days, with significant increase in exercise capacity especially after the first year. The perception of health was higher in the majority of the patients [23]. The ability of exercise training to alleviate depression and to increase the perception of feeling better improved appetite and contributed to counteract the reduction of energy and protein intake frequently found in HD patients [24].…”

“…Despite a number of benefits, the effect of increased physical activity on long-term survival of HD patients are still lacking [23]. …”

Feasibility and effectiveness of pre‐emptive rehabilitation in persons approaching dialysis (PREHAB)

“…; Cupisti et al . ). It has been proposed that a combination of interventions, including nutritional management, physical activity and pre‐dialysis education, is important to prevent nutritional decline and maintain physical function and HRQoL in persons with ESKD (Flesher et al .…”

Estimated Pulmonary Artery Systolic Pressure and Self-Reported Physical Function in Patients on Hemodialysis

“…Patients on chronic hemodialysis report extremely poor physical function [11,12]. Perhaps because of the many possible causes of poor self-reported physical function in patients with ESRD, including uremic myopathy [13], deconditioning from sedentary lifestyle [14], anemia, comorbid conditions, and others, the contribution of cardiopulmonary abnormalities seems to have been underappreciated. Because elevated PASP is potentially a result of structural heart disease and volume overload in patients with ESRD, we hypothesized that higher PASP would be associated with worse self-reported physical function in patients with ESRD.…”