Physical inactivity: a risk factor and target for intervention in renal care

Zelle, Dorien M.; Klaassen, Gerald; Adrichem, Edwin van; Bakker, Stephan J. L.; Corpeleijn, Eva; Navis, Gerjan

doi:10.1038/nrneph.2016.187

Cited by 225 publications

(227 citation statements)

References 189 publications

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“…These practices are similar to those noted in Delgado and Johansen [43]. This is in line with the sedentarism prevalent among HD patients [10]. This might be attributed to the widespread lack of knowledge among these patients or to the fact that exercise is not routinely advocated by the nephrologist within HD patient management [44].…”

Section: N (%) N (%)supporting

confidence: 76%

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

Salhab

Karavetian

Kooman

et al. 2018

AJNE

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Aim. Intradialytic exercise (IDE) improves hyperphosphatemia management in hemodialysis (HD) patient in addition to other clinical outcomes. The aim of the study is to present the strategies needed to integrate such a protocol in an HD unit in UAE and patients' baseline characteristics. Methods. The largest HD unit in Sharjah emirate was chosen. All eligible patients (n = 57) in the unit were included. Patients were stable adults HD patients who served as their own controls. The intervention included an aerobic low intensity IDE of 45 minutes per HD session, tailored to each patient's fitness scale (BORG scale) for 6 months. Patients were educated on the importance of exercise. Outcome measures were barriers to exercise, serum phosphorus (P), urea reduction ratio (URR), malnutrition inflammation score, quality of life (QOL using euroqol5) collected at baseline and post intervention. Results. A total of 41 patients completed the study, 61% were males and 90.2%, 53.7% and 14.6% suffered from hypertension, diabetes and cardiovascular disease, respectively. Hyperphosphatemia was prevalent among 75% of the patients with a mean of 5.76 ± 1.66 mg/dl. The mean age was 48 ± 14.37 years, BMI 24.98 ± 6.09 kg/m 2 , URR 71.88 ± 8.52%, and Kt/v 1.32 ± 1.09.The main barrier to exercise was identified to be fatigue on HD days by 58.5% of patients, followed by fear of getting hurt (36.6%). Finally, 80.4% of patients were mildly malnourished and QOL scale was 65.02% ± 18.54. Conclusion. Our study highlighted the widespread of hyperphosphatemia and malnutrition in our sample. The IDE regimen, if proven effective in future studies, could be integrated in the routine practice and may improve patients'outcomes.

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Section: N (%) N (%)supporting

confidence: 76%

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

Salhab

Karavetian

Kooman

et al. 2018

AJNE

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“…The BCM may help to identify a high-risk group with decreased muscle mass among patients with stage 3–5 CKD. Control of inflammation and underlying comorbidities such as DM and CVD, in addition to appropriate nutritional, pharmalogical, and exercise interventions [47,48], may have protective effects on muscle mass and benefit CKD patients with muscle wasting. Nevertheless, further studies are warranted to confirm our findings.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Decreased Lean Tissue Index in Patients with Chronic Kidney Disease

et al. 2017

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Muscle wasting is common and is associated with increased morbidity and mortality in patients with chronic kidney disease (CKD). However, factors associated with decreased muscle mass in CKD patients are seldom reported. We performed a cross-sectional study of 326 patients (age 65.8 ± 13.3 years) with stage 3–5 CKD who were not yet on dialysis. Muscle mass was determined using the Body Composition Monitor (BCM), a multifrequency bioimpedance spectroscopy device, and was expressed as the lean tissue index (LTI, lean tissue mass/height2). An LTI of less than 10% of the normal value (low LTI) indicates muscle wasting. Patients with low LTI (n = 40) tended to be diabetic, had significantly higher fat tissue index, urine protein creatinine ratio, and interleukin-6 and tumor necrosis factor-α levels, but had significantly lower serum albumin and hemoglobin levels compared with those with normal LTI. In multivariate linear regression analysis, age, sex, cardiovascular disease, and interleukin-6 were independently associated with LTI. Additionally, diabetes mellitus remained an independent predictor of muscle wasting according to low LTI by multivariate logistic regression analysis. We conclude that LTI has important clinical correlations. Determination of LTI may aid in clinical assessment by helping to identify muscle wasting among patients with stage 3–5 CKD.

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“…Physical activity (any bodily movement produced by the skeletal muscle that increases energy expenditure above a basal level) and exercise (a subcategory of physical activity that is planned, structured, and repetitive with the purpose of improving fitness or health) have been shown to be safe interventions for ESKD patients either on or off dialysis, and associated with a multitude of benefits including improved physical performance and quality of life . However, despite the benefits, evidence suggests that only ~6% of patients receiving dialysis treatment are engaging in physical activity on 4‐5 days of the week . As such, there is currently a gap between effective treatment and optimal engagement with and implementation of physical activity and exercise for patients with ESKD.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel

Clarke

Jhamb

Bennett

2019

Seminars in Dialysis

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Theory‐driven interventions are required to increase the adoption and implementation of physical activity and exercise programs among patients with ESKD. The Behavior Change Wheel (BCW) represents a synthesis of behavior change theories and can be used to aid the systematic development of theory‐driven interventions designed to change exercise behavior. The goal of this review was to synthesize barriers and facilitators to engagement and implementation of exercise and develop theory‐based recommendations for exercise behavior change interventions in patients with ESKD. We applied the BCW in the current context of exercise for ESKD patients and conducted an analysis of patients’ and health care professionals’ (HCPs) capabilities, opportunities, and motivations to engage or promote exercise, respectively. Our analysis identified a number of salient barriers that could be targeted via intervention to increase levels of physical activity and exercise. Intervention functions identified as most likely to change patient behavior included training, enablement, education, restructuring environment, persuasion, modeling, incentivizing, and coercion. Similarly, intervention functions most likely to change HCPs behavior for exercise promotion included training, modeling, education, environmental restructuring, persuasion, and incentivizing. We also considered potential over‐arching policy changes required to support these interventions. Our findings provide theory‐based recommendations that can help inform future clinical and research decision‐making for implementing exercise interventions in these patients. However, high‐quality research in this area is desperately needed to ensure that interventions not only be theory‐driven, but evidence‐based.

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Physical inactivity: a risk factor and target for intervention in renal care

Cited by 225 publications

References 189 publications

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

Intradialytic Aerobic Exercise in the United Arab Emirates: a Descriptive Study

Factors Associated with Decreased Lean Tissue Index in Patients with Chronic Kidney Disease

Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel

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