Sustained exercise programs for hemodialysis patients: The characteristics of successful approaches in Portugal, Canada, Mexico, and Germany

Abstract

Despite having good intentions, hemodialysis (HD) clinics often fail to sustain exercise programs that they initiate. There are many reasons for this, including a lack of funding, inadequate training of the clinic staff, a lack of exercise professionals to manage the program or train the staff, and the many challenges inherent to exercising a patient population with multiple comorbid diseases. Despite these barriers, there are several outstanding examples of successful exercise programs in HD clinics throughout the world. The aim of this manuscript is to review the characteristics of four successfully sustained HD exercise programs in Portugal, Canada, Mexico, and Germany. We describe the unique approaches they have used to fund and manage their programs, the varied exercise prescriptions they incorporate, the unique challenges they face, and discuss the benefits they have seen. While the programs differ in many regards, a consistent theme is that they each have substantial and committed support from the entire clinic staff, including the nephrologists, administration, nurses, dietitians, and technicians. This suggests that exercise programs in HD clinics can be successfully implemented and sustained provided significant effort is made to foster a culture of physical activity throughout the clinic.

Association between physical activity and mortality in end-stage kidney disease: a systematic review of observational studies

“…Such a comprehensive intervention is not common in ESKD patients, but is popular in pulmonary [ 47 ] and cardiac rehabilitation [ 48 ]. Nevertheless, some successful approaches of sustainable exercise programs are also known for ESKD patients, including intradialytic exercise, home-based exercise, inter-dialytic exercise, prehabilitation for transplant candidates, rehabilitation post-transplant and education programs [ 49 ]. The present findings should inform policy makers and other stakeholders for the need to address inactivity in this population.…”

Renal Rehabilitation: Exercise Intervention and Nutritional Support in Dialysis Patients

“…Since exercise therapy is the core of a comprehensive renal rehabilitation program, the relatively rich literature about exercise therapy for CKD patients was primarily reviewed. Thereafter, a number of systematic reviews for physical activity, renal function, lifestyle change in CKD including dialysis patients, as well as international surveys and editors' commentary, has been published in recent years [22][23][24][25][26][27][28][29][30][31][32].…”

Muscle-Bone Crosstalk in Chronic Kidney Disease: The Potential Modulatory Effects of Exercise

“…The influence of formalized groups demonstrates increased global interest in this area, which may in turn positively influence the prevention of the physical dysfunction associated with CKD, but especially with patients undergoing dialysis treatment. This is the case of the ongoing intradialytic exercise programs implemented in Mexico, Portugal, Canada and Germany which highlight the importance of demonstrating that, in addition to improving overall patient health, exercise programs need to be cost-effective, possibly through reduction of medications, improving dialysis compliance or even reducing hard outcomes such as hospitalizations and mortality [178].…”