Structured exercise programme during haemodialysis for patients
A structured exercise programme during haemodialysis for patients with chronic kidney disease: clinical benefit and long-term adherence
Long-term studies regarding the effect of a structured physical exercise programme (SPEP) during haemodialysis (HD) assessing compliance and clinical benefit are scarce.
In conclusion, we have developed and tested a combined cardiovascular and resistance personalised exercise programme, which can be integrated into normal dialysis care.
Patients’ strength and endurance as well as QoL improved significantly over a 1-year period and adherence was close to 80% after 5 years, correcting for the forced dropouts related to transplantation or death.
To the best of our knowledge, this is the first time that an SPEP was successfully performed over half a decade.
Exercise training for patients with dialysis should be seen as a main strategy aside from pharmacological therapy and dialysis. It has to be titrated similarly as the dose of medication.
For any medication or intervention to be effective, the patient’s adherence is crucial. In add- ition, for widespread application, it must be recognised by the health insurance system. Our SPEP as described here fulfils these four criteria: Each patient receives a personally adapted training programme including the mode and dose.
The adherence is boosted by collective training and a stimulating environment created in the dialysis unit. Last but not least, the improvement of QoL of the patients contributes to the motivation for contin- ued or even intensified exercise training.
Support of this exercise training by a German health insurance company with €8/patient/training session covers the direct costs and also contributes to the patients’ motivation.
- Beddhu S, Baird BC, Zitterkoph J, et al. Physical activity and mortality in chronic kidney disease (NHANES III). Clin J Am Soc Nephrol 2009;4:1901–6.
2. Tentori F, Elder SJ, Thumma J, et al. Physical exercise among participants in the Dialysis Outcomes and Practice Patterns Study (DOPPS): correlates and associated outcomes. Nephrol Dial Transplant 2010;25:3050–62.
3. Lopes AA, Lantz B, Morgenstern H, et al. Associations of self- reported physical activity types and levels with quality of life,
4. Kurella TM, Covinsky KE, Chertow GM, et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 2009;361:1539–47.
5. Painter P. Physical functioning in end-stage renal disease patients:
6. Kettner-Melsheimer A, Weiss M, Huber W. Physical work capacity in chronic renal disease. Int J Artif Organs 1987;10:23–30.
7. Johansen KL, Doyle J, Sakkas GK, et al. Neural and metabolic mechanisms of excessive muscle fatigue in maintenance hemodialysis patients. Am J Physiol Regul Integr Comp Physiol 2005;289:R805–13.
8. Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000;35(4 Suppl 1): S117–131.
9. Finkelstein FO, Wuerth D, Finkelstein SH. Health related quality of life and the CKD patient: challenges for the nephrology community. Kidney Int 2009;76:946–52.
10. Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis. Semin Nephrol 2006;26:68–79.
11. Kopple JD, Storer T, Casburi R. Impaired exercise capacity and exercise training in maintenance hemodialysis patients. J Ren Nutr 2005;15:44–8.
12. Painter P, Zimmerman SW. Exercise in end-stage renal disease. Am J Kidney Dis 1986;7:386–94.
13. Painter P. Determinants of exercise capacity in CKD patients treated with hemodialysis. Adv Chronic Kidney Dis 2009;16:437–48.
14. van Vilsteren MC, de Greef MH, Huisman RM. The effects of a low- to-moderate intensity pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized clinical trial. Nephrol Dial Transplant 2005;20:141–6.
15. Oh-Park M, Fast A, Gopal S, et al. Exercise for the dialyzed: aerobic and strength training during hemodialysis. Am J Phys Med Rehabil 2002;81:814–21.
16. Mercer TH, Crawford C, Gleeson NP, et al. Low-volume exercise rehabilitation improves functional capacity and self-reported functional status of dialysis patients. Am J Phys Med Rehabil 2002;81:162–7.
17. DePaul V, Moreland J, Eager T, et al. The effectiveness of aerobic and muscle strength training in patients receiving hemodialysis and EPO: a randomized controlled trial. Am J Kidney Dis 2002;40:1219–29.
18. Moinuddin I, Leehey DJ. A comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease. Adv Chronic Kidney Dis 2008;15:83–96.
19. Daul AE, Schafers RF, Daul K, et al. Exercise during hemodialysis. Clin Nephrol 2004;61(Suppl 1):S26–30.
20. Johansen KL. Exercise and dialysis. Hemodial Int 2008;12:290–300.
21. Painter P, Moore G, Carlson L, et al. Effects of exercise training plus quality of life. Am J Kidney Dis 2002;39:257–65.
22. Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis 2014;64:383–93.
23. Heiwe S, Jacobson SH. Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev 2011;(10):CD003236.
24. Smart N, Steele M. Exercise training in haemodialysis patients: a systematic review and meta-analysis. Nephrology (Carlton) 2011;16:626–32.
25. Johansen KL, Painter PL, Sakkas GK, et al. Effects of resistanceexercise training and nandrolone decanoate on body compositionand muscle function among patients who receive hemodialysis: arandomized, controlled trial. J Am Soc Nephrol 2006;17:2307–14.
26. Castaneda C, Gordon PL, Uhlin KL, et al. Resistance training tocounteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. A randomized, controlled trial. Ann Intern Med 2001;135:965–76.
27. Headley S, Germain M, Mailloux P, et al. Resistance training improves strength and functional measures in patients with end- stage renal disease. Am J Kidney Dis 2002;40:355–64.
28. Miller BW, Cress CL, Johnson ME, et al. Exercise during hemodialysis decreases the use of antihypertensive medications. Am J Kidney Dis 2002;39:828–33.
29. Anderson JE, Boivin MR Jr, Hatchett L. Effect of exercise training on interdialytic ambulatory and treatment-related blood pressure in hemodialysis patients. Ren Fail 2004;26:539–44.
30. Goldberg AP, Geltman EM, Gavin JR III, et al. Exercise training reduces coronary risk and effectively rehabilitates hemodialysis patients. Nephron 1986;42:311–16.
31. Kirkman DL, Roberts LD, Kelm M, et al. Interaction between intradialytic exercise and hemodialysis adequacy. Am J Nephrol 2013;38:475–82.
32. Vaithilingam I, Polkinghorne KR, Atkins RC, et al. Time and exercise improve phosphate removal in hemodialysis patients. Am J Kidney Dis 2004;43:85–9.
33. Kong CH, Tattersall JE, Greenwood RN, et al. The effect of exercise during haemodialysis on solute removal. Nephrol Dial Transplant 1999;14:2927–31.
34. Williams AD, Fassett RG, Coombes JS. Exercise in CKD: why is it important and how should it be delivered? Am J Kidney Dis 2014;64:329–31.
35. Capitanini A, Lange S, D’Alessandro C, et al. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients. Kidney Blood Press Res 2014;39:129–33.
36. Bennett PN, Breugelmans L, Barnard R, et al. Sustaining a hemodialysis exercise program: a review. Semin Dial 2010;23:62–73.
37. Goldberg L, Elliot DL, Kuehl KS. Assessment of exercise intensity formulas by use of ventilatory threshold. Chest 1988;94:95–8.
38. Kono K, Nishida Y, Moriyama Y, et al. Investigation of factors affecting the six-minute walk test results in hemodialysis patients. Ther Apher Dial 2014;18:623–7.
39. Steffen TM, Mollinger LA. Age- and gender-related test performance in community-dwelling adults. J Neurol Phys Ther 2005;29:181–8.
40. Segura-Orti E, Martinez-Olmos FJ. Test-retest reliability and minimal detectable change scores for sit-to-stand-to-sit tests, the six-minute walk test, the one-leg heel-rise test, and handgrip strength in people undergoing hemodialysis. Phys Ther 2011;91:1244–52.
41. Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med 2001;33:350–7.
42. Storer TW, Casaburi R, Sawelson S, et al. Endurance exercise training during haemodialysis improves strength, power, fatigability and physical performance in maintenance haemodialysis patients. Nephrol Dial Transplant 2005;20:1429–37.
43. Johansen KL. Exercise and chronic kidney disease: current recommendations. Sports Med 2005;35:485–99.
44. Kouidi E, Grekas D, Deligiannis A, et al. Outcomes of long-term exercise training in dialysis patients: comparison of two training programs. Clin Nephrol 2004;61(Suppl 1):S31–8.
45. Painter P, Carlson L, Carey S, et al. Low-functioning hemodialysis patients improve with exercise training. Am J Kidney Dis 2000;36:600–8. doi:10.1053/ajkd.2000.16200