The Dummies Guide to Starting an Exercise Program in your Dialysis Unit

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The Dummies Guide to Starting an Exercise
Program in your Dialysis Unit

• Dan Bayliss, MS CES
• Debbie Cote, RN CNN
• University of Virginia Renal Services
• University of Virginia Medical Center
• Charlottesville, VA

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Based on the Life Options Unit Self-Assessment
Manual for Renal RehabilitationModule 4
ExercisePractical Guide to Renal
Rehabilitationwww.lifeoptions.org
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Topics of Discussion

• UVA SitFit Exercise Program
• Why exercise?
• Benefits of exercise to the staff
• Components needed to start a program
• Obstacles to starting a program
• Cost of Equipment
• Patient Interest programs
• Documentation
• Testing
• Questions

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UVA SitFit Exercise Program

• Started by Kline Bolton, MD in 1998
• Full-time Masters-trained Exercise Physiologist
• 8 dialysis units
• Over 740 patients
• 30-35 of patients have exercise orders

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Why Exercise??

• Renal failure is a significant health care
  concern now and in the coming years
• The USRDS predicts significant growth in the
  prevalence of ESRD
• Researchers predict the ESRD population to reach
  gt600,000 by 2010
• Hypertension and diabetes rates are on the rise
  as well
• Patients who exercise during dialysis have fewer
  episodes of low systolic blood pressure that
  require treatment during dialysis

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NUMBER OF INCIDENT POINT PREVALENT
PATIENTSfigure 1.3, projected to 2010
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PROJECTED COST FOR ESRD CARE
Year
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Why Exercise cont.

• Recent research indicates the positive effects of
  exercise for dialysis patients
• Improves Kt/V
• Improves phosphorus levels
• Stabilizes blood pressure and reduces the number
  of low blood pressure episodes
• Improves blood glucose levels
• Improves lipid and carbohydrate metabolism
• Improves strength, endurance, flexibility
• Improves energy levels, QOL
• Increases exercise capacity by 21 to 25

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Why Exercise, cont.

• Help patients get back to work
• Improve their ability to care for themselves
• May prolong life
• IMPROVES QUALITY OF LIFE

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Benefits to the Staff

• Dialysis staff benefit when patients exercise
  through improved patient relationships, time
  savings (faster transfers), and reduced risk of
  work-related injuries (fewer lifts)
• May actually improve their PA levels!!

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Obstacles to Exercise

• Whos going to pay for it??
• Hospital/medical center grants
• Patient memorial funds
• donations
• Staff dedication/involvement
• MD clearance
• Patient noncompliance

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Components needed

• Administrative support
• Exercise Champion(s)
• Similar to anemia management person
• Strategies for identifying champion
• Solicit interest from staff, patients, or
  community volunteers
• Have staff in-services
• Call local college about internship program
• Equipment
• Patient involvement programs

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Essential Guides

• Life Options Rehabilitation booklets
• Unit Self-Assessment Tool for Renal
  Rehabilitation (USAT)
• Guide for the Nephrologist
• Prescribing Guide
• Guide for Patients on Dialysis
• www.lifeoptions.org

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Administrative Requirements

• Exercise Physiologist/Physical Therapist (?)
• Exercise champion (RN, Tech, SW)
• Administrative support
• Training staff
• Job descriptions including exercise program
• Billing
• Referrals (cardiac rehab, PT, social work)

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Floor Staff is the Key

• Exercise champion should not do all the work.
• Each staff member has the responsibility to
  encourage the patients
• If the staff is dedicated, patient exercise
  participation will be high
• Dont ask the patients if you want to exercise
• Most patients will automatically say no
• Instead, bring them the exercise equipment and
  ask how long do they want to go today

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Staff Strategies

• Dont ask, just bring the equipment to the
  patients
• Get involved with the patients
• Encourage other staff to get involved
• Have a pod/bay book

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Documentation

• Unit Exercise Bay/Pod Book
• Exercise daily set-up sheet
• Pertinent research papers
• Exercise Decision Tree
• Exercise bike protocol
• Potential problems
• Stretching guide
• Weight training guide
• Exercise Prescriptions
• Exercise progress/communication notes

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Equipment

• Stationary Cycle
• Monarch 881E
• CHAMP cycle
• Treadmill
• NuStep (www.nustep.com)
• OxyStepper
• Hand Weights
• Leg Weights
• TheraBands

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Cost of Equipment

• General Equipment
• Fitness, free weights 20.00
• Hand, ankle weights (per lb) 1.00
• Thera-Bands 1.30
• Stationary bike (CHAMP) 350.00
• Pedal exerciser 42.00
• Total 409.30

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Cost of Equipment cont.

• Exercise Room Equipment
• Treadmill 1300.00
• NuStep 3500.00
• AirDyne 465.00

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CHAMP Cycle

• Designed for dialysis chairs
• Inexpensive (300-500)
• Bulky ( 60lbs)

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Monarch 881E Rehab Trainer

• Clinically designed
• Easy to transport
• Tip and roll
• Expensive (1300)
• Breaks down often

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LifeCare OxyStepper

• Inexpensive
• Light and mobile
• Does not give cardiovascular exercise effect
  similar to cycling
• May be hard to reach

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Patient Interest Programs

• Pod Exercise Information sessions, or classes
• Cycle across America
• 12 Days of Exercise (Christmas holiday)
• Buddy Up program
• Exerciser of the Month
• Patient-Staff Match-up Program
• Wellness Programs including social work and
  nutrition

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Testing

• Two and Six-min walk test
• Sit-to-Stand test
• Stair Climbing test
• Lift-Reach test

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Closing

• If unit staff works together, and exercise
  program can be successful
• It does NOT have to come down to lack of money
  for a unit to have an exercise program
• Exercise should NOT be cutting edge anymore, it
  NEEDS to become a standard treatment for all
  dialysis units!
• Every patient should be asked, What are you
  doing for regular exercise?
• -- Patricia Painter, PhD

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Surgeon Generals Warning PHYSICAL INACTIVITY
MAY BE HAZARDOUS TO YOUR HEALTH Patricia Painter,
Ph.D.
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Contact Information

• UVA SitFit Exercise Program Website
• http//www.healthsystem.virginia.edu/
• Contact Person
• Dan Bayliss, MS CES
• Clinical Exercise Physiologist
• djb2c_at_virginia.edu
• 434-243-6218

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Questions??

• Give about two hours every day to exercise, for
  health must not be sacrificed to learning.
• Thomas Jefferson, 1789