Exercise and Dialysis: Why We Should and How You Can Exercise Your Patients

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Exercise and DialysisWhy We Should and How You
Can Exercise Your Patients

• Dan Bayliss, MS CES
• Debbie Cote, BSN RN CNN
• University of Virginia Renal Services
• University of Virginia Medical Center
• Charlottesville, VA 22901

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Discussion Topics

• Does Exercise Actually Help ESRD Patients?
• Exercise Benefits
• Patient Safety
• Research on Exercise and ESRD
• Starting a Program
• Contact Information

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Can anyone name a medication that has more
widespread benefits that physical activity and
exercise ???
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Quiz Question

• What of Americans are physically active?
• A. 10
• B. 25
• C. 50
• D. 75
• E. 100

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Physical Activity Obesity Rates
Hypertension RatesDiabetes Rates Multiple
Disease Rates ESRD Rates
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Does Exercise Really Help?

• Patients with ESRD are more physically inactive
  compared to apparently healthy population
• Reduction of physical activity leads to
  deterioration in muscle function, exercise
  tolerance, progressive disability, and various
  other unwanted events
• Hospitalizations
• CAD
• Decreased QOL

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Past and Current Research

• Exercise has been show to be extremely beneficial
  to patients with ESRD
• First study was in 1979
• Interest in research and exercise has increased
  in the past 10 years
• Still no standardized study to show the proper
  amount of exercise and duration of exercise for
  this population
• Dr. Patricia Painter is the leading authority on
  exercise and ESRD

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Exercise Benefits For ESRD Patients

• Improved exercise capacity
• Improved muscle strength
• Improved blood pressure control
• Improved lipid profile
• Improved glucose regulation
• Improved psychological profile
• Reduced effects of bone disease

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Exercise Benefits

• Regular exercise and activity can help interrupt
  the physical inactivity cycle, improves clinical
  and physical markers
• Strength
• Endurance
• Flexibility
• Sleep patterns
• Energy levels

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Starting Up an Exercise Program

• Starting a program is a collective effort
  including administration, staff, and patients
• A dialysis unit needs an exercise champion
• Benefits of exercise should be understood by
  staff and patients
• Staff training is vital

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Essential Components

• Exercise literature to all staff
• Exercise equipment
• Patient Interest programs
• Exercise bay/pod book

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Exercise Equipment

• CHAMP Cycle

• Monarch 881 E Rehab Trainer

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Exercise Equipment cont.

• NuStep

• OxyStepper

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Exercise Equipment cont

• Hand/Leg Weights

• TheraBands

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Obstacles to Starting a Program

• MONEY!!!!
• Medicare does not reimburse for exercise therapy
  similar to cardiac rehab
• Safety Concerns
• Lack of Interest
• Patient Noncompliance

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Potential Funds for Exercise Equipment

• Patient memorial funds
• Educational/clinical Grants
• Patient family participation
• Patient foundations
• Shad Ireland Foundation

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Costs of Exercise 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 Exercise Equipment cont.

• Exercise Room Equipment
• Treadmill 500-3000.00
• NuStep 3500.00
• AirDyne 465.00

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Safety of Exercise

• No untoward events have been reported in any of
  the research on exercise and ESRD as a result of
  exercise
• Exercise is considered to be safer on the patient
  than the actual dialysis treatment itself!!

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Components Needed

• Administrative Support
• Patient Education (classes, handouts)
• Staff Education (research)
• Exercise Prescription
• Patient Training
• Documentation
• Interest Programs

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Administrative Support

• History of UVA SitFit Exercise Program
• Role of Administration
• Addition of exercise in job description/performanc
  e appraisals
• Documentation as EMR
• Staff Participation
• Quality Indicators
• Evaluated every month on performance/compliance

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Administrative Support cont.

• Competition between units
• Exercise champion
• Can be PCA, nurse, social worker, or Dietician
• Needs to be fluent with the benefits of exercise
  and understand inclusion/exclusion criteria
• ONE PERSON SHOULD NOT BE THE ONLY PERSON RUNNING
  THE PROGRAM!!!

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Guides for Exercise

• Unit Exercise Book
• LifeOptions Rehabilitation Booklets
• Unit Self-Assessment Tool for Renal Rehab
• Guide for Nephrologist
• Guide for Patients
• Prescribing Guide
• www.lifeoptions.org

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Exercise Book Forms

• Exercise decision tree
• Inclusion/Exclusion criteria
• Pre, During, and Post exercise problem
  suggestions
• Exercise set up guide
• Stretching guide
• Hand/Leg weight guide
• Exercise Prescriptions
• Pertinent Exercise Research Papers

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Patient/Staff Interest Programs

• Any program that will generate interest and fun
  with the patients
• Exercise Information classes
• 12 Days of Exercise (Christmas)
• Cycle Across America
• Buddy/Buddy program
• Exercise of the Month
• Wellness Programs incorporating social work and
  nutrition aspects

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Exercise and PD/Transplant

• Exercise has been shown to help patients on other
  forms of dialysis
• Walking is recommended for transplant patients
  and donors immediately post surgery!!
• Physical activity has a positive effect on the
  patients inclusion on transplant list

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Why ISNT Exercise Standard??

• Physical activity and functioning for ESRD
  patients should be assessed for ALL patients at
  dialysis units
• Exercise and physical activity is equally as
  important as any medication given to the patient,
  even the dialysis treatment itself!

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Because of the reduction in cardiovascular risk
factors that results from exercise training, and
because of the need to prevent progressive
deconditioning, dialysis patients may actually be
placed at a greater risk for cardiac events and
adverse musculoskeletal outcomes in the are not
participating in regular physical activityAdv
Ren Repl Ther, Vol 6, No 2, 1999 pp 165-171
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Contact Information

• Dan Bayliss, MS CES
• Clinical Exercise Physiologist
• renalexercise_at_virginia.edu
• 434-243-6218
• SitFit Exercise Program Website
• www.uvasitfit.com