Exercise Training

Why Exercise?

Exercise has been proven to show vast amount of benefits in the general population [1] [2] [3] . With similar benefits found to carry over into the End Stage Renal Disease (ESRD) population[4] [5] [6] [7] [8] [9] . These benefits include reducing the risk of cardiovascular disease [10] , improvements in blood pressure[11] , improvements in psychological well being[12] and overbn,all quality of life[13] [14] . It was also shown that a non sedentary population had a decreased mortality rate then a sedentary population[15] .

Renal_disease_and_exercise.png
Diagram of potential adverse effects of sedentary behavior and chronic kidney disease and potential beneficial effects of exercise interventions.



Limitations to exercise

There are some factors that limit the duration, type, and intensity of exercise in the ESRD population[16] . These are:

  • · Lower maximum oxygen consumption (VO2 Peak)
  • · Muscle wasting (Atrophy)
  • · Weakness
  • · Lower physical performance
  • · Lower physical functioning

Due to these limitations ESRD patients cannot perform exercise at the same level as that of a healthy population, thus careful consideration is needed when prescribing an exercises.


Types of exercise


Aerobic Training

The purpose of this form of exercise is to improve VO2 peak and in doing such improve physical functioning[17] . It has been shown that aerobic training, resulting in an increase of VO2 peak, has also resulted in a decrease of arterial stiffness[18] , hypertension[19] , mental health[20] and blood pressure control[21] .

Resistance Training

The purpose of this form of exercise is to improve muscle strength as it is an important determinant of physical performance and activities of daily living (ADLs). As ESRD patients are weaker, they can benefit from this form of exercise. Minimal research has been conducted in this area so the benefits are not truly understood but it has been shown to reduce muscle atrophy in haemodialysis patients [22] . Also as resistance exercise can improve strength and bone density, long term results would reduce the risk of falls and fractures whilst improving their ability to complete ADLs [23] .


Risks to Exercise

There are many risks involved with ESRD patients performing exercise[24] . These include


Although there are these risks, they can be minimised and controlled by including warm-up and cool-down periods, supervision, avoiding high impact activities and beginning at a low intensity and progressing slowly as tolerated by the individual patient[25] . To further protect patients, medical screening and clearance should be considered before commencement. This would identify if a patient is at a high risk and help with modifying exercises and in terms of studies exclude them from participating [26] [27] [28] [29] [30] [31] .






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  1. ^ Fletcher, G.F., et al., Statement on exercise: benefits and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation, 1996. 94(4): p. 857.
  2. ^ Curfman, G.D., The Health Benefits of Exercise--A Critical Reappraisal. New England Journal of Medicine, 1993. 328(8): p. 574-576.
  3. ^ Elward, K. and E. Larson, Benefits of exercise for older adults. A review of existing evidence and current recommendations for the general population. Clinics in geriatric medicine, 1992. 8(1): p. 35.
  4. ^ Goldberg, A., et al., The metabolic and psychological effects of exercise training in hemodialysis patients. The American Journal of Clinical Nutrition, 1980. 33(7): p. 1620.
  5. ^ Konstantinidou, E., et al., Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Journal of Rehabilitation Medicine, 2002. 34(1): p. 40-45.
  6. ^ Macdonald, J.H., et al., Intradialytic exercise as anabolic therapy in haemodialysis patients–a pilot study. Clinical physiology and functional imaging, 2005. 25(2): p. 113-118.
  7. ^ Mustata, S., et al., Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. Journal of the American Society of Nephrology, 2004. 15(10): p. 2713.
  8. ^ Sietsema, K.E., et al., Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney international, 2004. 65(2): p. 719-724.
  9. ^ Yurtkuran, M., A. Alp, and K. Dilek, A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complementary Therapies in Medicine, 2007. 15(3): p. 164-171
  10. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  11. ^ Konstantinidou, E., et al., Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Journal of Rehabilitation Medicine, 2002. 34(1): p. 40-45.
  12. ^ Goldberg, A., et al., The metabolic and psychological effects of exercise training in hemodialysis patients. The American Journal of Clinical Nutrition, 1980. 33(7): p. 1620.
  13. ^ Yurtkuran, M., A. Alp, and K. Dilek, A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complementary Therapies in Medicine, 2007. 15(3): p. 164-171
  14. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  15. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  16. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  17. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  18. ^ Mustata, S., et al., Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. Journal of the American Society of Nephrology, 2004. 15(10): p. 2713.
  19. ^ Konstantinidou, E., et al., Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Journal of Rehabilitation Medicine, 2002. 34(1): p. 40-45.
  20. ^ Goldberg, A., et al., The metabolic and psychological effects of exercise training in hemodialysis patients. The American Journal of Clinical Nutrition, 1980. 33(7): p. 1620.
  21. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  22. ^ Kouidi, E., et al., The effects of exercise training on muscle atrophy in haemodialysis patients. Nephrology Dialysis Transplantation, 1998. 13(3): p. 685.
  23. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  24. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  25. ^ Johansen, K.L., Exercise in the end-stage renal disease population. Journal of the American Society of Nephrology, 2007. 18(6): p. 1845.
  26. ^ Goldberg, A., et al., The metabolic and psychological effects of exercise training in hemodialysis patients. The American Journal of Clinical Nutrition, 1980. 33(7): p. 1620.
  27. ^ Konstantinidou, E., et al., Exercise training in patients with end-stage renal disease on hemodialysis: comparison of three rehabilitation programs. Journal of Rehabilitation Medicine, 2002. 34(1): p. 40-45.
  28. ^ Macdonald, J.H., et al., Intradialytic exercise as anabolic therapy in haemodialysis patients–a pilot study. Clinical physiology and functional imaging, 2005. 25(2): p. 113-118.
  29. ^ Mustata, S., et al., Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. Journal of the American Society of Nephrology, 2004. 15(10): p. 2713.
  30. ^ Sietsema, K.E., et al., Exercise capacity as a predictor of survival among ambulatory patients with end-stage renal disease. Kidney international, 2004. 65(2): p. 719-724.
  31. ^ Yurtkuran, M., A. Alp, and K. Dilek, A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study. Complementary Therapies in Medicine, 2007. 15(3): p. 164-171