Kidney Friendly Exercise Therapy For Dialysis
Feb 13, 2023
The number of patients with chronic kidney disease (CKD) in China may reach more than 100 million, and the number of patients with chronic kidney disease is about 1 million to 2 million, which means that there is at least one patient with chronic kidney disease in every 10 people; the latest data shows that maintenance hemodialysis patients The quantity is about 800,000. An inactive lifestyle leads to decreased exercise capacity in MHD individuals and is the main cause of increased mortality in MHD patients. Exercise can improve muscle function and aerobic activity, effectively control blood pressure, and improve patients' fatigue and psychological conditions.
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1 The effect of exercise on hemodialysis
1 Quality of life
Due to years of illness, MHD patients have gradually reduced motor function, and muscle atrophy, and are under tremendous physical and psychological pressure, resulting in a gradual decline in the quality of life. Exercise can promote health and is an inexpensive way to improve the quality of life for dialysis patients.
The 6-minute walking test (Six-minute Walking Test, 6MWT) is usually used as a standard for evaluating the motor training function of MHD patients. Studies have confirmed that aerobic exercise in dialysis can significantly improve 6MWT results. Low-intensity, long-term exercise mode can effectively improve the physical condition of MHD patients, improve the quality of life of patients and their families, enable patients to undertake housework and social work, and increase the social return rate of patients.
2 Effect of hemodialysis
During resting dialysis, the systemic circulation is relatively slow, especially in the leg muscles, which slows down the balance of serum urea nitrogen during dialysis; exercise during dialysis can significantly improve the efficacy of hemodialysis. During the period of hemodialysis in uremic hemodialysis patients, exercise training can significantly increase the urea decline rate and urea clearance index (Kt/V), and ultimately improve the dialysis adequacy and dialysis effect. MHD patients lie on the bed during hemodialysis, imitate the pedaling exercise of cycling according to their physical strength, continue to pedal the pedals, and rest for 5-10 minutes if necessary. The patient's Kt/V, total urea clearance, and solute clearance index increased significantly. Ability training before dialysis, cycling within 2 hours after the start of dialysis, 30 minutes of exercise training between dialysis, and standard exercise 3 times a week for 6 months can prevent symptomatic hypotension during hemodialysis and improve dialysis tolerance.
3 nutrition
The incidence of malnutrition in MHD patients is high, which directly affects the quality of life of patients. Exercise can significantly improve serum total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol in MHD patients. Studies have shown that after one year of exercise treatment for MHD patients, the heart rate, blood pressure, hemoglobin, upper arm muscle circumference, sleep, and other body functions have been significantly improved. At the same time, exercise can significantly improve the spirit, appetite, physical strength, and sleep status of MHD patients, and the physical state of the body has also improved significantly.
4 psychological
Studies have shown that 65% of hemodialysis patients are in a state of depression, and 40% of hemodialysis patients are in a state of anxiety. Symptoms include: feeling pain most of the time, being full of troubles most of the time, not feeling happy at all, feeling dull, etc., and may have suicidal tendencies or mental syndrome. Exercise can relieve patients' fatigue, promote sleep quality, reduce depression, improve social adaptability, and help them find their value and joy in life. After a home-based aerobic exercise in MHD patients, physical function is enhanced, fatigue is relieved, sleep quality is improved, and the levels of inflammatory factors that can predict morbidity, mortality, and quality of life are reduced.
2 exercise program
The forms of exercise for MHD patients include walking, going up and down stairs, jogging, treadmill exercise during dialysis, etc. However, to ensure the safety of hemodialysis patients when exercising, individualized exercise prescriptions are formulated according to the characteristics of the patients.
1 Principle of dialysis exercise
exercise when you feel good;
Do not exercise on an empty stomach;
Adapt movement to seasonal climate and environment;
Wear loose, soft clothing, shoes, and hats;
The site should be flat and free of obstacles, with a quiet environment and fresh air;
The time should be 9:00~10:00 in the morning and 4:00~5:00 in the afternoon;
Resume exercise after 2 days of clinical recovery after fever or cold;
Start slowly when exercising, step by step, adapt gradually, and do what you can;
Before the start of exercise, monitor blood pressure and pulse in a resting state and make records, and measure again 30 minutes after the end of the exercise. If blood pressure and pulse are abnormal, stop exercise temporarily.
2 Frequency and time of dialysis exercise
Perform exercise therapy between dialysis, 3 to 5 times a week, at least 30 minutes each time, including the preparation phase, training phase, and end phase. Studies have shown that exercise must be performed more than 3 times a week, and exercise training can increase the functional reserve of the heart. To maintain and improve the cardiovascular function of dialysis patients, the training time is usually 20-30 minutes.
3 dialysis exercise methods
1) walking
Do it at home or on nearby streets and parks, each time for 2-3 minutes, rest for 2-3 minutes, average 60-80 steps/min, alternately, and walk for a total of 20-30 minutes. It is advisable to avoid heart palpitations, wheezing, and weakness of the lower limbs. Then according to their conditions extend the walking time, shorten the rest time, and gradually transition to daily morning exercises.
2) Up and down stairs
Use the stairs and step on the steps for training. In the beginning, you can hold the handle of the stairs with your hands or go up and down the steps with the help of others, extend from 5 minutes to 15 minutes each time, and gradually transition to completing the above-mentioned exercises independently.
3) Gymnastics
Bending forward, moving sideways, rotating, bending forward, repeating each movement 5-10 times.
4) Use sports equipment
For example, use an exercise bike for training, cycling at a speed of 10km/h for 5 minutes.
5) Resistance training
This training therapy is for some dialysis patients. Through the training of grip strength and forearm strength, the thinner blood vessels of the fistula-side limbs of patients can be filled, blood flow can be improved, and dialysis efficiency can be improved. You can choose dumbbells starting from 2kg to do forearm flexion and extension training, 6-10 times per group, 2-3 groups per day. You can also choose the rubber grip ring, 10 times per group, 3~5 groups per day.
4 Precautions for dialysis exercise
1) When exercising, you must strictly grasp the indications and contraindications, and follow the principles of exercise.
2) Step by step: start with a low amount of exercise, gradually increase the intensity, and alternate between rest and exercise, so that it can gradually adapt, and avoid excessive fatigue.
3) Persistence: Most sports training programs need a certain period to show curative effect, so after determining the exercise program, you must persevere and should not stop on your own.
4) Individualization: When exercising, formulate an individualized exercise program based on the patient's age, physical condition, activity habits, cardiopulmonary function, etc., and do not insist on consistency.
5) Appropriate adjustment: According to seasonal climate, sports conditions, and changes in illness, timely assessment and timely adjustment of training programs.
6) Outdoor sports: Pay more attention to the use of the surrounding living environment, pay attention to the safety of the venue, and try to choose to absorb more oxygen.
7) Pay attention to nutrition: reasonably supplement the necessary sugar, salt, vitamins, and iron; exercise should be carried out 2 hours after meals, and it is not suitable for exercise training when you are hungry.
3 Summary
Exercise therapy can improve cardiovascular function, enhance the efficiency of hemodialysis, improve malnutrition, relieve patient fatigue, reduce depression, promote sleep quality, and improve quality of life. But few MHD patients receive exercise therapy. Well-designed exercise therapy with appropriate exercise intensity, time, and frequency is beneficial to MHD patients, and it is worth promoting in future work.
for more information:ali.ma@wecistanche.com
