by Dan Bayliss MS, CES

Dan Bayliss is a Clinical Exercise Physiologist with University of Virginia Renal Services, University of Virginia Medical Center, Charlottesville, VA.

Exercise has been shown to help with a variety of diseases, especially heart and lung diseases and many forms of cancer. However, until recently, nephrologists would not recommend that patients with renal failure exercise for fear of causing more problems, especially in those patients who are diabetic or have high blood pressure.

Fortunately, research now shows that exercise—with specific guidelines for renal patients—can actually be helpful in managing renal disease and the effects it can have on the body. For example, dialysis patients (hemodialysis and peritoneal dialysis) have decreased muscle strength and endurance compared to people who don’t have renal disease. Exercise can help. But the benefits of exercise don’t stop there. Exercise can also specifically benefit people with renal disease by:

• Improving blood pressure control
• Giving you a better night’s sleep
• Helps muscles become stronger
• Lowering levels of fats (cholesterol and triglycerides) in your blood
• Better controlling your body weight
• Just making you feel less tired!

Starting to Exercise

If you’re interested in starting to exercise, the first thing you need to do is talk with your doctors (heart, lung, and kidney doctors) to see if it’s safe for you to exercise. The reason why you need to check with your doctors is because exercise can influence the effects of certain medications that many patients are on, and the medications would need to be adjusted so that you can exercise safely. Also, your doctors need to determine how much fluid to take off during your dialysis based on how much exercise you’re involved in. Once you start feeling better and your lab numbers improve, your doctors will know that it’s the exercise (at least in part) that’s the reason for the improvement!

For Hemodialysis Patients

Although most hemodialysis units don’t have an exercise program, you can exercise during your treatments while you’re sitting in your dialysis chair. Recent studies have shown that exercise during your treatment will also help improve your “Kt/V”—the number that indicates how well the toxins are being removed from your blood during your treatment.

Small hand-weights can be used during hemodialysis, using the arm without your vascular access. And if your unit has a pedaler or cycler (a stationary wheel you can pedal while seated), you can cycle during your treatments to improve the circulation in your legs. Any exercise is better than no exercise!

On the days that you’re not on dialysis, you have the opportunity to stay active by doing household chores, taking out the trash, walking to get the mail, going grocery shopping, etc. In addition, going for a walk once a day for 10 to 45 minutes will give you even more benefits. In a wheelchair? No problem. There are many stretching exercises that you can do to keep your arms and legs from getting stiff.

For Peritoneal Dialysis Patients

Peritoneal dialysis patients can also benefit from exercise for the same reasons mentioned above. But there are a few precautions that you need to be aware of. For example, swimming in open-water areas such as lakes or ponds—which are full of germs—will cause your catheter exit site to become infected. Also, to keep your catheter site from leaking, upright cycling should be carefully monitored in order to prevent pressure buildup on the catheter site.

For Transplant Patients

Finally, exercise has been shown to help improve the recovery of kidney transplant recipients. In fact, many patients are up walking one day after their surgery! Exercise will also help you maintain your strength and is a great weight-maintenance tool for transplant patients.

Enjoy It, and Don’t Overdo It

How hard do you need to exercise? An easy way to measure your exercise intensity is to use the “Talk Test.” The Talk Test means you should be able to carry on a normal conversation while exercising without becoming short of breath, or with what most experts describe as a “comfortable push.” If you do get short of breath, slow down... your body will tell you if you’re doing too much. The more you exercise, the more active you will be able to be while maintaining a normal conversation. This is because your body will become more efficient because of the exercise.

What kind of exercises should you do? You should choose an activity that you enjoy doing, such as walking, dancing, swimming, or any other activity that gets you moving around. Most people don’t stick with activities that they don’t enjoy. If you have access to a community gym or senior recreation center, they may have exercise programs and classes that you can attend. Also, many shopping malls open up early so that people can walk inside the mall before any of the shops open.

How long should you exercise? Start with what you can do, even if it’s only for a few minutes. Work toward exercising for 30 minutes most days of the week, but start slowly and gradually build up your endurance each week. For example, if you’re having trouble making it up the stairs in your home, start with a few steps, take a break, then take a couple more steps, and so on. After a few weeks, add some more steps before taking a break.

If you feel any of the following feelings, you should STOP exercising and report to your doctor:

• Chest pain
• Irregular or rapid heart beat
• Dizziness or light-headedness
• Extreme muscular or joint pain

Also, you shouldn’t exercise if you have a fever or have been inconsistent with your dialysis treatments. Exercise and your dialysis treatment should go hand in hand. Exercise should be as frequent as brushing your teeth or taking your medications—meaning every day!

If you have any questions about exercise, you should speak with your doctor. You should always check with your doctor before beginning any exercise program .

Exercise can help you overcome the big changes that have occurred in your life since beginning dialysis. Yes, it is safe for you to exercise. So why are you sitting there instead of going for a walk? Remember, if you don’t use it, you’ll lose it!!

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