Chronic Kidney Disease Patients and Exercise

Many patients with chronic kidney disease (CKD) are less physically active and have reduced physical functioning and performance compared to the general population. However, strong scientific research suggests that exercise interventions have the potential to improve several health parameters and outcomes in CKD patients.

Exercise is defined as a planned, structured and repetitive bodily movement to improve or maintain a component of physical fitness. An example of this is a 30-minute walk that improves aerobic fitness over time.

Benefits

For patients with CKD, the leading cause of death is cardiovascular disease. Inactivity is a strong risk factor for poor heart health, and exercise is helpful to improve overall health and reduce cardiovascular risk.

Some scientific studies have shown a link between exercise interventions and improvements in:

• Rate of decline in kidney function
• Maximal oxygen consumption
• Blood pressure
• Lipid profile
• Mental health
• Sleep habits
• Weight control
• Energy levels
• Physical function, flexibility and performance

The quality of evidence for each of these benefits is varied, and the impact of exercise on overall hospitalization and survival rates has not been determined. However, it is apparent that exercise training can be valuable for many patients with CKD.

The most commonly studied type of exercise intervention in CKD patients is aerobic exercise. However, other types of training, such as resistance exercise training, may offer other benefits such as increased muscle strength and function.

Risks and Safety

Exercise capacity is significantly reduced in CKD patients. In the past, it was thought that vigorous physical activity might be harmful to these individuals. It is likely in part due to these beliefs that these patients show a lack of participation in exercise activities.
 

We are now aware that patients who follow an exercise program have better health outcomes than those who do not. However, it is important that CKD patients follow an exercise program that is designed to accentuate the benefits and minimize the risks of exercise.

Patients with CKD should be aware of their physical limits and stop exercising when they feel tired, short of breath, sick, or dizzy.

Other danger signals might include pain, muscle cramps or a racing heartbeat. Additionally, exercise therapy should be stopped if the patient has a fever, experiences worsening of symptoms, or has another health condition that becomes worse with exercise.

In Practice

Even though there is significant evidence to support the therapeutic benefits of exercise for CKD patients, the level of inactivity in dialysis patients remains high. Furthermore, assessment, counseling and training for exercise interventions is not routinely offered to CKD patients, resulting in a gap in their care.

Patients with CKD should be encouraged to participate in regular physical activity. They may benefit from various types of exercise training interventions, including:

• Aerobic exercise training such as walking, swimming, or cycling
• Strength training
• Resistance training
• Flexibility training

A customized exercise program should be devised for each patient. This should include:

• the types and number of repetitions of each recommended exercise for each session
• the frequency of sessions
• the duration of each session
• the intensity of each session

Exercise programs should begin at a low intensity and gradually increase in rigor according to the tolerance of the patient. This helps to reduce the risk of injury and will increase the likelihood that the patient will continue the exercise therapy.

References

• http://www.ncbi.nlm.nih.gov/pubmed/15974634
• https://www.sciencedaily.com/releases/2014/11/141115083118.htm
• https://www.kidney.org/atoz/content/stayfit
• https://www.aakp.org/education/resourcelibrary/ckd-resources/item/physical-activity-and-exercise-the-wonder-drug.html