Exercise, Dialysis, and Environment: A Narrative Review in an Ecological Perspective

Abstract

Patient empowerment and environmental sustainability may contribute to creating efficient and resilient healthcare models. Chronic kidney diseases call for a sustainable approach aimed to improve physical function and mental health of patients and possibly to contribute to the slowing down of the evolution towards the end stage of renal disease (ESRD) with a reduction of the environmental and economic impact . Summary Multidisciplinary interventions should be implemented particularly at the final stages when patients are exposed to sedentariness, reduced health-related quality of life (HR-QoL), high cardiovascular morbidity and mortality and the health care services to high costs and participation in environmental pollution. Ecological strategies based on specific nutritional approaches, exercise and environment should be designed and tested. In particular, introduction to physical exercise represents a useful replacement therapy to counteract the hazards derived from the sedentary behavior of ESRD patients, being low physical function associated with poor clinical outcomes. A more active and healthy lifestyle, particularly in the natural environment, could impact on HR-QoL, mental and physical wellbeing but also on socialization, with lower levels of anxiety and fatigue stress. Otherwise the combination of sustainable models of exercise into the patients' daily routine can be enhanced by the biophilic design called to reproduce a natural environment in the dialysis center. Finally, the involvement of the personnel and of the health professionals to properly manage the exercise interventions and the related factors (location, modality, dose, intensity and duration) might improve the patients’ participation. In particular, ecological programs should be broadly inclusive aimed to target the lowest performing populations through minimal feasible doses of exercise. Key Messages Moving towards an ecological framework of lifestyle change, in the very advanced stages of kidney disease the potential synergies between environment, diet, and exercise may improve the physical and mental health of the patients and reduce the impact of dialysis.