Physical functioning in end‐stage renal disease patients: Update 2005

Abstract

Physical functioning in patients with end-stage renal disease treated with dialysis is low, whether measured using objective laboratory measures, physical performance testing, or self-reported measures. Peak oxygen uptake (VO2peak), self-reported functioning measures, and physical activity levels are independent predictors of mortality in these patients. Cardiovascular exercise training studies result in improvements in VO2peak, physical performance tests, and self-reported functioning. Resistance exercise training improves muscle strength. Exercise training may have positive benefits on other factors that are important clinical issues in dialysis patients, including cardiovascular risk profile, oxidative stress, and inflammation. Endothelial function, a surrogate marker of atherosclerosis, has been shown to improve with exercise training in dialysis patients. Although there have been numerous recent studies on benefits of exercise, few dialysis clinics or nephrologists provide encouragement or programs as a part of their routine care of their patients. There are many national guidelines that include exercise or increasing physical activity as a part of the treatment of many conditions that are relevant in dialysis patients, including hypertension, hyperlipidemia, and high cardiovascular disease risk. The nephrology community continues to state concern for outcomes; however, a simple, low-tech intervention that has many benefits to their patients (i.e., encouragement, recommendations, and opportunity for increasing physical activity) has not been adopted as part of the standard care. Adoption of routine counseling and encouragement for physical activity has the potential to improve outcomes, improve physical functioning, and optimize quality of life and overall health of dialysis patients.

Relationship between Conditions Addressed by Hemodialysis Guidelines and Non-ESRD-Specific Conditions Affecting Quality of Life

“…Studies have demonstrated the effectiveness of treatments for several of the conditions, including impaired physical function (6,30), pain (31), and depression (32,33). The co-occurrence of multiple conditions would appear to be a formidable barrier to their successful treatment because of the need for many interventions.…”

Physical activity level and depressive symptoms in patients undergoing hemodialysis: a cross-sectional study

“…While 98.6% of U.S.A. nephrologists who were present at the Meeting of the American Society of Nephrology in 2001 have recognized the benefits of PA, only 28.5% were prescribing exercises to their patients 30 , which draws attention to the investigation of the reasons why this prescription or referral for the practice of PA is not being properly considered. Studies have shown the benefits of PA on the relief of depressive and psychological well-being symptoms 31,32 , with reduction of the BDI score after a program of intra-dialysis aerobic exercises in patients undergoing HD 33 , as well as the Brazilian Society of Nephrology itself recommends the practice of regular physical activity as a non-pharmacological measure for the control of CKD 34 . It was observed, in this study, that most part of the sedentary consisted of subjects who used to be inactive before the four years of treatment.…”

Associations of Self-Reported Physical Activity Types and Levels with Quality of Life, Depression Symptoms, and Mortality in Hemodialysis Patients

“…Our findings provide additional support to the promotion of physical activity programs in hemodialysis units. Despite the evidence supporting a role of physical activity in improving outcomes, the nephrology community has apparently not emphasized counseling and exercise programs to improve physical activity for patients on MHD (35)(36)(37).…”