Exercise: The Wonder DrugExercise: The Wonder Drug Exercise Essentials for AllExercise Essentials for All

Dan Bayliss, MS CESDan Bayliss, MS CESClinical Exercise PhysiologistClinical Exercise PhysiologistUniversity of Virginia Renal University of Virginia Renal ServicesServicesUniversity of Virginia Medical University of Virginia Medical CenterCenterCharlottesville, VirginiaCharlottesville, Virginia

““Lack of activity destroys the Lack of activity destroys the good condition of every human good condition of every human

being, while movement and being, while movement and methodical physical exercise methodical physical exercise

save it and preserve it.”  save it and preserve it.”  ~Plato ~Plato

IntroductionIntroduction• Benefits of Exercise • Physical activity vs. Exercise• When Not To Exercise• How To Get Started• Exercise Components• Hemo vs. Peritoneal vs. Transplant • Helpful Hints• Additional Resources

Exercise?? Are you Kidding??Exercise?? Are you Kidding??

• You can do it!!• Activity levels and chronic disease• Does exercise/physical activity help?

Benefits of Exercise for Renal Benefits of Exercise for Renal PatientsPatients

• Increased endurance• Increased strength• Increased flexibility• Increased energy• Helps lose or maintain weight• Improves feelings of depression• Improves sleep!!• Improves blood pressure

Benefits cont.Benefits cont.

• Stabilizes blood sugar levels• Strengthens your heart• Improves cholesterol levels• Improves microcirculation• Reduces the risk for heart disease

Physical Activity vs. ExercisePhysical Activity vs. Exercise

• Physical Activity, defined by the American College of Sports Medicine (ACSM) as “any bodily movement that is produced by the contraction of skeletal muscles and increases energy expenditure.”

• In other words, get up and move!!

Exercise vs. Physical Activity cont.Exercise vs. Physical Activity cont.

• Exercise is defined as “a subclass of physical activity, planned structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.”

• In other words, going for a walk or going to the gym and working on cardio machines or even taking a pool class.

When Not To ExerciseWhen Not To Exercise• Body temperature >101.0 degrees (38.3

degrees C)• Missed more than one treatment• Newly undiagnosed illness• Pain• Not feeling well• Blood Pressure <200/100• Unstable sugar levels

SYMPTOMS THAT SHOULD SYMPTOMS THAT SHOULD BE REPORTED TO YOUR MDBE REPORTED TO YOUR MD

• Pain or pressure in chest, neck or jaw• Excessive fatigue, not related to lack of

sleep• Unusual shortness of breath• Dizziness or lightheadedness during or

after exercise• Persistent rapid or irregular heart rate

during or after exercise

How to Get StartedHow to Get Started

The “FITT” Principle

• FREQUENCY (days per week)• INTENSITY (how hard) • TYPE of Activity• Time (how long to go)

FREQUENCYFREQUENCY• Walk around your block once or twice a

week • Community program• Senior recreation program• Start with 5 or 10 min, or what you can

tolerate• Add 1-2 min every week• Goal duration should be 20-60 min

INTENSITYINTENSITYGo at your own pace• Talk Test

–Exercise at conversation level–If you’re short of breath, slow down

• Rating of Perceived Exertion (RPE)• Listen to your body!!

RPE ScaleRPE Scale

TYPE OF EXERCISETYPE OF EXERCISE

• Endurance Exercise• Anything that involves working your arms

and legs• Continuous, repetitive, structured activities

– Walking, cycling, dancing, swimming, stair climbing

• Warm-up/ Cool down

TIMETIME• Start with what you can tolerate• Walking

– add 1-2 min• Stair climbing

– Add 1-2 steps per week• Work towards 30-60 min most days of the

week• The more you do, the stronger you’ll get!!!• YOU CAN DO IT!!

Strengthening ExerciseStrengthening ExerciseHelps improve or maintain strength• AT LEAST 2x/week• Hand weights, leg weights, resistance

bands, milk jugs• Slow and easy progression• Lift 8-12 times• 8-10 different exercises• Take a break (1 set)• Repeat

Flexibility ExerciseFlexibility Exercise• Helps prevent joints from becoming stiff

and painful. • Types of flexibility exercises:

– Stretching– Yoga– Chair stretches

Outpatient HemodialysisOutpatient Hemodialysis• UVA unique to outpatient exercise• HD patients tend to be less active• Strengthening/flexibility exercise

recommended• Patients usually sit for 2-4 hours, what else

do you have to do?• Make the commitment to yourself• Consider it “gym time”• Exercises should be done within the first

hour of treatment

Peritoneal DialysisPeritoneal Dialysis• Exercise in the middle of dialysis

exchange and before adding the new dialysis fluid–Allows less pressure on the

catheter–Reduces the risk of hernias and

catheter leaks• Keep catheter clean

Peritoneal Dialysis cont.Peritoneal Dialysis cont.• Tips to keep in mind:• No full sit-ups, try curl-ups or “crunches”

Peritoneal Dialysis cont.Peritoneal Dialysis cont.

• Cycling–Keep bag away from pedals

• Swimming–Sea/pond water vs. chlorinated

water

TransplantTransplant • Benefits include:

– Weight management– Regaining physical function– Maintain muscle mass– Other benefits similar to Hemodialysis

patients– recovery from surgery

• Speak to your MD before starting• Walking is recommended immediately

post transplant

Transplant cont.Transplant cont.• NBA stars Alonzo Mourning and Sean

Elliot

Transplant GamesTransplant Games

• Transplant games

• Sponsored by NKF

Helpful HintsHelpful Hints• Talk to your MD before starting an

exercise program!• Keep a log • Start slow, results take time• Get other family members involved• Bound to wheelchair?• Physical Therapy/Cardiac Rehabilitation• Make physical activity a priority in your life!• It takes time but it also makes time!!

Additional ResourcesAdditional Resources

• www.lifeoptions.org–Exercise: A Guide for People on

Dialysis• www.smallstep.gov• www.kidney.org

–Staying Fit with Kidney Disease–Transplant Games

RenalRehabResourceCenter

www.lifeoptions.org(patients > free download materials)

1-800-468-7777

So whatever happens in Vegas, So whatever happens in Vegas, should NOT stay in Vegas when should NOT stay in Vegas when

it comes to exercise and physical it comes to exercise and physical activity!!activity!!

Surgeon General’s Warning:

PHYSICAL INACTIVITY MAY BE HAZARDOUS TO YOUR HEALTH

Patricia Painter, Ph.D.