Exercise for Kidney Patients - University of Leicester

University Hospitals of LeicesterNHS Trust

Exercise for Kidney Patients

Renal Services

Information for Patients

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Introduction

Regular exercise can:

• Give you more energy

• Make you feel stronger

• Improve your mood and quality of life

• Reduce stress and help you sleep

• Help your digestion and prevent excessive weight gain

• Help control blood pressure

• Reduce cholesterol levels and your chance of developing heartdisease

• Strengthen your heart and bones

• Help reduce your blood sugar

• Improve the efficiency of dialysis if this is relevant to you

• Overall, make you feel good …

Many kidney patients believe they cannot exercise. But most canexercise. It will help you feel better, stronger and more in controlof your health. You just have to tailor the exercise to you andyour circumstances. Whether you want to return to work, dodaily household activities, or manage your own health care,exercise will help you.

This guide answers some of the questions you may have and willhelp you establish an exercise programme to suit you.

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Why should I exercise?

People with kidney problems often suffer from a lack of physicalstrength, tiredness and muscle wasting, which reduces theircapacity for physical activity.

There are three main reasons why this happens:

• toxins build up in the body because the kidneys cannot excretethem properly;

• kidney patients often become anaemic, which causes tirednessand breathlessness;

• this means that the patient doesn’t feel like doing much, sothey lose fitness and strength, and feel even more tired.

How do I start an exercise programme?

There are three basic steps for you to take to start an exerciseprogramme:

1 Talk to the people involved in your care

They can tell what exercise is best for you because they knowabout your condition and treatment and what you can and can’tdo. Your carers will probably be very happy that you are askingabout exercise.

2 Plan your exercise programme

When planning an exercise programme, you need to look at fourthings:

• the type of exercise

• the length of time you spend exercising

• how often you exercise

• how hard you work while exercising.

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Your exercise plan

Type of exercise

A good exercise programme consists of three different kinds ofexercise : cardiovascular (for heart and lungs), resistance andstretching. Each of these has different health benefits and youshould try to do some of each kind.

Warming up and cooling down

Both cardiovascular and resistance sessions must always start witha 5 minute gentle warm-up with some light cardiovascularactivity, followed by some stretching. Then you can work harderfor a while, before slowing down again towards the end. Finishwith some more stretches.

Cardiovascular exercise

This is a continuous activity such as walking or cycling, using largemuscles. It benefits your whole body and makes you feel good.Think about what kind of thing you enjoy. Most people likewalking. This is an ideal exercise, and a very good way to start.Others may want to do something else such as cycling, swimmingor using gym equipment. It’s up to you! You can combinedifferent kinds of exercise on different days. We are introducingexercise bikes into some dialysis units and you may have theopportunity to use one of these.

Resistance exercise

This is for muscle strengthening, but will also benefit your wholebody. Kidney patients often suffer from muscle wasting andresistance exercise can help with this. Building stronger muscleswill help you do other forms of exercise more easily as well.

It is not necessary to lift heavy weights. It is better to use smallerweights and do more repetitions. We have included somesuggestions of exercises for you to do in this guide.

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Your exercise plan

S-t-r-e-t-c-h-i-n-g

It is easier to start exercising if you stretch first. Stretching issomething almost all patients can do.

We have included some stretching exercises for you in this guide.

How long to exercise

Work towards 30 minutes a session. You should build upgradually to this level.

There is nothing magical about 30 minutes. If you feel likewalking for 45 to 60 minutes, go ahead. Just be sure to followthe advice listed under ‘What are the signs that I should stopexercising?’ in this guide.

How often to exercise

Exercise at least three days a week. These should be non-consecutive days, for example, Monday, Wednesday and Friday.Three days a week is the minimum requirement to achieve thebenefits of your exercise. You can do it more often if you want to.

How hard to work while exercising

This is the most difficult to talk about without knowing your ownexercise capacity. Usually, the following ideas are helpful:

• Your breathing should not be so hard that you cannot talkwith someone exercising with you. (Try to get an exercisepartner such as a family member or a friend.) You should feelcompletely normal within one hour after exercising. If not,slow down next time.

• You should not feel so much muscle soreness that it keeps youfrom exercising the next session.

The most important thing is to start slowly and progress gradually,allowing your body to adapt to the increased levels of activity.

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Making the most of your exercise

When you exercise, you need to make sure you are doing enoughwork to benefit your health and increase your capacity to do thethings you want to do in life. But don’t do so much that it hurts oryou feel unwell.

When we are assessing with patients how much exercise theyshould do, we use the Borg 15-point Perceived Exertion Scale.This ranges from 6 to 20. At point 6 you would be sitting doingnothing. At point 20 you would have done so much exercise thatyou were exhausted and could do no more. You need to aim for asteady exercising pace, between 12 and 14.

While you are exercising, rate yourself against the Borg scale tothink about how much you are exerting yourself. How mucheffort are you putting in, how is your breathing and how do youfeel? If you rate yourself at 11 on the scale – fairly light – tryexercising harder to reach 12, 13 or 14. If you rate yourself at 17,you probably need to be working less hard at your exercise. Asyou build up your endurance, you should find you can do morework within the ‘moderately hard’ 12 to 14 scale.

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Making the most of your exercise

Borg 15-point Perceived Exertion Scale

6 No exertion at all7 Very, very light89 Very light1011 Fairly light1213 Moderately hard1415 Hard1617 Very hard1819 Very, very hard20 Exhaustion

Get started!

Don’t be nervous or think it’s going to be too hard. Many peoplewith renal failure say they are too tired to exercise. They thinkthat if they exercise they will be even more tired. The fact is, evena little bit of exercise, 15-20 minutes a day, will actually help youfeel LESS tired.

Start slowly and just do what you can – you aren’t aiming tobecome a marathon runner. As long as you keep doing itregularly (at least 3-4 times a week), you will gradually getstronger and be able to do more and more.

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Develop Flexibility - Stretching Exercises

Neck Stretch - Neck

• Sit or stand upright lookingstraight ahead

• Slowly lower your right earto your right shoulder

• Bring your head back upand lower your left ear toyour left ear

• Repeat a few times untilyour neck muscles feellooser

Head Turn - Neck

• Slowly turn your head tothe right looking over yourright shoulder

• Slowly turn your head backto centre

• Then turn your head to theleft to look over your leftshoulder

• Slowly return your head tothe centre

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Shoulder Shrug - Shoulders,chest and upper back

• Sit or stand upright

• Shrug your shoulders up toyour ears, hold and repeat

Chest and Upper Back Stretch -Shoulders, upper back andchest


• Put your hands on yourshoulders and elbows outto the side

• Touch your elbowstogether in front of yourchest

• Move your elbows out wideagain and squeeze yourshoulder blades together

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Arm Stretch and WristRotation - Arms, Wrists andShoulders


• Start with your armsstraight by your side

• Bring your arms up straightin front of you at shoulderheight

• Make small circles withyour wrists to the right andthen to the left

• Bring your arms back downto your side

Side Stretch - Neck and Side

• Sit or Stand upright

• Bring your hands up overyour head to stretch up tothe ceiling

• Lean over to your right,you should feel a stretchdown your left side

• Move back to the centre

• Now lean over to your leftside

• Move back to the centre

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Single Knee Pull - Lower backand back of thigh - hamstrings

• Sit up straight

• Bend over and pull yourknee towards your chestholding it with both hands

• Try to touch your foreheadto your knee, or as close asyou can get to it

• Hold for about 10 secondsand lower your knee backdown

• Repeat with the other leg

Hamstring Stretch - Back ofyour legs - Hamstrings

• Sit upright in a chair or onthe floor

• Using a towel, place it underyour foot and straighten yourleg lifting it off the floor

• Gently pull the ends of thetowel towards you flexingyour foot towards you

• Put your foot back to thefloor and repeat using theother leg

• If you find this easy sit onthe floor with one legstraight in front and reachdown to your toes

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Quadriceps Stretch - Front ofthigh - quadriceps

• Stand upright and hold onto something for support

• Hold onto your right ankleusing your right hand

• Bring your foot up to yourbum keeping your kneestogether

• Release your foot to thefloor and repeat using theother leg

Calf Stretch Back of lowerlegs – Calf

• Stand up straight and holdonto something for support

• Step your right leg straightback and make sure yourheel is pressed onto the floor

• Bend your front leg slightly,making you lean forwards

• Repeat with the other leg

• If you can’t feel the stretch,move your back leg slightlyfurther back

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Develop Muscle Strength - Resistance Exercises

You don’t need expensive equipment to do resistance exercise.You can use things that are around your house. If you use milkbottles you can vary their weight by varying the amount ofliquid. Tins of food also make good weights.

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Bicep Curl Front of arms -biceps

• Sit or stand upright holdingyour weight by your side

• Keeping your elbows byyour side bend your arms atthe elbows and bring yourhands up towards yourshoulder

• Repeat as many times asyou feel you can

Shoulder Press - Shouldersand upper back

• With your arms raised bendyour elbows at shoulderheight – just like in thephoto

• Push your arms straight upin the air

• Then move them backdown to the start positionwith your elbows bent

• Repeat as many times asyou can

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Side Raise - Side of shoulders

• Stand upright holding yourweights by your side

• With straight arms bringyour arms out to the side inline with your shoulder,making sure you keep yourback straight

• Under control, return yourarms to your side andrepeat as many times asyou can

Front Shoulder Raise - frontof shoulders

• Stand upright holding yourweights by your side

• With straight arms raiseyour hands in front of youto your shoulder height

• Under control, return yourarms back down to yoursides

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Tricep Extension - Back ofupper arm - triceps

• Stand upright with one armabove your hand and yourother supporting the elbow

• Slowly bend your arm andlower your arm behindyour head

• Slowly bring your arm backup again

• Repeat as many times asyou can then swap arms

Wall Push up - Upper arms –biceps and triceps

• Stand straight facing a wall

• Place both hands on thewall at shoulder height

• Lean forwards bendingyour elbows until your nosenearly touches the wall

• Push away from the walluntil you are upright

• Repeat

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Bench Press - Chest

• Lie flat on your back withyour knees bent

• Start with your arms bentand hands directly overyour chest and elbowstucked into your side

• Push your arms straight upinto the air

• Then under control returnthem to the start position

Sit up - Stomach - abdominals

• Lie flat on the floor withyour knees bent

• With your hands by yourhead, curl your head andshoulders until yourshoulder blades are off thefloor

• Slowly lower

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Back Extension - back

• Lie on your front with yourhands facing palms downby your head

• Slowly raise your head andshoulders off the floor

• Hold for a few seconds andslowly return your headand shoulders back downto the floor

Side Leg Lift - Hip

• Lie on your side

• Use the arm underneathyou to support your headand the other in front forsupport

• Slowly raise your top legand replace back down tothe floor

• Turn over and repeat withthe other leg

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Chair Squat - Top of legs –Hamstring and quadriceps

• Stand in front of a sturdychair and reach back andplace your hand on thearms for balance

• Have your feet shoulderwidth apart and go to sitdown, but don’t

• Hold this position for a fewseconds and push back upusing your legs to stand

Stair Step - thigh - quadriceps

• Stand up straight in frontof a small step

• Hold on to something closeto you if you wish, or placeboth hands on your hips

• Step up onto the step usingyour right foot and thenyour left

• Step back down with yourright then left

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Lower Leg Extension - Thigh -Quadriceps

• Sit upright with both feetflat on the floor

• Hold onto the seat forsupport

• Lift one leg off the floorand hold it out straight

• Bend your knee and slowlylower your foot to the floor

• Repeat with the oppositeleg

Back Leg Swing - back of legs- hamstrings and back

• Stand upright in front of achair and hold the back forsupport

• Keeping your back straightbring one leg behind youpointing your toes

• Slowly return your foot tothe floor

• It’s important not to archyour back

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Heel Raise - Lower legs - Calf

• Stand in front of a chairand hold on to the back forsupport

• With both feet, lift yourheels and stand on the ballsof your feet

• Slowly return to standing

• If you find this easy putyour hands on your hips

Lunge - Lower legs -Quadriceps and hamstringsand bum

• Find something you can holdonto, a broom for example

• Step your left foot out infront with the heel of yourback foot slightly off thefloor

• Keeping your back straightbend your front kneekeeping it over your foot.

• Hold for a few seconds andpush back up

• Repeat using the other leg

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Develop Endurance - Cardiovascular Exercises

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Develop Endurance - Cardiovascular Exercises

But also enjoy your favourite activities…

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Frequently asked questions

What do I need for exercise sessions?

A decision

Give exercise a try for a period of three months. One exercisesession will not help. As the time goes by, you will start to feelthe benefit. Consider exercise to be a part of your treatment,together with your diet and medicines.

Persistence

There will be times that you will miss your exercise sessions forany number of reasons, including hospitalisations. Don’t give up!Start again from a lower threshold and you will soon work yourfitness up again. There will be good days and bad days. If somedays you feel very tired, you can exercise for a shorter period oftime. Even five minutes is better than nothing!

Clothes and shoes

You don’t need fancy or expensive sports clothes for exercise.Wear comfortable shoes (not high heels!) and clothes that arenot too tight. If you have several layers of light clothing you canremove or add some of them as needed.

I’m so busy. How can I find time to exercise?

Anyone can work some exercise into the daily schedule.Remember – it will really help you, so it’s worth making it apriority.

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You can do many exercises at home, outdoors or even at work.Here are some suggestions:

• Exercise while watching TV. You can do stretching exercises oruse free weights or equipment such as an exercise bike;

• Exercise around the neighbourhood. You can walk or cycle tothe shops, work in the garden, mow the lawn or take out aball or Frisbee and offer to play a game with the kids;

• Get your family or friends to exercise with you – it’s good forthem too!

• Exercise at work. Park your car at a distance or get off the busa stop early and walk 10 minutes to the office. Use the stairsinstead of the lift, and take a brisk walk in your lunch break.

Are there any times when I should not exercise?

Yes. You should not exercise without talking with your doctor ifany of the following occurs:

• you have a fever

• you have changed your dialysis schedule

• you have changed your medicine schedule

• your physical condition has changed

• you have eaten too much

• the weather is very hot and humid, unless you exercise in anair-conditioned place

• you have joint or bone problems that become worse withexercise

If you stop exercising for any of these reasons, speak to yourdoctor before beginning again.

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What are the signs that I should stop exercising?

Stop at once if you notice any of the following during an exercisesession:

• If you feel chest pain

• If you feel irregular or rapid heart beats

• If you feel sick to your stomach

• If you get leg cramps

• If you feel dizzy or light-headed.

If you need any more advice, please talk to the doctors, nurses orother members of the clinical team you see regularly.

If you have any questions about our research into the effects ofexercise on people with kidney disease, members of the RenalResearch Group will be happy to talk to you. Please contact theteam's senior scientist and immunologist on 0116 252 5033 oremail [email protected]

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Your questions and comments

Haddaad rabto warqadan oo turjuman oo ku duuban cajaladama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta0116 258 4382.

Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasınıisterseniz lütfen servis müdürüne 0116 258 4382 telefonundanulaşabilirsiniz.

If you would like this information in anotherlanguage or format, please contact theService Equality Manager on 0116 258 4382

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Exercise for Kidney Patients - University of Leicester