Excercise ////// come on you slackers

Exercising legs while having dialysis boosts toxin removal from blood: study
Provided by: Canadian Press
May. 11, 2006

TORONTO (CP) - Exercising while undergoing dialysis appears to improve removal of toxins from the body and increase physical stamina for patients with severe kidney disease, a Canadian study has found.

The five-month study by researchers at Queen’s University found that patients who took part in a total of one hour of lower-extremity exercise while sitting in a dialysis chair showed a 20 per cent increase in the amount of urea removed through their blood and were able to walk significantly farther in a standard stamina test.

Urea is a toxic byproduct from the metabolism of protein and is used as a marker for up to almost 100 possible toxic substances that build up in the body due to kidney failure.

Hemodialysis takes over the key jobs performed by healthy kidneys - cleaning the blood of toxins and extracting excess fluid that would normally be voided as urine. The three-times-a-week procedure, which circulates blood through the dialysis machine and then back into the patient, takes about four hours per session.

"The standard saying is: ‘What goes in, stays in,’ " principal researcher Cheryl King-VanVlack said of the effects of kidney failure. The buildup of toxins and excess fluid - especially in the 48 hours between dialysis bouts - can damage almost every organ system in the body, including the heart, blood vessels, muscles and the nervous system.

The resulting condition is known as uremic syndrome and it can halve a person’s capacity to perform physical activities, for instance, making it difficult to walk up stairs without puffing, she said.

“Therefore, it’s very essential in order to maintain as optimal a physical function as you can to try to have an exercise program,” King-VanVlack, chair of graduate studies in rehabilitative science at Queen’s, said from Kingston, Ont.

Exercising while undergoing dialysis not only increases stamina and helps stave off the nasty effects of uremic syndrome, it also gives often-bored patients something to do while stuck in the dialysis chair.

The Queen’s study involved 13 men and women in their early 20s to 80s, who exercised their legs three times a week on special stationary “bikes” or mini-steppers that were placed in front of their dialysis chairs, said King-VanVlack. The exercise was done for 30 minutes in each of the first two hours of dialysis, when patients were strongest.

King-VanVlack said that during exercise, blood flow through the tissue increases, opening up capillaries and providing a greater surface area for exchange of substances from tissue to blood. That allows more toxins to be removed.

Physical function and stamina also improved for participants. In standard endurance tests - in which a person walks as fast and as far as they can in six minutes - the distance patients were able to achieve rose by 14 per cent.

In a previously published paper looking at patient perceptions of the exercise program, one participant said “it gives you more stamina, more strength in your legs,” while another reported: “I definitely feel stronger . . . it’s a lot easier for going up stairs, just doing anything, I know I have a lot more strength.”

About 15,000 Canadians were on hemodialysis at the start of 2004, the Kidney Foundation of Canada, quoting the latest figures available, says on its website. That figure represents a doubling of cases since 1993; the number is predicted to double again in the next decade, due in part to a rising epidemic of potentially kidney-destroying Type 2 diabetes.

Commenting on the study, Toronto nephrologist Dr. Sheldon Tobe said that although the number of participants was small, the results are clinically significant.

“It shows us a way that we can actually improve efficiency of the dialysis procedure,” said Tobe of Sunnybrook Health Sciences Centre, who was not involved in the study. “It shows us that we can make our patients healthier and it does that all during a period of time when a patient is just sitting there tied to the machine, really not able to do much.”

Tobe believes the results, along with the findings of other studies, are enough to recommend that hospitals consider equipping dialysis units with sit-down exercise machines.

Creating space and equipment costs could pose some financial barriers, but the benefits would be worth it, he said.

“If we make (patients) stronger . . . that’s been correlated with fewer falls; fewer falls means fewer broken hips,” which represent a far greater drain on health-care resources and patients’ quality of life, Tobe said.

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They had an excercise program back in the early years…doing it while on dialysis…

after 3 weeks of doing it I got a stroke… :frowning:

I heard a lot about this study, which was conducted in a city not too far from where I live.

Every stupid idea has its day, and it seems, another day. When I was dialyzing in-centre, I felt like I was barely alive during the treatment. Exercise while on treatment? I just can’t see it. I get my exercise during the off-hours fine, but during dialysis? Forget it, unless they put me right next to the ER while I’m doing it. Dialysis is hard enough as it is, and probably hard enough on the heart without adding to it with exercise, and I’ve seen how insanely long it takes to get a paramedic ambulance there when a problem does occur. I don’t know how a person could even do that without getting multiple pressure alarms the whole time. They must have selected their test patients very well. Any pressure at all on my arm during in-centre hemo and it was reset time for sure. Whatever gains they get in clearance are probably offset by having to turn the speed down. Armed with this study, the provincial government in Ontario is probably going to make dialysis patients start running or pedaling during treatments to produce electricity for the power grid :slight_smile:


Many clinics throughout the U.S. have started exercise programs for people on dialysis. In clinical trials of research on dialysis, people on dialysis in control groups who do not exercise become progressively weaker and more debilitated over a few months’ time compared with the experimental group of dialysis patients that exercised on dialysis who stayed the same or got somewhat better. Poor physical functioning affects one’s ability to do life activities, negatively impacts quality of life, and has been found to be predictive of hospitalization and death.

Clinics that have started exercise programs have considered that patients on dialysis can use that “down time” to improve their muscle strength and endurance. They are often bored and some experience depression, anxiety, muscle cramping and restless legs. Research has shown that these can be reduced with exercise. Physicians working at clinics where exercise is available have told me that their exercising patients take fewer pain and anti-anxiety medications and appear happier. One physician several years ago told me about improvement in exercising patients’ URRs, the subject of the research in the above abstract. In addition, patient self-report surveys show that exercising patients perceive they feel better physically and emotionally.

Gus, I’m sorry you had a stroke. Yours is the first serious complication that I’ve heard of or read about in research on exercise and the type of thing that dialysis professionals worry about. Was your blood pressure high before or during your exercise program? How long did your exercise and at what intensity level? Did the staff monitor your blood pressure while you were on dialysis? Did you have the stroke while you were exercising or at home? I’ve heard that strokes are more common than we know with young people and even babies have them. As long as exercise protocols are followed, patients typically only report muscle soreness as a result.

The Life Options Rehabilitation Advisory Council has produced exercise materials for patients and nephrologists that includes a prescribing guide for physicians. These materials were developed by an exercise professional and physicians. You can find them at http://www.lifeoptions.org under “free materials.”

Exercise has been done safely in dialysis clinics for years as long as it is physician prescribed and patients and staff follow a reasonable protocol with regular monitoring. In fact, if you do a search on the National Library of Medicine’s PubMed database for exercise & dialysis you’ll find over 600 studies from 1967-2006 on exercise in people on dialysis from 1967-2006. They are not all on exercise during dialysis, but report on exercise or the benefits of exercise and some report on in-center exercise programs. Choose “exercise program” & dialysis and you’ll find 36 studies from 1999-2006 done in the U.S. and other countries.

Patients should always check with their nephrologist and cardiologist (if applicable) before starting any exercise program. The doctor should review their health history to see if there’s any reason why they shouldn’t exercise. Patients who are exercising should report any symptoms that occur while exercising to their doctor and/or dialysis staff.

When exercise is done on dialysis, it’s usually done in the first hour of dialysis. Before exercise is started, patients must not have a fever and must have blood pressures below a certain level. The doctor who found that exercise at his US clinic improved URRs and resulted in less urea rebound after dialysis encouraged his patients to exercise in the last hour of dialysis, but that seems to not be the norm.

If dialysis patients don’t exercise during dialysis, they need to exercise at home. I suspect many dialysis patients get home and like most healthy Americans, they sit on their butts. If dialzying in-center, they feel tired and washed out, have limited energy and endurance, and feel like there’s no way they could exercise. If they start an exercise program, they try to do too much too fast and give up before they get much benefit out of it. Here are fact sheets that go along with a lengthy report by the surgeon general on activity and health:

What no one tells most people on dialysis is that they will get weaker if they don’t exercise. This will happen much faster than in people that don’t have kidney failure. Besides the benefits I mentioned before, exercise causes sweat that gets rid of some extra fluid, it keeps bones healthy (weight-bearing exercises especially), reduces anemia with less medication, stimulates appetite (important in those that have little or none), and more.

Obese USA,

My advice to all over weight Americans on dialysis and non-Americans is to learn how to eat healthy and to execise everyday for at least 15-30 minutes…
– Keep in shape and feel good with good management on your diet and being active…
– Avoid eating at fast food restaurants, just now and then but not occasionally.
– Avoid soft drinks and try water and juices
– Add more veggies to your diet…
– No fried foods, try steam and oven baked instead…

I am wondering how Nocturnees are expected to exercise in bed under the covers? Perhaps I better not go there…

A wonderful experience I had on my couple of days away at Noosaville hospital, QLD on hols was a heavenly half hour foot and leg massage provided every day by hospital volunteers. It was absolutely heavenly and I felt great afterwards.

I have an idea, use one of those therapy beds that have moving Jade beads…that will really breakup uremic syndrome… :?:

I have a problem with low pulse during txs. and it wipes me out. Doctor kept insisting that it was the med. I’m on, which has been cut so far down that now I’m not taking any. I think most people my age or younger that are on dialysis don’t spend their down time just sitting around so there is no reason to exercise during tx… People don’t realize that most pts. just don’t feel that great during txs… I’m in fact one of the few pts. in the unit I go to that doesn’t fall asleep during tx… After 1/2 hr. or so I don’t even have any concentration and often just close my eyes. However, if once on home hemo I feel better I will glady peddle during txs… and after too. I’ve gained weight since being on dialysis and would love to have the stamina to get rid of it. Lin.

When I started this thread, I didn’t know it was going to turn out to be so entertaining. Over the years, I have heard other patients mention the exercise wheels that can be used on dialysis. I think one patient said that her unit had them, but no one showed any interest so they packed them away in a closet. Another patient said there was a gym in her dialysis bldg., but didn’t really elaborate on how involved patients were in using it.

I wonder where these units are that use the exercise wheels as no one ever mentions them online. When I first heard of the concept, I thought I would like to try it, but when I really thought about it, it does not seem to be a good idea as I certainly agree with others that the effect of dialysis on the body is so intense, and one is protective of not jarring needles, that he feels completely unwell to exercise at the same time - that is the last thing one is able to comfortably and safely do while on conventional dialysis.

It is not a matter of being bored with nothing to do so why not exercise. It would put undue stress on an already stressed body (from the tx.) and might definitely cause a heart attack or stroke. I am especially surprised by the doctor who thought the last hour of the tx would be the best time for patients to exercise in order to improve clearance, as the last hour is the very most intense segment of the tx as far as pressure on the body, lack of mental clarity etc. It would be like telling a boxer to go jog when he had just received a knock out punch.

And I can just imagine my staff monitoring me whice using the exercise wheel—“I’ll be back in a sec…have to go check the bicarb in the back.”…don’t leave…come back here :!: :!: :!: :!: :!: :?

It is hard to believe patients who were involved in these trials really said they felt better. I mean like how many of them were left alive lol? No, seriously, I am all for exercise…just not while on the machine. Really and truly, I think every neph should advocate exercise for patients and provide education on it. Not a single one of mine (7 to date) has ever even mentioned it. Then again, not every neph or staff is in good physical shape and has the best health habits, either :frowning:

Now like beachy, something I could REALLY get into while on tx is massage :o A neck rub, leg rub, foot rub…bring it on :!: :!: :!: And, Gus, you’ve got it right with the jade beads therapy bed, uremic syndrome pack it up :!: :stuck_out_tongue:

perhaps they tried it at one point in the units because it’s easier to get some people to do something if it’s done in a group setting. When I worked in homecare there were pts. who would do the rehab exercises the therapist gave them, and others who would complain they weren’t working; they only did them on the days the therapist came and was coercing them into action.
I have limitations now but not just because of dialysis, so I’m looking forward to getting back into shape. When I took my dogs to the vet. last he mentioned “they” are a tad overweight; me too because walking two dogs that are different sizes is exercise!
The first unit I was in had an exercise bike; I couldn’t use it because the machine alarmed for pressures if I even breathed heavy. Never saw anyone else use it. Lin.

When I was in Singapore in 2004 I dialyzed at a beautiful unit – it was their showcase. In the lobby of the third floor 18 station unit they had a couple stationary exercise bikes and I think a treadmill. I was told that some patients used it as part of an overall coercive system of compliance – to the NKF of Singapore’s credit they have the best mortality rate I’ve ever heard of - the dialysis system was run like a benevolent dictatorship.

During treatment – perhaps for my benefit as I was part of an official delegation but they said this was a regular occurrence – they put on an exercise video that came on all the TVs, interrupting what ever you had been watching. The video switched between a guy and a gal who demonstrated movement exercises while they supposedly dialyzed. I say supposedly because I noticed they didn’t have a bicarb or acid bottle hooked up to the front of the machine but they did have lines of red fluid going to/from their arms.

I pointed out the discrepancy and the staff had to admit they were actors. heh.

We have Pedlars at NKC. I’ve never used them. Of greater use is the agreement NKC has with the YMCA. Every NKC dialyzor can join the YMCA at a discount – the Y accepts NKC determination of need, no more paper work to fill out and the monthly rate is set based on NKC’s determination of the dilayzor’s ability to pay. Everyone has to pay at least $5 a month- the thinking is that people do not value what they get for free.

As far as the study, I think it is more about movement than exercise. The blood tends to stay in one of four flow paths – left leg, right leg, left arm, right arm. By moving around you get the blood to ‘mix’ more i.e. distribute the waste products more evenly.

I think movement while on dialysis can be done by most of us without having to worry about having a heart attack I’m don’t think you’d need to break a sweat. I can see how the more you move around the more efficient your dialysis could get.

As I understand it, when someone has kidney failure toxins build up in the tissues. Toxins in the tissues need to get into the bloodstream to be removed during dialysis. As the blood becomes cleaner, more toxins move from the tissues into the bloodstream. When someone exercises on dialysis, apparently the toxins in the tissues move into the blood stream faster making dialysis more efficient and removing more toxins and improving Kt/V and URR.

I worked in a clinic that had an exercise bike. There were patients that used it every treatment. One patient would have biked her whole dialysis treatment if we’d let her. The main deterrent I saw to our biking program was that if the tech that started the program wasn’t there to push the staff who didn’t like to move the bike from person to person, it didn’t always happen. Staff who didn’t exercise themselves didn’t ask patients if they’d like to bike in a way that encouraged its use. They also relocated biking patients to chairs where space did not allow biking and patients didn’t feel comfortable telling staff that was why they stopped biking.

I observed patients who got more leg strength – enough that they were able to stop using walkers or canes and walked independently. I’ve worked in enough clinics and watched patients come in walking independently who later needed to use canes, then walkers, then wheelchairs to think that if a few minutes of low intensity biking can prevent that, as the research shows, I’m for it.

I suspect the folks on this message board are exercising and may not need a dialysis exercise program. However, there are many patients who don’t know what to do to exercise safely and need a little extra encouragement that clinic patients and staff can provide along with making a contest or game out of it. Here are some tips and stories about exercise–some shared by patients and others by professionals:

Check out the other tips and stories on the Life Options website (http://www.lifeoptions.org). The idea is no matter whether you exercise on dialysis or exercise independently at home or at a gym, get moving and listen to your body when it tells you enough is enough. And always ask your doctor if it is safe for you to exercise and what exercises you should and should not do. Keep in mind that cardiac rehab is for patients who had recent heart attacks and has them use bikes and treadmills at higher intensity than people on dialysis probably exercise.

Here’s the abstract that I bet is is the basis of the report Jane posted. As you’ll see, the patients were stable and had been on dialysis 6 months or longer and the researchers screened patients for any reasons that would make it unsafe for them to bike during the first two hours of dialysis at low intensity.

Arch Phys Med Rehabil. 2006 May;87(5):680-7.

Exercise training during hemodialysis improves dialysis efficacy and physical performance.

Parsons TL, Toffelmire EB, King-VanVlack CE.

School of Rehabilitation Therapy, Queen’s University, and Division of
Nephrology, Kingston General Hospital, ON, Canada.

OBJECTIVE: To determine the impact of a 20-week intradialytic exercise program, consisting of 60 minutes of cumulative duration, low-intensity exercise during the first 2 hours of dialysis, on dialysis efficacy, physical performance, and quality of life in self-care hemodialysis (HD) patients. DESIGN: One-group repeated measures. SETTING: Satellite HD units affiliated with a Canadian teaching hospital. PARTICIPANTS: A convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac, pulmonary, and/or musculoskeletal pathology that would preclude exercise. INTERVENTION: A 5-month intradialytic exercise program in which subjects exercised 3 times a week (cycle ergometer, mini-stepper) for 30 minutes in each of the first 2 hours of HD. MAIN OUTCOME MEASURES: Dialysis efficacy (in single-pool model of urea kinetics [spKt/V]) was assessed prior to and at the end of each month of the exercise program. Physical function (6-minute walk test [6MWT]), and quality of life. (Kidney Disease Quality of Life-Short Form [KDQOL]) were determined at baseline and at weeks 10 and 20 of the exercise program. RESULTS: SpKt/V increased 11% at the end of the first month of the program (P<.05) and remained elevated for the duration of the program (18%-19%). Distance walked on the 6MWT increased by 14% at both weeks 10 and 20 (P<.05). No changes were noted in KDQOL scores. CONCLUSIONS: A low-intensity intradialytic exercise program is a viable adjunctive therapy, which improves HD efficacy and physical function in HD patients.

Do nocturnal hemo and you’ll have lots of time to exercise during the day :slight_smile:

One thing I’ve noticed about exercise for me is that anything more than about half an hour on my bike or walking, and I get some pretty vicious restless legs syndrome later on that day.


I have an all body workout bike that I use…first time I used that device I was only able to do 50 cycles, now I do about 400 cycles, only for about 15-30 minutes…

Thanks for all the info you shared on exercise. I found it very interesting. I am for anything that improves the dialysis tx. Although I haven’t had time yet to research this further, it sounds like the required leg movements are slower than an exercise bike so then that does not sound excessive.

I looked up “ergometer dialysis” on Yahoo and found loads of articles. I was really surprised to find so much on this since it’s rarely spoken of. Now I’m even getting aggravated to think that none of my nephs have emphasized exercise. I see so many patients who can not walk unassisted. The lack of education is appalling. For nephs to look at patients’ labs for under 60 seconds and then take off without providing any significant education or guidance, they are not doing their job.

I did read your Life Options articles and it seems that the services of physical rehabilitation trainers are also very underutilized. It seems that dialysis patients should have an exercise regime tailored to their special needs and this should be a significant part of their overall care since deterioration can occur so quickly without their awareness. It appears Life Options did their homework- how nice it would be if more nephs and unit staff stressed the importance of exercise, too.

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Time to train all doctors to look after seriously ill patientsThe patient cycled behind the ergometer from their dialysis chair initially, but could progress to pedalling on the ergometer chair if they so wished. …
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Time and exercise improve phosphate removal in hemodialysis patients… 12 different patients underwent an exercise program in which they pedaled a bicycle ergometer either immediately before or during dialysis. …
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve& db=PubMed&list_uids=14712431&dopt=Abstract

Exercise for the dialyzed: aerobic and strength training during …Training, consisting of cycle ergometer exercise and strengthening of the knee extensors two to three times a week for 3 mo, was done during dialysis. …
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve& db=PubMed&list_uids=12394992&dopt=Abstract
[ More results from www.ncbi.nlm.nih.gov ]

Effect of Exercise during Dialysis on Urea Clearance: A … a dialysis session compared with no exercise performed during another dialysis session. Renal patients (N = 8) pedaled a bicycle ergometer for 30 min, …

Changes in muscle morphology in dialysis patients after 6 months …2003 European Renal Association-European Dialysis and Transplant Association … [2] implemented a cycle ergometer training regime of 6 months duration that …

Report from the Second International Congress on Quality of Life …Today, the majority of dialysis patients are elderly, however, these patients were able to participate in bed-bicycle ergometer training during …

[PDF] -Carnitine Supplementation in a Hemodialysis Patient with a …File Format: PDF/Adobe Acrobat
ergometer (20 W, 15 min) 1 year before (d), at baseline §, and … right-heart catheterization after dialysis ses-. sions slightly increased from 2.8 to …
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF& ProduktNr=223854&Ausgabe=224789&Art…

Five Months of Physical Exercise in Hemodialysis Patients: Effects …From the Dialysis Centre, 100 HD patients from a total of 260 were invited … The test was performed on an electrically braked Krogh bicycle ergometer with …
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext& ProduktNr=228539&Ausgabe=229953&am…
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[PDF] HaveYou Ever Considered Home Dialysis? HOME HEMODIALYSISFile Format: PDF/Adobe Acrobat - View as HTML
b) home dialysis staff available or on call 24. hours a day for dialysis medical … bicycle. Teadora uses an arm. ergometer to build upper. body strength. …

Medicine & Science in Sports & Exercise - Fulltext: Volume 34(8 …HD patients exercised during the first 2 h of dialysis also under the supervision of an exercise physiologist with a cycle ergometer (Monark 814) attached …
www.ms-se.com/pt/re/msse/fulltext.00005768-200208000-00002. htm;jsessionid=DryRDY8K0MXqWybEQWdXC4fMGRQBpD4…

Guys still interested in this? :lol:

Read more about it on this article…

“…Blood flow through the tissue is increased when exercise using lower extremity muscles allows capillaries to open up more to provide a greater surface area for exchange of substances from tissue to blood, researchers say. …”

Wouldn’t raising the room temperature do the same thing?