Patient fitness: Staying well with renal failure

Patient fitness: Staying well with renal failure

Can I take part in vigorous physical activity?
Yes. In the past, it was thought that people with kidney disease would not be able to join in vigorous activity. We know now that patients who decide to follow an exercise program are stronger and have more energy.

How does exercise benefit me?
With exercise, it becomes easier to get around, do your necessary tasks and still have some energy left over for other activities you enjoy.
In addition to increased energy, other benefits from exercise may include:
Improved muscle physical functioning
Better blood pressure control
Improved muscle strength
Lowered level of blood fats (cholesterol and triglycerides)
Better sleep
Better control of body weight

Do I need to see my doctor before starting exercise?
Yes. Before beginning any exercise program, be sure to check with your doctor.
When planning a directed exercise program, you need to look at four things:
Type of exercise
Length of time you spend exercising
How often you exercise
How hard you work while exercising.

Type of Exercise
Choose continuous activity such as walking, swimming, bicycling (indoors or out), skiing, aerobic dancing or any other activities in which you need to move large muscle groups continuously.
Low-level strengthening exercises may also be beneficial as part of your program. Design your program to use low weights and high repetitions, and avoid heavy lifting.

How Hard to Work While Exercising
This is the most difficult to talk about without knowing your own exercise capacity. Usually, the following ideas are helpful:
Your breathing should not be so hard that you cannot talk with someone exercising with you. (Try to get an exercise partner such as a family member or a friend.) You should feel completely normal within one hour after exercising. (If not, slow down next time.)
You should not feel so much muscle soreness that it keeps you from exercising the next session.
The intensity should be a “comfortable push” level.
Start out slowly each session to warm up, then pick up your pace, then slow down again when you are about to finish.
The most important thing is to start slowly and progress gradually, allowing your body to adapt to the increased levels of activity.
Are there any times when I should not exercise?
Yes. You should not exercise without talking with your doctor if any 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 an air-conditioned place
You have joint or bone problems that become worse with exercise
If you stop exercising for any of these reasons, speak to your doctor before beginning again.

Surgeons at Newcastle’s Freeman Hospital are often left facing problems over the cardiovascular fitness of the patients they are preparing for major surgery.
In many cases, effects of life-saving operations, like transplantations, can be hampered by the poor general fitness of recipients.
Now medics are launching a pilot Nordic Walking fitness programme at the hospital to help prepare their patients for operations, giving them the best chance of returning to full health as quickly as possible.
Mr Colin Wilson, a consultant transplant surgeon specialising in liver, kidney and pancreas transplantations at the Freeman, said: “Due to the nature of their conditions, a lot of patients have issues surrounding their cardiovascular fitness.
“When you have kidney or liver failure the effects of poor fitness are heightened, so when it comes to surgery you run into problems with patients getting infections, or even risking heart attacks or strokes.
Surgeon Colin Wilson
“We have proved that by increasing cardiovascular fitness these types of problems are reduced.”
As things stand, only about 15 to 20% of patients who undergo transplant surgery manage to get back to full, post-operative employment and medics at the Freeman would like to see that figure rise.
Mr Wilson said: “The problem is, telling a pre-op patient to go to the gym can be quite intimidating for them. A 70 year old is not necessarily going to feel comfortable in that environment.
“By introducing Nordic walking, we are providing them with a low impact, yet core strengthening routine which allows them to improve their overall fitness.”
It is hoped the pilot programme will prove a success in encouraging patients to improve their health pre-surgery, while encouraging them to carry on with a fitness routine, post-op.

The Tyneside Kidney Patients Association is supporting this initiative by encouraging patients to participate, it is hoped that it will expand throughout the North East and will have no costs to the participants.
I spent many years on Haemo Dialysis and understand how difficult it is to motivate yourself to get involved in any form of exercise but Nordic Walking is a low impact, gets you into the outdoors and is led by professionals.
At a recent conference I attended a leading transplant surgeon described a number of situations when a patient on the transplant register got “the call” only to find the transplant would not happen as their levels of fitness was deemed too low to undergo sedation and surgery.
If you wish to take part in our Nordic Walking programme please let me know.

Keith Vickers
Keith Vickers
We support kidney patients in Tyneside, Northumberland and Durham who are on some form of treatment for renal failure.

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