Years ago, physicians would rarely recommend exercise for end-stage renal disease (ESRD) patients because they thought they were too unstable to handle the intensity of exercise. However, in the last couple years, physical activity and exercise has been shown to help renal patients rather than hurt them.

First, let’s talk about the difference between physical activity and exercise – a common confusion for most people. According to the American College of Sports Medicine (ACSM), physical activity is defined as “any bodily movement that is produced by the contraction of skeletal muscle and that substantially increases energy expenditure.” This simply means getting up and moving around – doing household chores, raking leaves or walking the dog – is physical activity. Exercise, on the other hand, 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,” such as taking a 20-40 minute walk or going to the gym. What most people don’t know is that you don’t have to knock yourself out to get all these benefits. You do not have to become a marathon runner or a disciple of Lance Armstrong – all you have to do is get up and move most of the day.

There are so many good things that can happen to you if you get up and move around most of the day. Specifically, for renal patients, research has shown that consistent physical activity and/or exercise will have a profound affect on your blood pressure and sugar levels. These conditions are the top reasons people get renal disease. A few of the proven benefits include:

  • Increased flexibility.
  • Strengthening the heart and other muscles.
  • Increased energy.
  • Helping with weight control.
  • Improving feelings of depression.
  • Improving self-esteem and well-being.
  • Improving sleep.

The most common concerns I hear from renal patients is “I’m too old to exercise” or “I have a disease and I shouldn’t be exercising.” First, you are NEVER too old to be physically active or exercise. Secondly, just because you have a disease does not mean you will not receive the same effects that someone without a disease will get. In fact, it is even more important that you become physically active now that you have a disease. People with renal, heart or lung disease tend to become less active once diagnosed. This is the worst thing someone can do because it will make your physical problems even worse.

Now the good news… the progression of your disease is preventable, and in some cases, even reversible! Heck, it may even be fun!

Now, the nuts and bolts on how to get started on being more physically active. The first thing you need to do is to inform all your doctors (nephrologist, family practice physician, etc.) as to what you are about to do. Physical activity and exercise may or may not have an affect on certain medications you are taking and, depending on what type of dialysis treatment you are engaged in, fluid intake or loss (through sweating) may become a factor in your treatment. You need to be on the same page with your doctor when exercising. Almost any physical activity or exercise will be good for you but a good fitness plan includes the following:

Cardiovascular (Endurance) Exercise: This helps your heart, lungs and circulation work more efficiently. Cardiovascular exercises are done for a period of time and involve your arms and legs. Walking is by far the best exercise for renal patients, although yoga and water exercise are also good options, or you can also exercise with a community exercise class. In addition, you can exercise at your dialysis unit if there is a program available. Cardiovascular exercise will help improve your endurance so you can be active longer and not get tired. Always start with a warm-up and cool-down period. This means to begin and end each session with easy exercises such as stretching. The best exercise to do is simply walking; however, you should find something you enjoy. Bicycling, aquatic exercise and stair stepping are good options for renal patients (see the Physical Activity Pyramid). Take a gradual approach when starting an endurance exercise program. Start with 5-10 minutes every day and add a minute every week to where you are to build up to exercising 20-40 min per day. (See the Example Walking Program below.)

Strengthening Exercise: This helps you become stronger or maintain your strength. Hand or leg weights are common forms or resistance exercise but elastic bands are also helpful.

Flexibility Exercise: This will help prevent your joints from becoming stiff and painful. Remember, if you do not use them, you will lose them (see the Example Walking Program below).

Example Walking Program

Week        Warm up        Times per day        Duration        Cool down

    1               3 min                     1                      5 min                3 min   

    2               3 min                     1                      7 min                3 min   

    3               3 min                     1                      9 min                3 min   

    4               5 min                     2                     11 min               5 min   

    5               5 min                     2                     12 min               5 min   

    6               5 min                     2                     13 min               5 min   

    7               5 min                     2                     15 min               5 min   

    8               5 min                     1                     18 min               5 min   

    9               5 min                     1                     20 min               5 min   

  10               5 min                     1                     25 min               5 min   

How Hard?

The idea is to work hard enough but not to the point of exhaustion. A good tool is the Talk Test. If you can exercise without getting short of breath, you are exercising at a good level. If you find yourself short of breath after about 10 minutes of exercise, slow down. Listen to what your body is telling you and adjust your intensity based on how you feel.

How Long?

There is no hurry to this process… you have the time to start slow and progress slow. Exercise a minimum of three days per week for 20-40 minutes. Perhaps one day you can do endurance exercises and the next day you can focus on flexibility and/or strengthening.

Even if you are having trouble walking or are in a wheelchair, you can still exercise! A physical therapist is trained to help individuals with this problem and is a great person to ask how to do it. Ask your doctor for a referral; several visits may be covered by your insurance.

A good habit to get into is writing down what you are doing. Keep a log of your physical activity or exercise by listing the time of day, time of exercise, duration of exercise, and feelings you had while you were exercising. This is a useful tool to monitor your progress as well as being a valuable tool for your physician.

Remember, your health is important whether you have renal disease or not. You can do it! The benefits of physical activity and exercise go beyond what most people think. Make physical activity a priority in your life... it should be as common as brushing your teeth every day.

Note: Please consult your physician before altering your diet or participating in physical exercise.

Daniel Bayliss, MS, CES, is a clinical exercise physiologist for the University of Virginia Renal Services in Charlottesville, Va., and is exercise coordinator for seven dialysis centers associated with UVA. He is a certified exercise specialist, personal trainer and certified water fitness instructor for UVA Aquatic and Fitness Center. Dan is also a volunteer running coach for the Charlottesville chapter of Team in Training, a program developed by the Leukemia and Lymphoma Society.

Article adapted from Exercise: A Guide for People on Dialysis by LifeOptions Rehabilitation Advisory Council.

Where to go for more information:

ACSM (American College of Sports Medicine) Fitness Book
Available for a small fee though:

Human Kinetics Publishers
P.O. Box 5076
Champaign, IL 61825-5076

Life Options Rehabilitation Resource Center
c/o The Medical Education Institute, Inc
414 D’Onofrio Drive, Suite 200
Madison, WI 53719-2803
800-486-7777

Pep Up Your Life
American Association of Retired Persons (AARP)
601 East Street, NW
Washington, DC 20049
202-434-2277                                                                        

Staying Fit with Kidney Disease
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
Brochure #05-02
800-622-9010

Web sites:

www.lifeoptions.org
www.mayohealth.org
www.kidney.org
www.smallstep.gov

This article originally appeared in the November 2005 issue of aakpRENALIFE, Vol. 21, No. 3.