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Nylen ES, Gandhi SM, Kheirbek R, Kokkinos P. Enhanced fitness and renal function in Type 2 diabetes. Diabet Med 2015; 32:1342-5. [PMID: 25943475 DOI: 10.1111/dme.12789] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 12/14/2022]
Abstract
AIMS To investigate the renal effects of fitness in people with diabetes with mild renal dysfunction. METHODS The effect of a 12-week exercise programme on estimated GFR in 128 people with diabetes was evaluated. RESULTS All cardiometabolic variables improved after 12 weeks of supervised exercise. Although there was a modest 3.9% increase in estimated GFR from baseline in the 128 people who completed the study, those with baseline chronic kidney disease stages 2 and 3 were found to have significant (6 and 12%, respectively; p < 0.01) improvements in post-exercise estimated GFR. Moreover, 42% of the people with chronic kidney disease stage 3 improved to chronic kidney disease stage 2 after the intervention. CONCLUSION Short-term exercise improves renal function in those with more moderate baseline chronic kidney disease. Thus, renal function appears to be responsive to enhanced physical fitness. Being a strong and modifiable risk factor, enhanced fitness should be considered a non-pharmacological adjunct in the management of diabetic kidney disease.
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Affiliation(s)
- E S Nylen
- Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - S M Gandhi
- Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - R Kheirbek
- Department of Geriatrics, Veterans Affairs Medical Center, Washington, DC, USA
| | - P Kokkinos
- Department of Cardiology, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Cardiology, Georgetown University School of Medicine, Washington, DC, USA
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Silva LC, Marinho PÉM. Knowledge among nephrologists about the importance of exercise in the intradialytic period. J Phys Ther Sci 2015; 27:2991-4. [PMID: 26504342 PMCID: PMC4616143 DOI: 10.1589/jpts.27.2991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/24/2015] [Indexed: 11/25/2022] Open
Abstract
[Purpose] To assess knowledge among nephrologists at hemodialysis services about routine
intradialytic therapeutic exercise, in the city of Recife. [Subjects and Methods] A
cross-sectional study, consisting of 49 nephrologists working in public and/or private
hemodialysis services, who responded to a semi-structured questionnaire about their
academic background, medical residency, and knowledge about exercise during the
intradialytic period. [Results] About 56.3% practiced for more than 10 years as
nephrologists, 69.4% did not receive information about intradialytic physical exercise
while in residency, 81.6% considered intradialytic exercise to be important, and 53.0% did
not prescribe exercise during hemodialysis. About 61.2% consider the level of physical
activity among their patients to be poor. Nephrologists graduating within 2 years were 10
times more likely to prescribe exercise, compared to those with more than 2 years since
graduation. [Conclusion] Our study found that the nephrologists interviewed do not usually
prescribe intradialytic therapeutic exercise, despite understanding its importance as part
of the treatment process. It is necessary to update doctors about the importance of
exercise for patients during the intradialytic period, as well as to incorporate this
knowledge at the undergraduate level.
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Physical excercise programs in CKD: lights, shades and perspectives: a position paper of the “Physical Exercise in CKD Study Group” of the Italian Society of Nephrology. J Nephrol 2015; 28:143-50. [DOI: 10.1007/s40620-014-0169-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
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Mendoza M, Han M, Meyring-Wösten A, Wilund K, Kotanko P. It's a Non-Dialysis Day… Do You Know How Your Patient Is Doing? A Case for Research into Interdialytic Activity. Blood Purif 2015; 39:74-83. [DOI: 10.1159/000369430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hemodialysis (HD) patients are less active than their healthy counterparts; this is associated with higher mortality. Healthcare workers observe their patients only during HD, which accounts for about 7% of the week. Knowing more about what occurs in between sessions, particularly with respect to physical activity, may improve patient care and prognosis. Yet without a standard method to measure interdialytic activity, it is difficult to compare the effect of interventions. However, it is unclear how interdialytic activity can be accurately measured. Since activity associated with quality of life is multi-dimensional, objective and subjective tools should be used in conjunction. While commercially available tracking devices can be seamlessly incorporated into everyday life and can increase awareness of user's activity, their validation is needed in the HD population. Fertile topics for research should include the relationship between objective and subjective measures in HD patients, and the investigation of physical activity in non-ambulatory HD patients.
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Esteve Simó V, Junqué A, Fulquet M, Duarte V, Saurina A, Pou M, Moreno F, Carneiro J, Ramírez de Arellano M. Complete Low-Intensity Endurance Training Programme in Haemodialysis Patients: Improving the Care of Renal Patients. ACTA ACUST UNITED AC 2014; 128:387-93. [DOI: 10.1159/000369253] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
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Painter P, Clark L, Olausson J. Physical Function and Physical Activity Assessment and Promotion in the Hemodialysis Clinic: A Qualitative Study. Am J Kidney Dis 2014; 64:425-33. [DOI: 10.1053/j.ajkd.2014.01.433] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/17/2014] [Indexed: 11/11/2022]
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Williams AD, Fassett RG, Coombes JS. Exercise in CKD: Why Is It important and How Should It Be Delivered? Am J Kidney Dis 2014; 64:329-31. [DOI: 10.1053/j.ajkd.2014.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/11/2022]
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Capitanini A, Lange S, D'Alessandro C, Salotti E, Tavolaro A, Baronti ME, Giannese D, Cupisti A. Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients. Kidney Blood Press Res 2014; 39:129-33. [PMID: 25117740 DOI: 10.1159/000355787] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal "exercise team" for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients.
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Aucella F, Gesuete A, Battaglia Y. A "nephrological" approach to physical activity. Kidney Blood Press Res 2014; 39:189-96. [PMID: 25118037 DOI: 10.1159/000355796] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
Despite consensus among nephrologists that exercise is important and probably beneficial for their patients, assessment of physical function or encouragement of physical activity is not a part of the routine management of patients with CKD. In order to plan an useful strategy for exercise training we need to clearly define some questions. First of all, nephrologists need to be aware of physical exercise benefits; lack of motivation and increased perceived risk by health care professionals have been identified as contributing factors to physical inactivity. Moreover, the main elements necessary for sustaining exercise programs in this population have to take in account, such as the requirement of exercise professionals, equipment and space, individual prescription, adequate commitment from dialysis and medical staff. When PA may not be implemented, a comprehensive, individualized occupational therapy program may improve functional independence and activity of daily living. Finally, physical function has to be careful monitored and assesses by medical staff.
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Affiliation(s)
- Filippo Aucella
- Nephrology and Dialysis Unit, Scientific Institute for Research and Health Care, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
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Activité physique chez les patients dialysés : comment et pourquoi l’évaluer et mettre en place un programme ? Nephrol Ther 2014; 10:151-8. [DOI: 10.1016/j.nephro.2013.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/01/2013] [Accepted: 12/26/2013] [Indexed: 11/30/2022]
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Kirkman DL, Edwards DG, Lennon-Edwards S. Exercise as an Adjunct Therapy In Chronic Kidney Disease. RENAL NUTRITION FORUM 2014; 33:1-8. [PMID: 26069463 PMCID: PMC4461233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Physical activity levels are low in patients with chronic kidney disease (CKD). Evidence indicates that a sedentary lifestyle contributes to increased morbidity and mortality risk; thus, increasing physical activity is an undeniable aspect of a healthy lifestyle. Despite the myriad of health benefits associated with exercise, as well as clinical guidelines in its favor, exercise is still not prescribed as part of routine care in the CKD patient population. This article briefly discusses the benefits of regular exercise implemented across all stages of CKD on independent predictors of survival such as cardiorespiratory fitness, cardiovascular health and protein-energy wasting. Health care providers of the multidisciplinary nephrology team play a pivotal role in the encouragement and implementation of increasing physical activity levels. In order to increase physical activity counseling and enhance healthcare providers' confidence in prescribing exercise for CKD patients, general recommendations for physical activity in these patients are provided.
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Affiliation(s)
| | - David G. Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware
| | - Shannon Lennon-Edwards
- Department of Behavioral Health and Nutrition, University of Delaware
- Department of Kinesiology and Applied Physiology, University of Delaware
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Wang IK, Tsai MK, Liang CC, Yen TH, Huang CC, Wen SF, Wen CP. The role of physical activity in chronic kidney disease in the presence of diabetes mellitus: a prospective cohort study. Am J Nephrol 2013; 38:509-16. [PMID: 24356340 DOI: 10.1159/000357133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/06/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS Although the effect of exercise on health is well established, nephrologists seldom consider physical activity in the treatment of chronic kidney disease (CKD) or CKD in the presence of diabetes mellitus (DM/CKD). The aim of the present study was to analyze the benefits of leisure-time physical activity (LTPA) in DM/CKD. METHODS A total of 445,075 adult participants who underwent a medical screening program between 1996 and 2008 were prospectively recruited. Of these, 7,863 DM/CKD subjects were identified. Each participant was categorized according to LTPA level (a product of duration and intensity) as inactive, low-active or fully active. Hazard ratios (HRs) for mortality risk were calculated. RESULTS Fully active LTPA was associated with lower odds of DM/CKD development and lower risk of mortality among patients with DM/CKD in a dose-response relationship. The fully active and low-active DM/CKD groups had a 26% (HR 0.74, 95% CI 0.66-0.85) and 13% (HR 0.87, 95% CI 0.75-1.01) lower risk of all-cause mortality, respectively, in comparison to the inactive group. The association of exercise with mortality rate reduction was more pronounced among DM/CKD subjects (mortality rate reduction of 446.5 per 100,000 person-years) than among subjects with diabetes alone or CKD alone. CONCLUSION Exercise, at the recommended level or more, is associated not only with lower odds of DM/CKD but also with a 26% lower mortality risk among DM/CKD patients. Nephrologists should encourage all DM/CKD subjects to be physically active
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Affiliation(s)
- I-Kuan Wang
- Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan, ROC
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The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease. Curr Opin Nephrol Hypertens 2013; 22:615-23. [DOI: 10.1097/mnh.0b013e328365b43a] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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64
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Painter P, Marcus RL. Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol 2012; 8:861-72. [PMID: 23220421 DOI: 10.2215/cjn.06590712] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with CKD are characterized by low levels of physical functioning, which, along with low physical activity, predict poor outcomes in those treated with dialysis. The hallmark of clinical care in geriatric practice and geriatric research is the orientation to and assessment of physical function and functional limitations. Although there is increasing interest in physical function and physical activity in patients with CKD, the nephrology field has not focused on this aspect of care. This paper provides an in-depth review of the measurement of physical function and physical activity. It focuses on physiologic impairments and physical performance limitations (impaired mobility and functional limitations). The review is based on established frameworks of physical impairment and functional limitations that have guided research in physical function in the aging population. Definitions and measures for physiologic impairments, physical performance limitations, self-reported function, and physical activity are presented. On the basis of the information presented, recommendations for incorporating routine assessment of physical function and encouragement for physical activity in clinical care are provided.
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Affiliation(s)
- Patricia Painter
- Department of Physical Therapy University of Utah, Salt Lake City, Utah 84108, USA.
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Manfredini F, Mallamaci F, Catizone L, Zoccali C. The burden of physical inactivity in chronic kidney disease: is there an exit strategy? Nephrol Dial Transplant 2012; 27:2143-5. [PMID: 22553371 DOI: 10.1093/ndt/gfs120] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Delgado C, Johansen KL. Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant 2011; 27:1152-7. [PMID: 21795245 DOI: 10.1093/ndt/gfr404] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physical inactivity is a strong predictor of mortality in patients with end-stage renal disease and is associated with poor physical functioning. Patients with end-stage renal disease are inactive even compared to sedentary individuals without kidney disease. We sought to identify patient barriers to physical activity. METHODS Adult patients on hemodialysis in the San Francisco Bay Area were recruited and asked to complete a study survey composed of questions about self-reported level of physical functioning, physical activity participation, patient physical activity preference and barriers to physical activity. Univariate and multivariable linear regression analyses were performed to study the association between barriers to physical activity and participation in physical activity. RESULTS A total of 100 patients participated in the study, the majority of whom were male (73%), with a mean age of 60 ± 15 years. Twenty-seven percent identified themselves as white, 30% black and 21% Hispanic. The majority of participants strongly agreed that a sedentary lifestyle was a health risk (98%) and that increasing exercise was a benefit (98%). However, 92% of participants reported at least one barrier to physical activity. The most commonly reported barriers were fatigue on dialysis days and non-dialysis days (67 and 40%, respectively) and shortness of breath (48%). In multivariate analysis, a greater number of reported barriers was associated with lower levels of physical activity (P < 0.02). Post-dialysis fatigue was not associated with differences in activity level in multivariate analysis. Lack of motivation was associated with less physical activity. Endorsement of too many medical problems and not having enough time on dialysis days were also associated with less activity in adjusted analysis. CONCLUSION We have identified a number of barriers to physical activity that can be addressed in studies aimed at increasing levels of physical activity. Inconsistent with nephrologists' reported assumptions, dialysis patients were interested in physical activity.
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Affiliation(s)
- Cynthia Delgado
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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