Encouraging Exercise with Chronic Kidney Disease

The association between physical exercise and the overall health of patients with chronic renal failure shows great promise. As a trainer, could you recognize whether a new client might suffer from chronic kidney disease (CKD)? While not displaying overt signs, this special population needs our help and expertise.

CKD and Compounding Co-Morbidity

Patients living with renal failure often suffer from elevated blood pressure, which leads to problems of its own. We already recognize how exercise can facilitate the lowering of blood pressure in healthy adults; individuals with CKD tend to respond in a similar manner. Studies indicate that for individuals over the age of 50, physical activity can significantly reduce blood pressure in patients even in the midst of renal failure.

Does Dialysis Preclude Safe Exercise?

One such research endeavor sought to determine whether 24 weeks of resistance training, concurrent with hemodialysis, could improve exercise capacity, muscle strength, physical functioning, and overall quality of life for CKD patients, compared to a low-intensity cardio-based program.

Twenty-seven patients, whose average age ranged from 55 – 60 years old, were assigned to either a resistance-based training regimen or low-intensity aerobic training. Using the Borg Rate of Perceived Exertion, subjects in the resistance group performed three sets of four exercises at an intensity of 12 – 15 out of a possible 20 on the Borg scale. Over the course of 24 weeks, trainers helped the subjects utilize weights and elastic bands during all training sessions. Standard testing methods helped determine the study’s outcomes. Relying upon the “sit/stand/sit” tests, 6-minute walking test, and knee extensor strength, data pointed favorably to resistance training during hemodialysis as improving these patients’ overall physical fitness functioning.

What Works Best – Cardio or Strength Training?

Adults living with chronic kidney disease tend towards sedentary lifestyles, ultimately leading to reduced physical functioning, higher mortality rates, and a diminished quality of life. Those who receive peritoneal dialysis (PD) as part of their treatment often present with significant frailty. Since few research labs participate in studies attempting to correlate PD with exercise, one particular protocol purposely aimed to answer the question of feasibility and/or benefits of a combined resistance and cardiovascular exercise program for CKD patients.

Led by Dr. Emma Watson, Dr. Tom Wilkinson, and Professor Alice Smith of the University of Leicester, this protocol focused on non-dialysis-dependent individuals living with CKD.  Subjects participated in either aerobic exercise, or a protocol combining aerobic activity with resistance training. Both groups exercised for 12 weeks, three times a week.

At the conclusion of the study, all of the subjects showed a marked increase in overall strength, leg muscle size, and cardiorespiratory fitness. While engaging in aerobic exercise alone – such as walking, cycling, swimming, rowing – did in fact bring about some positive changes, the addition of weightlifting led to even greater gains in muscle mass (9% versus 5%) and strength (49% versus 17%). This suggests that non-dialysis-dependent patients with CKD can comfortably add resistance training as part of an overall supervised exercise program.

“There is limited research on the effects of exercise in CKD patients, and a lack of knowledge on what exercise is most beneficial in this group” says Dr. Tom Wilkinson from the University of Leicester’s Department of Infection, Immunity and Inflammation. “Our study shows that both aerobic exercises and strength exercises are important in CKD patients in keeping muscles strong and healthy and can be combined successfully and safely.”

 

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Push, but Not Too Hard

Research shows that appropriate exercise can greatly benefit CKD patients, but many will need gentle convincing to get started. Having kidney disease ramps up one’s risk of developing cardiac complications. Regular participation in an exercise program can protect the heart in a myriad of ways: lowering blood pressure, controlling cholesterol, preventing diabetes, and strengthening blood vessels.

Any time we take on a client who finds exercise daunting or new to a sedentary lifestyle, the question arises as to just how much we should push. Of course, we want to remain professional, ensuring that a client feels good about themselves and makes progress. However, for someone living with chronic kidney disease and/or regular dialysis treatments, exercise may elicit a great deal of concern, even fear. If you sense that a client needs more convincing, arm yourself with the positive statistics and share them openly and honestly. With proper training, CKD patients can successfully follow the same basic principles of strength training as healthier individuals, albeit progressing at a slower rate.

Creating a Safe Environment for Successful Workouts

Keep in mind the following points when designing/customizing training programs for such individuals ~

• Muscle soreness the next day should not prevent a future training session.
• Strive for a “comfortable push” level of intensity following a sufficient warm-up.
• Breathing might get hard, but not so uncomfortable that conversation cannot take place.
• Normal resting heart/respiration rates should return within an hour post-exercise.
• Conclude with cool-down movements and stretching.

The Winning Triad of Diet, Medication and Exercise

Fatigue, weakness, and overall cachexia (muscle wasting) go hand-in-hand with the later stages of CKD, due to an accumulation of toxins circulating in a patient’s bloodstream. Clients in the throes of renal failure may complain that these factors make them too tired to exercise. Our job gets a bit more challenging as we strive to convince such individuals that even a little bit of exercise, 15-20 minutes a day, will actually provide energy. Trainers might encourage hesitant clients by suggesting that exercise plays just as vital a role in their comprehensive treatment as diet and medication. Even light to moderate strength training can improve the development of lean muscle mass, empowering the individual both physically and emotionally.

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References:

academic.oup.com/ckj/article/11/6/822/5054721

www.kidney.org.uk/lets-get-active-exercise-for-kidney-patients

www.kidney.org/atoz/content/stayfit

journals.physiology.org/doi/full/10.1152/ajprenal.00012.2018

www2.le.ac.uk/offices/press/press-releases/2018/march/weightlifting-shows-benefits-for-kidney-disease-patients

pubmed.ncbi.nlm.nih.gov/32701595/

pubmed.ncbi.nlm.nih.gov/6567229/

www.medscape.com/viewarticle/561596

pubmed.ncbi.nlm.nih.gov/32734246/

pubmed.ncbi.nlm.nih.gov/19473613/

pubmed.ncbi.nlm.nih.gov/28316986/