END-STAGE RENAL DISEASE AND EXERCISE

End-Stage Renal Disease And Exercise 

     Chronic renal failure results from structural renal damage and progressively diminished renal function. Once initiated, the disease progresses to end-stage renal disease (ESRD), requiring some form of renal replacement therapy such as dialysis or transplantation. 

   Medical History and Diagnosis/

    Mrs. X is a 65 -year -old Lagos female with known ESRD.She has been on hemodialysis for 30 months, and her treatment prescription is for 3 days per week with 3-hr treatment sessions each day. She has a graft in her right upper arm as her access site. She presents with the complaints of lack of energy, weakness, and decreased endurance. Her nephrologist refer her to Exercise Physiologist and she came to me for Exercise Prescription and also reviews. Mrs X's chart to find out that her ESRD is secondary to long-term non-insulin -dependent diabetes (18years). She has also developed severe peripheral neuropathy as a result of her diabetes. 

Exercise Test Results 
   The Exercise Physiologist then conducts a battery of physical function tests to assess Mrs X's physical ability. These tests consist of the sit-to-stand test, the 6 minutes walk, and the 20-foot gait speed test at both a comfortable and a fast pace. The results of these tests are as follows :sit-to-stand test, 32.02 s, which is 29% of  normal age -predicted values (38),6-min walk, 352ft, 22-ft normal gait speed, 56.02cm,which is 43% of normal age normal values 42.Her self reported physical function scale on the SF-37 

Health Status Questionnaires is 56 (average age value 83). During her walking tests, Mrs X exhibits poor balance and endurance as a result of her peripheral neuropathy and general weakness,respectively. Physical activity questionnaires are administered to assess her current activity as well as degree of difficulty of those activities.

Exercise Prescription 
    With the assessment complete, an exercise prescription is developed. Mrs. X is first counseled on exercise as it relates to her diabetes and glycemic control. Written information is also provided. The exercise prescription continues only when it is certain that Mrs X fully understands the balance between exercise and glycemic control. Because of her poor balance and endurance, a stationary bicycle is the preferred mode for cardiovascular exercise. She is asked to begin with a frequency of 3 to 4days per week, on non-dialysis days, because she generally feels better on those days. The duration of the exercise is 10mins with two bouts each exercise day, totaling 20 mins of exercise each exercise day. 
The initial prescribed intensity should be light to moderate, or enjoyable. She is asked to gradually progress each week with a goal of 30 min of continuous cycling 3 to 4 days per week, minimum. Her initial exercise prescription also includes various flexibility exercises for upper and lower body as well as for the back. She is asked to do these exercises daily. Strengthening exercises are also prescribe. Again, both upper and lower body exercises that use the major muscle groups are encouraged. 

These exercises are prescribed for 3 days per week on nonconsecutive days. She will initially perform the exercises without resistance weight and gradually progress to performing them with weight. Her initial prescription consists of one set of 10 repetitions of each exercise. The Exercise Physiologist reviews Mrs X progress weekly at her dialysis treatments. Progression and exercise participation are noted in the patient's chart. At the end of 12 weeks of exercise, Mrs. X  physical functioning is again assessed with the battery of physical function tests and the activity questionnaires. 

    Question 

What causes Mrs X to have poor balance during walking? How does this affect her exercise prescription?.

Comments

Post a Comment

Popular posts from this blog

BEHAVIOURAL CHANGE CAMPAIGN

Image
Hello Everyone in Behavioural Therapy Class! This is to share our memorable event of propagating awareness on behavioural change campaign for market women in Ondo State. Find below some pictures of the event and I nwill welcome your contribution and your feedback. These are few pictures of the event where my humble self (Prof Wale Ajao) and the students have embarked on a 2-day behavioural change campaign to educate our market women on the usefulness of hygiene and to prevent Lassa fever and coronavirus in our environment. Market women are the ones that have more flair for spreading the virus. Market women should be informed that cleaning of the environment where their foodstuffs are been stocked should be kept clean while bad food items should not be sold at the market in order to prevent Lassa fever. Question for the week: 1. We should regularly wash our hands to avoid Lassa fever and coronavirus, Yes/No? 2. Coronavirus emanated from China, Yes/No? 3. These are the common
Read more

MOVING TOWARDS WELLNESS THROUGH LIFESTYLE MANAGEMENT

Hello Everbody, Wellness is the ability to live life fully, with vitality and meaning. Wellness is dynamic and multidimensional :it incorporates physical, emotional, intellectual, spiritual, social, interpersonal and environmental dimensions. People today have greater control over, and Greater responsibility for, their health than ever before. Behaviours that promote wellness include being physically active, choosing a healthy diet, maintaining a healthy body weight, managing stress all the time, avoiding use of tobacco and drinking alcohol wisely, if at all and protecting oneself from diseases and injury. Although heredity, environment and health care all play roles in wellness and disease, behaviour can mitigate their effects. Understanding and knowledge about topics in wellness and about yourself is necessary to begin making changes in behaviour. Observations by others and landmark events can help get people started on change. Strong motivation to change and an internal contro
Read more

YOUR FITNESS YOUR HEALTH

Many Africans may be surprised at the extent and strength of the evidence linking physical activity to numerous health improvements. Most importantly, regularly physical activity greatly reduces the risk of dying from coronary heart disease, the leading cause of death in Africa today. Physical activity also reduces the risk of developing non-communicable diseases in our society.             In Africa today, our society is just beginning to recognize the role of regular Physical activity in good health management. Physical activity evaluation provides morbidity and mortality prognostic information from hemodynamic, electrocar diographic, cardiovascular and pulmonary exercise responses. Physical activity also evaluate muscular strength, muscular endurance, flexibility and cardiovascular capacity, provides valuable information that enables exercise professionals to determine a clients overall functional capability, assess his or her safety for physical exertion, prescribe exercise, in
Read more