EXERCISE PRESCRIPTION FOR END-STAGE RENAL DISEASE TREATED WITH DIALYSIS

Exercise Prescription For End-Stage Renal Disease Treated with Dialysis.                            

Cardiovascular Exercise        
The Exercise clinicians should use the following guidelines in prescribing cardiovascular exercise for dialysis patients :                    

Mode :walking, cycling, swimming, low -level aerobics, mild stepping.        

Frequency :4 to 5 days per week.                                      

Intensity :RPE of 12 to 15 (on 6 to 20 point scale)           

Duration :work up to 30 min of continuous exercise.         

Progression :start with intervals of intermittent exercise and gradually increase the work intervals until continuous exercise is tolerated.

Strengthening Exercise. Following are guidelines for prescribing strengthening exercise for dialysis patients :                                

Mode :Theraband, isometric, very low hand /ankle weights, body weight resistance.                            

Frequency : 2 to 3 days per week.                                      

Sets :three sets of exercises for major muscle groups.      

Repetitions : 12 to 15 repetitions of each exercise.     

Progression : start with one set of 12 repetitions with 1 to 2 ib weights, increase gradually.

Special Considerations. Several additional considerations should be recognized when one is working with dialysis patients:  
                                 
*Patients will have very low fitness levels.  
                        
*Timing of exercise sessions should be coordinated with dialysis sessions.              

* Patients will experience frequent hospitalizations and setbacks.                                    

*Gradual progression is critical.                                        

*Heart rate prescriptions are typically invalid -use of RPE is recommended.                       

*Maximal exercise testing is typically not tolerated well by the majority of patients and is not 
diagnostically useful for those with coronary artery disease because of peripheral muscle fatigue.      

*Performance based testing is more feasible and useful.      

*One repetition maximum testing for strength is not recommended because of secondary hyperparathyroidism -related bone/joint problems.                

*Prevalence of orthopedic problems will be significant.     

*Motivation of patients is often a challenge.                      

*Every attempt should be made to educate dialysis staff about the benefits of exercise so they can also help motivate patients to participate.

Note:
For  patients treated with continuous ambulatory peritoneal dialysis, the exercise may be best tolerated at a time when the abdomen is drained of fluid, which allows for greater diaphragmatic excursion and less pressure against the catheter during exertion,reducing the risk of hernias or leaks around the catheter site. 
Patients may choose to exercise in the middle of a dialysis exchange after draining fluid and before introducing the new dialysis fluid. This requires capping off the catheter for exercise  a technique that must be discussed with the dialysis nurse.

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