By Noor Siti Huda Bte Jamaluddin
Muscle wasting and fatigue are common side-effects in patients who have been receiving dialysis treatment over a long period. Over time, these effects could have a negative impact on their physical functioning and thereby affecting their activities of daily living (ADL): instrumental and basic . In general, the quality of life (QoL) of dialysis patients is known to decline over time .
The common factors leading to a decline in physical functionality of dialysis patients are inactivity, functional and structural muscle abnormalities, inflammation and anaemia . Physical inactivity is a known risk factor of mortality in chronic kidney disease population . Although peritoneal fluid infusion into the peritoneum does not affect one’s physical capacity, studies indicate low physical functioning and physical activity within peritoneal dialysis population and which is strongly associated with mortality among patients who are new to dialysis [3, 5-7]. A study performed in Yokosuka, Japan, highlights two factors which contributed to the risk of short-term mortality after dialysis initiation: impaired mobility at the start of dialysis and the decline in mobility after starting dialysis .
Knowing the increased mortality risks associated with physical inactivity, patients on dialysis are encouraged to stay active by doing the things they like with a certain degree of life/behaviour adjustment, like eating right and performing regular exercise. Participating in regular physical activity can improve one’s musculoskeletal health, control body weight and reduce symptoms of depression . Kidney Disease Outcomes Quality Initiative (KDOQI) recommends that dialysis patients should be encouraged to increase their level of physical activity, emphasizing on increasing strength and endurance to the point where they are able to adopt the recommended levels of physical activity. Dialysis patients are recommended to set a goal of moderate intensity cardiovascular exercise for 30 minutes every day. However, they should be referred to either physical therapy or cardiac rehabilitation on a periodic basis in order to ensure that their unique challenges to exercise are identified and to enable them to follow the exercise regime successfully .
There are several options where physical activity can be incorporated into the lives of dialysis patients: during, before or after the dialysis exchange sessions. In several studies, physical activities like cycling, 6-min walk or a low impact exercise were performed and supervised by centre staff during dialysis sessions and their effects on dialysis effectiveness were monitored and measured [11-14]. In a study by Parson, it was reported that mild exercise during the first two hours of haemodialysis therapy enhanced dialysate urea removal but not serum urea clearance . Another two separate studies, by Kong and Sun respectively, reported decrease in post-hemodialysis rebound rates of urea and creatinine in response to a single exercise session during hemodialysis therapy [16-17]. Zaluska reported a dialysis efficacy improvement of 16% during the first hour of dialysis over a six months period but not without the influence of protein catabolic rate which increases urea clearance . Another study, examining the effects of a 12-week exercise program in 13 continuous ambulatory peritoneal dialysis (CAPD) patients, reported no significant changes in serum urea, creatinine, albumin and haematocrit levels . Nonetheless, several studies have shown that introduction of an exercise program to dialysis patients, either delivered in-centre or home-based, improves physical capacity and certain aspects of QoL [11-14,18]. These results from various studies are encouraging and highlight the need of long-term studies to evaluate effects of sustainable exercise programs on clinical endpoints, including death and cardiovascular disease, in dialysis population [20-21].
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