Exercise as part of kidney care

The important role of exercise in the health and wellbeing of people with long-term conditions is often overlooked or relegated to a few encouraging nonspecific remarks at the end of a consultation. The publication of two systematic reviews and meta analyses of exercise training provides a useful prompt and reminder to both clinicians and patients about the value of exercise as part of patient care.

Coincidentally the need to take a proactive whole system approach was brought home to me last week when I visited the York kidney service where there are plenty of exercise machines available and the philosophy to encourage all to participate as much, or as little, as they wish. The dialysis unit is strategically placed just down the corridor from the physiotherapy gym. Staff encouragement, easy availability of exercise “bikes”, positive comments from other patients and closeness of the physio gym has resulted in most who are able responding to the exercise challenge … and feeling better! In York I was also struck by how few dialysis patients needed antihypertensive medicines. That might be partly due to the high rates of exercise but also by using bio impedance to measure fluid overload and giving authority to dialysis nursing staff to reduce dry weight targets, the team have developed a system that seems to work better than most at getting and keeping patients on haemodialysis at their ideal dry weight By contrast, any increase in dry weight needs a doctor’s review and sign-off. Remarkable figures – well done the York unit.

A Cochrane review, Exercise training for adults with chronic kidney disease
by the Karolinska Institute concluded that there is a good evidence base showing benefit from exercise for all patients with Chronic Kidney disease (CKD) (whatever their stage).

Forty-five studies, randomising 1863 participants were included in the review. Thirty two studies presented data that could be included in the meta-analyses. The review showed that regular exercise training significantly improved physical fitness, physical functioning (eg walking capacity), and health-related quality of life in adults at all stages of CKD including those who were a receiving dialysis or had a kidney transplant. Beneficial effects were also seen on other outcome measures, such as blood pressure control.

This systematic review and meta-analysis presents evidence-based data for clinicians and patients on which type of exercise regimen (type of exercises, intensity, frequency and duration of exercise) should be used, in which settings and patient groups to optimise the training regime and improve outcomes. The results should be reviewed and used by individual clinical teams working with patients to consider how to implement exercise as part of the care plan for people with kidney disease . This information should encourage patients with CKD that there is scientific evidence for the beneficial effects of regular exercise training. It should identify who will benefit from which exercise intervention and allow patients to tailor their exercise regime to their needs and goals.

Exercise training specifically in haemodialysis patients was also the subject of a systematic review and meta-analysis from Australia; Exercise training in haemodialysis patients: A systematic review and meta-analysis. These authors reached the same conclusions as the Cochrane Group. Exercise training is safe and imparts large improvements for patients on dialysis.