Exercise for the Kidney Patient NKF People First Conference 2007

1. Exercise for the Kidney PatientNKF People First Conference 2007 Mandy Newberry, M.Ed Exercise Physiologist University of Virginia

2. What you will get out of exercise How to get started Strategy Precautions Exercise demonstration The Game Plan:

3. You are stronger You sleep better at night You have better control of your weight You have a more positive attitude You have MORE energy!!! Benefits of exercise that YOU may notice

4. Better control of your blood pressure Lower cholesterol Improved KT/V or URR Stronger bones Blood sugar is more stable Benefits your doctor may notice

5. Discuss the idea with your doctor. How to get started

6. While you are resting: Very little blood flow in your muscles A lot of your body tissue is unexposed to the dialysis During exercise: Muscle blood flow increases More tissue mass is exposed to the dialysis treatment How will exercise during dialysis help me?

7. Fever Dialysis schedule has changed or you’ve missed a day Medications have changed Your physical condition has changed You have eaten too much Hot, humid weather (unless you are in air conditioning) You have joint or bone problems that become worse with exercise When should you NOT exercise

8. -Overall decline in physical well-being -Fluid build-up in tissues -Loss of bone minerals -Shortness of breath -Loss of Appetite -Hypertension -Fatigue -Anemia What happens if I don’t exercise?

9. ~The Strategy~ ~The Strategy~

10. Warm-up Cardio Strength training Cool-down 4 steps to success

11. Movement!!! Warm-up

12. Cardio Stationary Cycle Stepper

13. Strength training Body Weight Hand weights Ankle Weights Resistance Bands

14. Movement!!! Cool-down

15. F-frequency I-intensity T-time T-type The FITT Principle:

16. How often per week should I exercise? Activities such as walking and cycling should be done on most if not all days of the week Strength training should be done 2-3 days per week on non-consecutive days (Monday-Wednesday-Friday) Frequency

17. How hard should I exercise? You should be able to carry on a conversation You should feel completely normal within 1 hour after exercising You should not feel so much muscle soreness that it keeps you from your daily activities The intensity should feel like a ‘comfortable push’ Begin each session slowly to get your muscles warm. Increase the intensity for the majority of the session and then slow down again as you near the end. Intensity

18. How long should each exercise session be? Ultimately, the goal is to engage in continuous exercise for at least 30 minutes. This can be accomplished over a long period of time, beginning at just a couple minutes on your first day and gradually increasing throughout the following weeks. Your strategy may also be to exercise for 10 minutes, three times a day. Time

19. What should I use to exercise? Do whatever you like best!!! Type

20. When you feel very tired If you are short of breath If you feel chest pain If you feel irregular or rapid heart beats If you feel sick to your stomach If you get leg cramps If you feel dizzy or light-headed When to STOP exercising

22. People First 2007 – Celebrate Life Exercise Demonstration

23. Neck Stretch • Sit or stand up straight and look straight ahead. • Slowly lower your right hear toward your right shoulder. Bring your head back up and lower your left ear to your left shoulder. Repeat right ear to right shoulder. Drop your chin to your chest and slowly roll your chin across your chest until your left ear reaches your left shoulder. • Lift up your chin until you are looking straight ahead

24. Arm/Hand Stretch • Sit or stand straight up. • Stretch your arms straight out in front of you at shoulder height. • Stretch out your fingers, then make a fist and stretch out your fingers again. Repeat. • Keep your arms stretched out and interlock your fingers, palms facing you. Push your hands as far away from you as you can, rounding out your shoulders.

25. Shoulder Shrug & Rotation • Sit or stand straight up. • Shrug your shoulders up to your ears. Hold. Lower and repeat. • Make forward circles with your right shoulder. Then with your left. • Make backward circles with your right shoulder. Then with your left.

26. Chest & Upper Back Stretch • Stand or sit straight up. • Put your hands on your shoulders with your elbows out to the side. • Make circles with your elbows. First forward, then back. • Stop circling and touch your elbows together in front of your chest. • Open your elbows out again and squeeze your shoulder blades together. Feel the stretch across your chest. Repeat.

27. Side Stretch • Stand or sit up straight. • Reach your arms over your head and stretch toward the ceiling. • Reach over your head and lean to your right side. Feel the stretch. • Come back up straight and reach over your head and lean left. Repeat. • Return to center and lower your arms.

28. Single Knee Pull • Sit up straight. • Bend over, grab your left knee with both hands, and pull it toward your chest. • Tip your chin to your chest and try to touch your forehead to your knee. • Go as far as you comfortably can. Hold. • Lower your left knee and repeat the exercise with your right knee. • This can also be done in a reclined position.

29. Leg Stretch • Sit up straight with your feet on the floor. • Grasp the chair for balance. • Slowly raise your right leg until it is straight out in front of you. • Point your toes then bend your ankle and slowly bring your toes back toward you. Repeat. • Bend your knee and slowly lower your foot to the floor. Do the same exercise with your other leg.

30. Arm Curl • Stand or sit up straight in a chair. • Keep your elbows close to your sides and bend your arms at the elbows. • Turn your palms up and make a fist with each hand. • Slowly lift your fist (with or without weight) up to your shoulder and lower. Alternate arms.

31. Arm Extension • Stand or sit up straight in a chair. • Bend one arm at the elbow and bring your elbow up close to your ear. (Your hand will go behind your shoulder). • Keeping your bent elbow pointing out in front of you and close to your head, straighten your arm above your head. (Imagine you’re throwing a baseball.) • Bend the elbow again and slowly lower your hand behind your shoulder. • Repeat with the opposite arm. • Use a stretch band or small weight to add resistance.

32. Lower Leg Extension • Sit up straight with your feet flat on the floor. • Hold onto the seat of the chair to support your back. • Lift one leg off the floor and hold it out straight. (Ankle weights can be used). Hold. • Bend your knee and slowly lower your foot to the floor. • Repeat with the opposite leg.

33. Straight Leg Raise • Lean back in a chair with legs raised on a foot rest. • Grasp the arms of the chair or the sides of the seat for balance. • Slowly lift your whole leg – without bending the knee. Ankle weights can be used.) Count to five. • Slowly lower. Repeat with the opposite leg.

34. Seated Marching • Lean back in a chair with legs raised on a foot rest. • Place your hands on the seat or arms of the chair for balance. • Bend your legs at the knee, one at a time, and slowly bring them toward your chest as though you were marching or bicycling in the air. -

35. Exercise related benefits Discuss with your doctor Begin slowly and progress gradually Never exercise outside of your comfort zone Overview

36. Thank You and Best Wishes!