An Amazing “Medication” Exercise During Dialysis

1. An Amazing “Medication”Exercise During Dialysis Amanda Newberry, M.Ed Exercise Physiologist University of Virginia Renal Services

2. Why is exercise during dialysis important? • 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 Imagine a wet sponge!

3. Other benefits of physical activity and exercise… • Reduces risk of premature death • Reduces risk of heart disease and diabetes • Improves blood pressure control • Helps control body weight • Improves muscle and bone strength • Decreases risk of falls

4. What does this mean to you? • Longer life! • You are stronger • Less slips, trips and tumbles • You sleep better at night • You feel happier • You have more energy!!!

5. Physical Functioning • The ability perform activities required in your daily life

6. Physical Functioning • Does your health limit you in these activities? • Pushing a vacuum cleaner, bowling or playing golf • Lifting or carrying groceries • Climbing several flights of stairs • Bending or kneeling • Walking more than one mile, walking several blocks • Bathing or dressing yourself • If so, how much??? ■ Limited a lot ■ Limited a little ■ Not limited at all

7. Physical Inactivity leads to… • Overall decline in physical well-being • Fluid build up in tissues • Loss of bone strength • Loss of appetite • Hypertension • Dependence • Fatigue • Anemia

8. When should you not exercise? • Fever • Dialysis schedule has changed or you’ve missed a day • Medications have changed • Your physical condition has changed • You have eaten too much • You have joint or bone problems that become worse with exercise

9. When to stop exercising • If you become very tired • If become 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

10. Barriers to Exercise • Weather • No exercise equipment • Fatigue • Illness • Depression • Lack of motivation Exercise can actually help improve many of these barriers!!!

11. The FITT Principle • Frequency • Intensity • Time • Type

12. Frequency • How often per week should I exercise? • Activities such as walking and cycling should be done on most days • Strength training should be done 2-3 days per week on non-consecutive days (Monday-Wednesday-Friday) • Great opportunity to exercise 3 days a week during dialysis!

13. Intensity • How hard should I exercise? • You should be able to carry on a conversation • 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.

14. Time • 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.

15. Type • What can I use to exercise? Do whatever you like best!!!

16. Cycle

17. Ankle Weights

18. Exercise Demonstration Exercise is Medicine™!! Exercise is Medicine™!!

19. Arm Curls • Place elbow at your side or on the arm rest. • Grasp a hand weight with palm facing upward. • Slowly bend elbow and raise hand toward same shoulder. • Lower and Repeat.

20. Toe Taps • Place feet flat on floor. • Keeping heels on floor, raise toes toward knees. • Fatigue should be felt in the front of lower legs.

21. Reclined Toe Taps • Raise leg rest for support. • Point toes toward ceiling. • Pull toes toward knees. • Return to start and repeat.

22. Sit with feet flat on floor. Slowly straighten one knee and raise foot until parallel to floor. Lower and repeat with other leg. Lower Leg Raises

23. Reclined Lower Leg Raises • Raise leg rest for support. • Carefully take one foot off of chair and allow to swing freely. • Slowly raise foot to height of leg rest. • Lower and repeat.

24. Place feet flat on the floor. Keeping knees bent, raise one knee off of the chair as high as is comfortable. Lower and repeat. Seated Marching

25. Reclined Seated Marching • Raise leg rest for support. • Slowly bend one knee and pull toward chest. • Lower and repeat with other leg.

26. Straight Leg Raises • Raise leg rest for support. • Slowly lift one leg to a comfortable height. • Lower and repeat.

27. While seated upright or reclined, flex the muscles you are sitting on! ‘Rear-end’ Squeezes

28. Review • Exercise can improve your quality of life • Discuss participating in an exercise program with your doctor • Begin slowly, progress gradually • Exercise is a necessity for all of us!