Chronic kidney disease is a common health problem in the Caribbean, more so in T&T, where it is the fourth leading cause of death. A person is diagnosed with chronic kidney disease (CKD) if their kidneys are not functioning optimally, which can be indicated by either microalbuminuria (which means there are high levels of protein in your urine because the kidney is not working well to filter them out) or decreasing glomerular filtration rate (GFR).
These factors are used to stage kidney diseases which usually has five stages. Stage 1 usually means that the patient’s GFR is normal and there is low albumin in their urine and are considered to not have chronic kidney disease, stage 5 means that the patient’s GFR is very low and they need renal replacement therapy which is usually either dialysis or kidney transplant.
Additionally, diabetes, hypertension and cardiovascular diseases are very common in persons with kidneys, and these other chronic diseases become more prevalent as the stages increase. This means that there is a need for healthy lifestyle habits to be promoted amongst patients with CKD.
The Benefits of Exercise
for CKD Patients
The National Kidney Foundation encourages patients with CKD to exercise, because of the many health benefits of exercise offered to them. Benefits include increasing energy levels and endurance, increase physical function, increase muscular strength, improved balance and coordination, decreased levels of fat, better weight control, improved blood pressure (which means less damage to the kidneys), better control of blood sugar (less stress on the kidneys) and better quality sleep.
for Starting an
While the benefits of exercises sound great, there several factors to take into consideration before CKD patients start an exercise programme, especially one of a moderate to vigorous intensity or if they have not been exercising in the past three months. Few of these factors are:
• Medical clearance is needed from a physician (as many CKD patients also present with cardiovascular diseases).
• Some patients are on multiple medications for other conditions, such as diabetes, hypertension, high cholesterol, and some of these medications might affect their exercise tolerance.
• Exercise testing for stage 5 CKD patients or those receiving maintenance dialysis should be done on non dialysis days and their blood pressure monitored on the arm that does not contain the arteriovenous fistula.
The Exercise Prescription
Exercise programmes for patients with CKD can incorporate various types of exercises:
Aerobic Training: can be done 3-5 days per week, moderate intensity (meaning you are breathing harder during the exercise but able to have a conversation), 20-60 minutes of continuous activity (bouts of 3-5 minutes can be accumulated in a day to reach up to 20-60 minutes if continuous activity cannot be tolerated) and types of activities include walking, cycling, swimming, etc.
Resistance Training: 2-3 days per week, can start with 1 set of 10-15 repetitions (achieve multiple sets over time), use 8-10 different exercises that target the main muscle groups (resistance should not be too heavy) and types of activities may include body weighted, machines or bands.
Flexibility Activities: 2-3 days per week, stretch to the point of tension or tightness or slight discomfort (not pain), hold stretches for 10-30 seconds and various static and dynamic stretches can be done.
Exercise Training Considerations
• Some persons may not be able to do a continuous exercise session initially, these sessions can be broken down into 3-5 minutes bouts with a total time of 15 minutes for the session, eventually this can be progressed.
Slow down progression if there is a medical setback.
Ideally exercise should be done on non dialysis days (to prevent excessive drop in blood pressure).
Patients with peritoneal dialysis are encouraged to drain fluid before exercise to prevent discomfort.
Recipients of kidney transplant can exercise during periods of rejection; however exercise intensity must be reduced.
• STOP exercising if the person experiences muscular cramps, joint pains, nausea/vomiting, pain in the face/jaw, difficulty speaking, or seeing, abnormal shortness of breath, sudden dizziness or headaches or sudden weakness in the limbs.
The point to take away is that exercise can be safe for persons with CKD, once they receive medical clearance to participate in exercise and listen to their bodies and gradually progress themselves. Exercise has many health benefits and can help these patients to improve their daily function. Seeking advice from trained professionals and having a good support system is very important. #TTmoves (The information in this article is based on 2018 recommendations made by the American College of Sports Medicine).