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.

Im­por­tant Con­sid­er­a­tions

for Start­ing an

Ex­er­cise Pro­gramme

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).