CKD and Exercise

中國醫藥大學北港附設醫院復健科主任陳信水

CKD associated physical dysfunction

• Muscle wasting

• Weight loss

• Excessive fatigue

• Sexual dysfunction

• Uremic myopathy

• Uremic neuropathy

Factors leading to poor physical function in CKD

• Inactivity

• Functional and structural muscle abnormalities

• Inflammation

• Blood flow and anemia

History of HD exercise

• 30 years ago: first introduced.– Exercise training improves abnormal lipid and car

bohydrate metabolism in hemodialysis patients. – Trans Am Soc Artif Intern Organs. 1979;25:431-7

• Previous study:– The effectiveness of intradialytic leg ergometry ex

ercise for improving sedentary life style and fatigue among patients with chronic kidney disease: A randomized clinical trial

– Int J Nurs Stud. 2010 May 25.

Exercise is a good advice to HD patients

• 1979-2005: many studies to HD with exercise benefits.

• Critical review to commend exercise is a good health to HD.

• 2005 to now :exercises are not provacated to suggest to HD patients. Why?

Uncontrolled triads

Nonrandomized controlled trials

Randomized controlled trials

Randomized controlled trials

The effects of exercise

• Muscle structure and function

• Cardiac function

• Blood pressure and other cardiovascular risk factors.

• Glycemic control and insulin resistance

• HD efficiency

• Psychological adaptation, quality of life and nutrition

The assessment of exercise capacity

• Exercise tolerance tests

• Functional capacity tests

• Neuromuscular function tests

• Muscle composition and structure.

Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patie

nts with end-stage renal disease.

Practical methods for applying exercise therapy

• Recommendations– Age over 65y/o or 45-64y/o with chronic diseases can

be apply to ACKD patients.• Circulation 2007;116:1094-1105

• Exercise type: aerobic, resistance and flexibility activities.– Aerobic:30 min, mod intensity, 5 days/week– Resistance: major muscle group, 2 times/week– Flexibility activities: all days that A and R performed.

Exercise protocols

• Intra-dialysis exercise

• Home exercise

Adaptation to exercise training in hemodialysis

• Physical adaptations to exercise training

• Functional adaptations to exercise training

• Psychologic adaptations to exercise training

Physical adaptations to exercise training

• The cardiorespiratory system and aerobic capacity.

• Cardiac functioning.

• Muscle architecture and neuromuscular control.

• Components of metabolic syndrome.

• Dialysis adequacy.

Functional adaptations to exercise training

• Muscular strength

• Functional performance

• Disability

• Depression• Quality of life

Psychological adaptations to exercise training

Limitation on exercise therapy

• Exercise protocols currently available have often been developed for research.

• The dropout rate is high.

• Clear contraindication for exercise are excluded most of HD patients.

• Age-relative limitation

Exercise is contraindicated in CKD Patients with

• a systolic blood pressure > 200 mm Hg or a diastolic blood pressure > 110 mm Hg.

• electrolyte abnormalities.

• recent myocardial infarction.

• recent changes in the electrocardiogram.

The American College of Sports Medicine (ACSM)

Conclusion

• No large randomized controlled trials evaluating the survival benefits of exercise.

• Frail and incapacitated patients are mostly need physical rehabilitation as a part of there clinical care

• Exercise are likely to be significant gains for healthcare system by reducing the collateral costs of CKD patient who was deconditioning.