Renal Rehabilitation Program—An aerobic exercise program in the

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					Renal Rehabilitation Program—An aerobic
exercise program in the hemodialysis unit

      S. Iqbal, H. Perrault, P. Barré and M. Vasilevsky
    McGill University Health Centre and McGill University




              April, 2005, SQN
                    Background

 Aerobic exercise on dialysis benefits
     Improve bp, well-being, physical activity,
      muscle mass, cardiac mass and may be solute
      clearance
 Feasibility of developing a program
     Maintaining is a main issue since 40% stop
      exercising after a year.
     Need encouragement and all staff to support
                 Objectives

 Assess change in CVD risk factors (bp, hgb)
 Assess change in biochemistry (Potassium,
  Phosphate, urea clearance)
 Quality of life measures (Rand)
                Study Design

 Feasibility study to start an exercise program
  in the hemodialysis unit and assess the
  difference in quality of life measures, some
  traditional CVD risk factors and dialysis
  parameters before and after the intervention.
 Used one sample before and after
  comparison with non-parametric (sign test)
              Study Population

 Eight volunteers (morning and afternoon
  shifts) recruited after negative exercise stress
  test was documented.
 Six completed six months of exercise, 1
  completed 3 months and one died from septic
  shock. (25% didn’t complete)
                 Intervention

 6 month aerobic exercise program for
  hemodialysis during the first hour of dialysis
  treatment
 Started with 10-15 minutes and slowly
  increased the time
 Supervised by an exercise therapist (2:1
  ratio)
Champion Chair
                        Results (before)

Characteristics            Mean/Proportion   Standard    Range
                                             deviation
Demographics
Age (years)                58                13          36-72
Gender (male)              0.50
Chronic Disease Score      4                 0.6         3-5
Biochemistry
Serum Potassium            4.3               1.5         4.7-5.5
Serum Phosphate            1.47              0.61        0.8-2.5
Hemodynamics
VO2 max                    0.79              0.09        0.65-0.8
Systolic BP                124               17          103-148
Diastolic BP               71                8           53-78
Results Cont’d
            Results cont’d

        blood pressure and post dialysis w eights


200

150

100

50

 0
      SBP                   DBP                     post w eights
                              Results
                    biochemistry and clearance

6

5

4

3

2

1

0
    potassium         kt/v             PO4(*)    calcium




      *P = 0.0078
                       Results

              PTH levels before and after

         60
         55
         50
         45
pmol/L




         40
         35
         30
         25
         20
         15
                       before    after
 Phosphate binders (didn’t change)
  Calcium Carbonate 1.5g/day,
  Renagel 2400 mg/day
 Calcitriol 0.25 g/day stayed same
            Hemoglobin before and after

      135

      130

      125
g/L




      120

      115

      110

      105
                                     average Hgb



                                                          Epo dose


                                  12000
                                  10000
                 Units per week




                                   8000
                                   6000
                                   4000
                                   2000
                                     0
                                  -2000
                                                   Erythropoietin dose before and after
                         Conclusion

 It is feasible to exercise patients – just need to make
  sure health care team feel the same way and support
  the program
 More pleasant environment for everyone
 Trends towards improvement: quality of life, bp,
  Hgb
 PO4 very significant in small sample size
      Healthier life style effect (take binders)
      Or exercise
      Role in bone disease