“I’ve been doing sports on dialysis for 15 years, it’s really good for me, so I can still work a bit,” says the 66-year-old. “When I started cycling on dialysis, I could walk 50 meters, now after a year I can do 500 meters, I’m very happy about it,” says the 82-year-old patient. A 63-year-old has been on dialysis for seven years and has already had heart surgery. He, too, exercises regularly while he is connected to the blood wash. He feels fitter as a result and realizes that he has recovered better after the surgery.
All of these patients took part in a study examining whether chronic kidney disease patients benefited from regular exercise. In the current edition of New England Journal of Medicine – Evidence the results are presented. Sports physicians and kidney experts from Munich, Bischofswerda and Cologne show in almost 1000 patients who are dialyzed at 21 locations that the sick improve their physical performance considerably and also have to spend fewer days in the hospital.
Endurance was trained for 30 minutes and strength for 30 minutes during each dialysis session
“The results are unbelievable: coordination, strength and endurance improve, quality of life also and above all hospital admissions as well as time in hospital decrease over the year of training,” says sports physician Martin Halle from the Technical University of Munich, who works at the study was involved. Using the time during dialysis to exercise also has many advantages for patients. “They have an alternative occupation to watching TV and when the group exercises in the dialysis room, there is a positive atmosphere.” In addition, dialysis works more efficiently because the substances to be filtered are better mobilized into the blood through movement. “According to our study, it is difficult to understand why dialysis has so far taken place without training,” says Halle.
For the study, which is one of the largest in which a physical therapy approach was examined for the chronically ill, the patients were given a set of pedals mounted on their dialysis bed so that they could train their endurance adapted to their age and ability – like on a recumbent bike. They also strengthened their leg muscles with crushed balls and gymnastics balls. Since the patients have to do artificial blood washing three times a week for four to five hours anyway, no additional time was required for physical activation, so most patients continued with the exercise program – endurance was trained for 30 minutes and strength for 30 minutes during each dialysis session .
During the study and at the conclusion after one year, the patients showed progressively better results on standardized tests, which indicate the level of frailty and are a measure of fitness in old age and in impaired health. After the 12-month program, the patients were able to get up from a sitting position within 60 seconds more often, their walking distance increased and their hand strength increased somewhat – all of these skills are important for independent living in old age. In addition, the patients who had exercised regularly had to go to the clinic significantly less frequently than the control group because of complications or other illnesses.
The material expenditure for the sports program is limited
“Of the patients on dialysis, 30 percent have diabetes and many already have heart diseases such as cardiac insufficiency or calcified heart vessels,” says nephrologist Kirsten Anding-Rost from the Bischofswerda dialysis center. “With the training, negative effects on the heart and circulation can be counteracted.” She also points out that patients on dialysis are often frail, unsteady on their feet and often fall. Physical condition continues to deteriorate before and during dialysis. “Only physical training can counteract that,” says Anding-Rost.
The material expenditure for the sports program is limited, and according to the study, hospital admissions and sick days in the clinic are reduced as a result. “With this cost saving, you can easily finance the training of the patients,” says the nephrologist Gero von Gersdorff from the University Hospital in Cologne. “And over the long term, we expect falls and maybe even mortality to decrease.” In Germany, around 75,000 patients are dependent on a dialysis procedure. Many of them are considered multimorbid, meaning they suffer from multiple diseases, particularly diabetes and damage to the heart and blood vessels.