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The “Dummies” Guide to The “Dummies” Guide to Starting an Exercise Program Starting an Exercise Program
in your Dialysis Unitin your Dialysis UnitDan Bayliss, MS CESDan Bayliss, MS CES
Debbie Cote, RN CNNDebbie Cote, RN CNN
University of Virginia Renal ServicesUniversity of Virginia Renal Services
University of Virginia Medical CenterUniversity of Virginia Medical Center
Charlottesville, VA Charlottesville, VA
Based on the Life Options Unit Based on the Life Options Unit Self-Assessment Manual for Self-Assessment Manual for
Renal RehabilitationRenal Rehabilitation
Module 4: ExerciseModule 4: Exercise
Practical Guide to Renal Practical Guide to Renal RehabilitationRehabilitation
www.lifeoptions.orgwww.lifeoptions.org
Topics of DiscussionTopics of Discussion• UVA SitFit Exercise Program• Why exercise?• Benefits of exercise to the staff• Components needed to start a program• Obstacles to starting a program• Cost of Equipment• Patient Interest programs• Documentation• Testing• Questions
UVA SitFit Exercise ProgramUVA SitFit Exercise Program
• Started by Kline Bolton, MD in 1998
• Full-time Master’s-trained Exercise Physiologist
• 8 dialysis units • Over 740 patients• 30-35% of patients have
exercise orders
Why Exercise??Why Exercise??• Renal failure is a significant health care
concern now and in the coming years– The USRDS predicts significant growth in the
prevalence of ESRD– Researchers predict the ESRD population to
reach >600,000 by 2010– Hypertension and diabetes rates are on the
rise as well
• Patients who exercise during dialysis have fewer episodes of low systolic blood pressure that require treatment during dialysis
NUMBER OF INCIDENT & POINT NUMBER OF INCIDENT & POINT PREVALENT PATIENTSPREVALENT PATIENTS
figure 1.3, projected to 2010figure 1.3, projected to 2010
1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Num
ber o
f pat
ient
s (in
thou
sand
s)
0
100
200
300
400
500
600
700
IncidenceR2=99.8%
Point prevalenceR2=99.7%
ProjectionNumber of patients
95% Confidence interval
326,217
372,407
661,330
86,82598,953
172,667
2003 M-1 Projected 447,689*
2003 actual prevalent count: 452,957 (+1.2 %)
651,330
JASN 2001; Vol JASN 2001; Vol 12:2753-275812:2753-2758
2003 M-1 Projected 118,779*
0
5
10
15
20
25
30
1990 1994 1998 2002 2006 2010
11.8 16.5 28.3
Do
llars
(b
illio
ns)
Year
PROJECTED COST FOR ESRD CAREPROJECTED COST FOR ESRD CARE
Why Exercise cont.Why Exercise cont.• Recent research indicates the positive
effects of exercise for dialysis patients– Improves Kt/V– Improves phosphorus levels– Stabilizes blood pressure and reduces the
number of low blood pressure episodes– Improves blood glucose levels– Improves lipid and carbohydrate metabolism– Improves strength, endurance, flexibility– Improves energy levels, QOL– Increases exercise capacity by 21 to 25%
Why Exercise, cont.Why Exercise, cont.
• Help patients get back to work• Improve their ability to care for themselves• May prolong life• IMPROVES QUALITY OF LIFE
Benefits to the Staff Benefits to the Staff
• Dialysis staff benefit when patients exercise through improved patient relationships, time savings (faster transfers), and reduced risk of work-related injuries (fewer lifts)
• May actually improve their PA levels!!
Obstacles to ExerciseObstacles to Exercise
• Who’s going to pay for it??– Hospital/medical center grants– Patient memorial funds– donations
• Staff dedication/involvement• MD clearance• Patient noncompliance
Components neededComponents needed• Administrative support• Exercise “Champion(s)”
– Similar to anemia management person – Strategies for identifying champion
• Solicit interest from staff, patients, or community volunteers
• Have staff in-services• Call local college about internship program
• Equipment• Patient involvement programs
Essential GuidesEssential Guides• Life Options Rehabilitation booklets
– Unit Self-Assessment Tool for Renal Rehabilitation (USAT)
– Guide for the Nephrologist– Prescribing Guide– Guide for Patients on Dialysis– www.lifeoptions.org
Administrative RequirementsAdministrative Requirements
• Exercise Physiologist/Physical Therapist (?)• Exercise “champion” (RN, Tech, SW)• Administrative support• Training staff• Job descriptions including exercise program• Billing• Referrals (cardiac rehab, PT, social work)
Floor Staff is the KeyFloor Staff is the Key• Exercise “champion” should not do all the
work.• Each staff member has the responsibility
to encourage the patients• If the staff is dedicated, patient exercise
participation will be high• Don’t ask the patients if you want to
exercise– Most patients will automatically say “no”– Instead, bring them the exercise equipment
and ask how long do they want to go today
Staff StrategiesStaff Strategies
• Don’t ask, just bring the equipment to the patients
• Get involved with the patients• Encourage other staff to get involved• Have a pod/bay book
DocumentationDocumentation• Unit Exercise Bay/Pod Book
– Exercise daily set-up sheet– Pertinent research papers– Exercise Decision Tree– Exercise bike protocol– Potential problems– Stretching guide– Weight training guide– Exercise Prescriptions– Exercise progress/communication notes
EquipmentEquipment• Stationary Cycle
– Monarch 881E – CHAMP cycle
• Treadmill • NuStep® (www.nustep.com)• OxyStepper®
• Hand Weights• Leg Weights• TheraBands®
Cost of EquipmentCost of Equipment
• General Equipment– Fitness, free weights $20.00– Hand, ankle weights (per lb) $1.00– Thera-Bands® $1.30– Stationary bike (CHAMP) $350.00– Pedal exerciser $42.00
Total $409.30
Cost of Equipment cont.Cost of Equipment cont.
• Exercise Room Equipment– Treadmill $1300.00– NuStep® $3500.00– AirDyne® $465.00
CHAMP CycleCHAMP Cycle
• Designed for dialysis chairs
• Inexpensive ($300-500)• Bulky (~ 60lbs)
Monarch 881E Rehab TrainerMonarch 881E Rehab Trainer
• Clinically designed• Easy to transport
– Tip and roll
• Expensive (~$1300)• Breaks down often
LifeCare OxyStepperLifeCare OxyStepper
• Inexpensive• Light and mobile• Does not give
cardiovascular exercise effect similar to cycling
• May be hard to reach
Patient Interest ProgramsPatient Interest Programs
• Pod Exercise Information sessions, or “classes”
• Cycle across America• 12 Days of Exercise (Christmas holiday)• “Buddy Up” program• Exerciser of the Month• Patient-Staff Match-up Program• Wellness Programs including social work
and nutrition
TestingTesting
• Two and Six-min walk test• Sit-to-Stand test• Stair Climbing test• Lift-Reach test
ClosingClosing• If unit staff works together, and exercise program
can be successful• It does NOT have to come down to lack of money for
a unit to have an exercise program• Exercise should NOT be “cutting edge” anymore, it
NEEDS to become a standard treatment for all dialysis units!
“Every patient should be asked, ‘What are you doing for regular exercise?’”
-- Patricia Painter, PhD
Surgeon General’s Warning:
PHYSICAL INACTIVITY MAY BE HAZARDOUS TO YOUR
HEALTHPatricia Painter, Ph.D.
Contact InformationContact InformationUVA SitFit Exercise Program Website:
http://www.healthsystem.virginia.edu/
Contact Person:Dan Bayliss, MS CESClinical Exercise [email protected]
Questions??Questions??
“Give about two hours every day to exercise, for health must not be sacrificed to
learning.” Thomas Jefferson, 1789