exercise in patients pranissa - thaiheart.org · microsoft powerpoint - exercise in patients...
TRANSCRIPT
![Page 1: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/1.jpg)
Exercise in Patients with End‐stageExercise in Patients with End stage renal Disease
![Page 2: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/2.jpg)
• Chronic renal failure : d l d i l
• End‐stage renal gradual and progressive loss of the ability of the kidneys to function
disease :A complete or near
l f l f hto functionStructural kidney damageProgressive diminished
complete failure of the kidneys to function
Progressive diminished renal function
![Page 3: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/3.jpg)
• Causes : long standing DM, HT, autoimmune disease glomerulonephritis pyelonephritisdisease, glomerulonephritis, pyelonephritis, polycystic kidney, congenital abnormalities
• Kidney function < 10‐15% → progressive renal failure→ uremic symptomsfailure → uremic symptoms
![Page 4: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/4.jpg)
• Loss of excretory function :↑ toxin in
• Loss of regulatory functionfunction : ↑ toxin in
bloodfunction
• Uremic syndrome : • Extracellular volume ↑, electrolyte imbalance
fatigue, nausea, malaise, anorexia, • HT peripheral edemaneurologic symptoms HT, peripheral edema,
pulmonary edema, CHF
![Page 5: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/5.jpg)
• Abnormal excretion of ammonia, hydrogen ion
• ↓ production of erythropoietin
• Metabolic acidosis • Anemia of ESRD
![Page 6: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/6.jpg)
↑ parathyroid hormone↑ parathyroid hormone• ↑ phosphate• ↓ active vitamin D• ↓ absorption calcium → ↓ circulatory calcium↓ p ↓ y• ↓ bone minerals
Renal osteodystrophy
![Page 7: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/7.jpg)
• Insulin resistance• Hyperglycemia• Hyperglycemia• Hyperlipidemia• Diagnosis : ↑ BUN, ↑ Cr, ↓ GFRCardiovascular diseaseCardiovascular disease• Main cause of death• Incidence > general population 5‐30 times• Transplant patients > general population 4 timesp p g p p
![Page 8: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/8.jpg)
T t t f Ch i l f ilTreatment of Chronic renal failure
Di t t i di t di fl id• Dietary measures : protein, dietary sodium, fluid restrictions → ↓nitrogen waste products
• Very strict BP control• Very strict BP control
f d l diTreatment of End‐stage renal disease
• Hemodialysis• Peritoneal dialysisPeritoneal dialysis• Renal transplantation
![Page 9: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/9.jpg)
Physical performance in CKD patientsPhysical performance in CKD patients
• Physically inactivey y• ↓ VO2 peak• ↓ physical functioning
![Page 10: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/10.jpg)
Exercise and RehabilitationExercise and Rehabilitation
• Dialysis patients : limited exercise capacity , 39 ‐60% of normal age‐expected levelsg p
• Unable to perform exercise testM f HR i d d• Measurement of HR is not recommended
for determining training intensityg g y
![Page 11: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/11.jpg)
Performance physical function measuresPerformance physical function measures in dialysis patients
• 6‐minutes walk testG it d t t• Gait speed test
• The sit to stand test• Walking stair climbing testS lf SF 36 H l h S• Self‐report : SF‐36 Health Status Questionnaire
![Page 12: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/12.jpg)
Exercise training responseExercise training response• Aerobic and resistance training improve physical• Aerobic and resistance training improve physical functioning , performance, quality of life
l h l• ± Impact on survival or hospitalization, improvement of BP, lipids profile
• Dialysis patients : ↑ VO 2 max(below age‐predicted values)(below age‐predicted values)
• Transplant patients : markedimprovement in VO 2 max
![Page 13: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/13.jpg)
Exercise prescriptionExercise prescription
Goal : maintenance of functionand independenceand independence
Type of activity• ROM + strengthening → non‐weight bearing aerobic exercise : stationary cyclingy y g
• Concern about the access sites• Transplant patients: non‐contact sport, avoid vigorous activities
![Page 14: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/14.jpg)
Timing • Best on non‐dialysis day• Before dialysis day : up to the patients: weight gain ( > 2‐3 kg) shortness of breath BP↑ ?: weight gain ( > 2‐3 kg), shortness of breath, BP ↑ ?• During hemodialysis : better during the first 1‐1.5 hr• Continuous ambulatory peritoneal dialysis : exercise in the middle of a dialysis exchange
• After dialysis : extremely fatique
![Page 15: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/15.jpg)
Frequency of exerciseFrequency of exercise• Stretching exercise : during and after dialysisSt th i i 3 d / k• Strengthening exercise : 3 days/week
• Aerobic exercise : at least 3 days/weekIntensity : RPE• Initially : very short duration, no warm‐up and
l d hcool down phaseExercise ≥ 20 minutes : • Warm‐up and cool down : RPE = 9 to10• Conditioning : RPE = 12 to 15
![Page 16: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/16.jpg)
P i f iProgression of exercise• Duration : start from interval training 2‐3 minutes• ROM + strengthening exercise : start from low weight + high repetition → cardiovascular activityg p y
• Exercise during dialysis: start from 10 minutes
![Page 17: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/17.jpg)
Risk of exerciseRisk of exercise
M l k l l i j f d i j• Musculoskeletal injury : fracture, tendon injury• Cardiac complication : dysrhythmia, ischemiaMinimize risks by• Proper medical screeningp g• Appropriate warm‐up and cool down• Good environment and equipmentGood environment and equipment• Start slowly and progress
exercise graduallyexercise gradually• Avoid high impact activity
![Page 18: Exercise in Patients Pranissa - thaiheart.org · Microsoft PowerPoint - Exercise in Patients Pranissa [Compatibility Mode] Author: Administrator Created Date: 10/31/2012 3:32:48 PM](https://reader035.vdocument.in/reader035/viewer/2022063017/5fd76adae66f2626e435bed3/html5/thumbnails/18.jpg)
THANK YOU