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    1. 1. Exercise: The Wonder Drug Exercise Essentials for All Dan Bayliss, MS CES Clinical Exercise Physiologist University of Virginia Renal Services University of Virginia Medical Center Charlottesville, Virginia
    2. 2. “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.”  ~Plato
    3. 4. Introduction <ul><li>Benefits of Exercise </li></ul><ul><li>Physical activity vs. Exercise </li></ul><ul><li>When Not To Exercise </li></ul><ul><li>How To Get Started </li></ul><ul><li>Exercise Components </li></ul><ul><li>Hemo vs. Peritoneal vs. Transplant </li></ul><ul><li>Helpful Hints </li></ul><ul><li>Additional Resources </li></ul>
    4. 5. Exercise?? Are you Kidding?? <ul><li>You can do it!! </li></ul><ul><li>Activity levels and chronic disease </li></ul><ul><li>Does exercise/physical activity help? </li></ul>
    5. 6. Benefits of Exercise for Renal Patients <ul><li>Increased endurance </li></ul><ul><li>Increased strength </li></ul><ul><li>Increased flexibility </li></ul><ul><li>Increased energy </li></ul><ul><li>Helps lose or maintain weight </li></ul><ul><li>Improves feelings of depression </li></ul><ul><li>Improves sleep!! </li></ul><ul><li>Improves blood pressure </li></ul>
    6. 7. Benefits cont. <ul><li>Stabilizes blood sugar levels </li></ul><ul><li>Strengthens your heart </li></ul><ul><li>Improves cholesterol levels </li></ul><ul><li>Improves microcirculation </li></ul><ul><li>Reduces the risk for heart disease </li></ul>
    7. 8. Physical Activity vs. Exercise <ul><li>Physical Activity , defined by the American College of Sports Medicine (ACSM) as “any bodily movement that is produced by the contraction of skeletal muscles and increases energy expenditure.” </li></ul><ul><li>In other words, get up and move!! </li></ul>
    8. 9. Exercise vs. Physical Activity cont. <ul><li>Exercise is defined as “a subclass of physical activity, planned structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.” </li></ul><ul><li>In other words, going for a walk or going to the gym and working on cardio machines or even taking a pool class. </li></ul>
    9. 11. When Not To Exercise <ul><li>Body temperature >101.0 degrees (38.3 degrees C) </li></ul><ul><li>Missed more than one treatment </li></ul><ul><li>Newly undiagnosed illness </li></ul><ul><li>Pain </li></ul><ul><li>Not feeling well </li></ul><ul><li>Blood Pressure <200/100 </li></ul><ul><li>Unstable sugar levels </li></ul>
    10. 12. SYMPTOMS THAT SHOULD BE REPORTED TO YOUR MD <ul><li>Pain or pressure in chest, neck or jaw </li></ul><ul><li>Excessive fatigue, not related to lack of sleep </li></ul><ul><li>Unusual shortness of breath </li></ul><ul><li>Dizziness or lightheadedness during or after exercise </li></ul><ul><li>Persistent rapid or irregular heart rate during or after exercise </li></ul>
    11. 13. How to Get Started <ul><li>The “ FITT ” Principle </li></ul><ul><li>F REQUENCY (days per week) </li></ul><ul><li>I NTENSITY (how hard) </li></ul><ul><li>T YPE of Activity </li></ul><ul><li>T ime (how long to go) </li></ul>
    12. 14. FREQUENCY <ul><li>Walk around your block once or twice a week </li></ul><ul><li>Community program </li></ul><ul><li>Senior recreation program </li></ul><ul><li>Start with 5 or 10 min, or what you can tolerate </li></ul><ul><li>Add 1-2 min every week </li></ul><ul><li>Goal duration should be 20-60 min </li></ul>
    13. 15. INTENSITY <ul><li>Go at your own pace </li></ul><ul><li>Talk Test </li></ul><ul><ul><li>Exercise at conversation level </li></ul></ul><ul><ul><li>If you’re short of breath, slow down </li></ul></ul><ul><li>Rating of Perceived Exertion (RPE) </li></ul><ul><li>Listen to your body!! </li></ul>
    14. 16. RPE Scale
    15. 17. TYPE OF EXERCISE <ul><li>Endurance Exercise </li></ul><ul><li>Anything that involves working your arms and legs </li></ul><ul><li>Continuous, repetitive, structured activities </li></ul><ul><ul><li>Walking, cycling, dancing, swimming, stair climbing </li></ul></ul><ul><li>Warm-up/ Cool down </li></ul>
    16. 18. TIME <ul><li>Start with what you can tolerate </li></ul><ul><li>Walking </li></ul><ul><ul><li>add 1-2 min </li></ul></ul><ul><li>Stair climbing </li></ul><ul><ul><li>Add 1-2 steps per week </li></ul></ul><ul><li>Work towards 30-60 min most days of the week </li></ul><ul><li>The more you do, the stronger you’ll get!!! </li></ul><ul><li>YOU CAN DO IT!! </li></ul>
    17. 19. Strengthening Exercise <ul><li>Helps improve or maintain strength </li></ul><ul><li>AT LEAST 2x/week </li></ul><ul><li>Hand weights, leg weights, resistance bands, milk jugs </li></ul><ul><li>Slow and easy progression </li></ul><ul><li>Lift 8-12 times </li></ul><ul><li>8-10 different exercises </li></ul><ul><li>Take a break (1 set) </li></ul><ul><li>Repeat </li></ul>
    18. 20. Flexibility Exercise <ul><li>Helps prevent joints from becoming stiff and painful. </li></ul><ul><li>Types of flexibility exercises: </li></ul><ul><ul><li>Stretching </li></ul></ul><ul><ul><li>Yoga </li></ul></ul><ul><ul><li>Chair stretches </li></ul></ul>
    19. 21. Outpatient Hemodialysis <ul><li>UVA unique to outpatient exercise </li></ul><ul><li>HD patients tend to be less active </li></ul><ul><li>Strengthening/flexibility exercise recommended </li></ul><ul><li>Patients usually sit for 2-4 hours, what else do you have to do? </li></ul><ul><li>Make the commitment to yourself </li></ul><ul><li>Consider it “gym time” </li></ul><ul><li>Exercises should be done within the first hour of treatment </li></ul>
    20. 22. Peritoneal Dialysis <ul><li>Exercise in the middle of dialysis exchange and before adding the new dialysis fluid </li></ul><ul><ul><li>Allows less pressure on the catheter </li></ul></ul><ul><ul><li>Reduces the risk of hernias and catheter leaks </li></ul></ul><ul><li>Keep catheter clean </li></ul>
    21. 23. Peritoneal Dialysis cont. <ul><li>Tips to keep in mind: </li></ul><ul><li>No full sit-ups, try curl-ups or “crunches” </li></ul>
    22. 24. Peritoneal Dialysis cont. <ul><li>Cycling </li></ul><ul><ul><li>Keep bag away from pedals </li></ul></ul><ul><li>Swimming </li></ul><ul><ul><li>Sea/pond water vs. chlorinated water </li></ul></ul>
    23. 25. Transplant <ul><li>Benefits include: </li></ul><ul><ul><li>Weight management </li></ul></ul><ul><ul><li>Regaining physical function </li></ul></ul><ul><ul><li>Maintain muscle mass </li></ul></ul><ul><ul><li>Other benefits similar to Hemodialysis patients </li></ul></ul><ul><ul><li>recovery from surgery </li></ul></ul><ul><li>Speak to your MD before starting </li></ul><ul><li>Walking is recommended immediately post transplant </li></ul>
    24. 26. Transplant cont. <ul><li>NBA stars Alonzo Mourning and Sean Elliot </li></ul>
    25. 27. Transplant Games <ul><li>Transplant games </li></ul><ul><li>Sponsored by NKF </li></ul>
    26. 28. Helpful Hints <ul><li>Talk to your MD before starting an exercise program! </li></ul><ul><li>Keep a log </li></ul><ul><li>Start slow, results take time </li></ul><ul><li>Get other family members involved </li></ul><ul><li>Bound to wheelchair? </li></ul><ul><li>Physical Therapy/Cardiac Rehabilitation </li></ul><ul><li>Make physical activity a priority in your life! </li></ul><ul><li>It takes time but it also makes time!! </li></ul>
    27. 29. Additional Resources <ul><li> </li></ul><ul><ul><li>Exercise: A Guide for People on Dialysis </li></ul></ul><ul><li> </li></ul><ul><li> </li></ul><ul><ul><li>Staying Fit with Kidney Disease </li></ul></ul><ul><ul><li>Transplant Games </li></ul></ul>
    28. 30. Renal Rehab Resource Center (patients > free download materials) 1-800-468-7777
    29. 31. So whatever happens in Vegas, should NOT stay in Vegas when it comes to exercise and physical activity!!
    30. 32. Surgeon General’s Warning: PHYSICAL INACTIVITY MAY BE HAZARDOUS TO YOUR HEALTH Patricia Painter, Ph.D.