Browsing by Person "Macdougall, I. C."

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Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease
(Oxford University Press, 2012-10) Greenwood, S.; Lindup, H.; Taylor, K. J.; Koufaki, Pelagia; Rush, Robert; Macdougall, I. C.; Mercer, Tom
Background Physical activity has the potential to positively impact upon aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients independent of the stage of the disease process. Physical activity is recommended in a number of national CKD guidelines, but its incorporation into routine care has been slow. The translation of research-led physical activity programmes into an established procedure appears to be a particular obstacle. This study included 263 patients, consecutively referred over a 4-year period, to a pragmatic 12-week renal rehabilitation (RR) programme delivered within a National Health Service (NHS). Methods One hundred and thirty-one patients were assessed and started the RR programme. Anxiety and depression were measured using the hospital anxiety and depression (HAD) scale. The self-reported level of fitness was measured with the Duke's activity status index (DASI), and exercise capacity was assessed with the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 s (STS60), timed up and go (TUAG) and stair-climb descent (SCD) tests. All measures were assessed at baseline and at 12 weeks. Attendance and completion of the RR programme were recorded for all patients. Results There were significant improvements in exercise capacity and functional ability ranging from 21 to 44%, and significant improvements in anxiety (15%) and depression (29%) in the 77 patients who completed the RR programme. The self-reported level of fitness was found to be significantly associated with completion (P = 0.01), with older participants showing a trend towards being more likely to complete (P= 0.07). Fifty-four patients, out of the 131 patients who commenced the RR programme, failed to complete 12 or more of the 24 scheduled sessions. Patients requiring haemodialysis (HD) treatment constituted the largest number of dropouts/non-completers (49%) in the study. Conclusions This study demonstrates that a pragmatically constructed, NHS-delivered exercise-based RR can substantially improve both physical function and mental well-being for the wide range of CKD patients who regularly participated (55%). Compliance/adherence data indicate that this type of rehabilitation programme is particularly well received by pre-dialysis (PD) CKD and post-transplantation patients.
Exercise counselling practices for patients with chronic kidney disease in the UK: A renal multidisciplinary team perspective
(Karger, 2014-12) Greenwood, S.; Koufaki, Pelagia; Rush, Robert; Macdougall, I. C.; Mercer, Tom
Background: Patients with chronic kidney disease (CKD) have elevated cardiovascular disease (CVD) risk. Physical activity (PA) is a strong and independent CVD risk factor, and despite the fact that current clinical practice guidelines recommend simultaneous treatment of multiple risk factors for optimum management of CKD, PA is rarely addressed by renal care teams. The aim of this observational cross-sectional survey was to document current exercise/PA practices across renal units in the UK, and capture views and experiences regarding the provision of PA/exercise options for patients with CKD. Methods: An 18-item online survey questionnaire regarding exercise counselling practice patterns was administered to 565 multidisciplinary renal care professionals. Results: 142 individuals (25% response rate) completed the questionnaire. Overall, 42% of respondents discussed and encouraged PA, but only 18 and 11% facilitated implementation of PA for their patients. Nephrologists (p < 0.003) were more likely to prescribe or recommend PA compared to professionals with a nursing background and believed that specific renal rehabilitation services, including an active PA/exercise component, should be available to all patients (p < 0.01). The most commonly reported barriers for the development and implementation of PA/exercise options included lack of funding, time, and knowledgeable personnel, such as physiotherapists or other exercise professionals. Conclusion: Beliefs and attitudes towards PA amongst members of the renal multidisciplinary team are encouraging. However there is a big gap between believing in the benefits of PA and promoting/implementing PA for patient benefit. This gap needs to be minimised by at least trying to address some of the reported barriers. 2014 S. Karger AG, Basel
Exercise Therapy in Individuals With Chronic Kidney Disease: A Systematic Review and Synthesis of the Research Evidence
(Springer, 2013-10) Koufaki, Pelagia; Greenwood, Sharlene A.; Macdougall, I. C.; Mercer, Tom
Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease (CVD) which is considered the leading cause of morbidity and mortality in this cohort of patients. Additional independent risk factors for poor health outcomes among many include diabetes, physical inactivity and physical dysfunction. Physical inactivity partly contributes to the accelerated deterioration of physical function in people in all stages of CKD, to levels that significantly impact on clinically and patient important outcomes such as morbidity, employment, quality of life (QoL) and ultimately survival. Ongoing research aims to determine the effectiveness and impact of exercise rehabilitation on reducing/ managing the risk of CVD, alleviating physical function limitations, preventing disability and enhancing QoL. Current research also aims to elucidate the mechanisms via which exercise therapy may contribute to clinically relevant benefits. An evaluative overview of the available evidence from experimental interventions to modify PA levels, highlights the huge variability in exercise training and assessment protocols utilised and inconsistency in reporting procedures that hampers, systematic synthesis of the evidence. Nonetheless, the general conclusion that can be deciphered is that a mixed cardiovascular and resistance training programme that lasts at least 4-6 months, results in significant improvements in cardiorespiratory fitness. However, this level of improvement, does not consistently and meaningfully translates into enhanced CV risk profile or renal function, or QoL, even in the presence of improved physical function as a result of increased PA levels. The relatively short duration of interventions as well as the extremely small sample sizes, combined with the inherent large variability in individual responses and progression, may be partially responsible for the lack of a systematic and consistent effect. Moreover, the dose of exercise may have not been sufficient to produce larger effects in relatively short periods of time. Thus, although the research evidence base needs more work, that should incorporate more accurate and systematic approaches in the prescription and delivery of exercise dosage, the association between exercise and some enhanced outcomes in the CKD population is sufficiently strong to recognise the potential importance of this area of renal care and further invest in it.
Renal rehabilitation: the benefits, barriers and exercise options available for patients with Chronic Kidney Disease
(Mark Allen Healthcare, 2014-01-22) O'Connor, E.; Koufaki, Pelagia; Clark, R.; Lindup, H.; Mercer, Tom; Macdougall, I. C.; Greenwood, S.
This article discusses the benefits of well-designed exercise provision, appropriate for chronic kidney disease (CKD), such as enhanced functional capacity, improvements in quality of life, and weight maintenance. However, these things are not usually provided as part of routine care for CKD patients.