60 - Physical Activity, Function, and Exercise-Based Rehabilitation for People on Dialysis

Abstract

The focus on increasing physical activity (PA) for those people with a high burden of cardiometabolic conditions and complications (i.e., kidney failure, diabetes, cardiovascular comorbidities), for managing symptoms and maintaining physical well-being, is at an all-time high. Rehabilitation, meaning recovering or restoring what is necessary to get on with living, has been a low priority in most dialysis facilities, and the inclusion of integrated rehabilitation programs for dialysis patients is not routinely offered as part of patient care. A published British Association of Sport and Exercise Science (BASES) expert statement in 2015 on exercise for people with chronic kidney disease (CKD) suggests that every stable patient with CKD, irrespective of age, gender, comorbidities, or prior exercise experience, should be provided with specific written advice on how to safely and effectively increase PA to (i) enhance confidence and self-efficacy in performing physical activities; (ii) attenuate deterioration of physical function and associated limitations in activities of daily living; (iii) increase physiological reserve; (iv) reduce comorbid events; and (v) enhance quality of life. The focus of this chapter is on the core principle of exercise for reversing the effects of physical deconditioning and optimizing physical functioning and quality of life in patients on dialysis.