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 Physiologistdjb2c@virginia.edu434-243-6218

Questions??Questions??

“Give about two hours every day to exercise, for health must not be sacrificed to

learning.” Thomas Jefferson, 1789