Patients with chronic kidney disease should also be active
2022-07-11
Many patients with chronic kidney disease lack exercise for many reasons: some people are weak or in a bad mood, some are worried that exercise will aggravate kidney disease, and hemodialysis or peritoneal dialysis patients reduce activity because they are worried that exercise will damage vascular pathways or peritoneal dialysis catheters. Different conditions do have adverse effects on motor function. For example, forearm vascular access may affect the large-scale movement and fine motor skills of the arm. Peritoneal dialysis patients are not suitable for swimming or lifting heavy objects, but these should not be "legitimate" reasons for patients with chronic kidney disease not to participate in exercise. Moderate exercise is very necessary for patients with different types of renal insufficiency. With the decline of renal function, patients with chronic kidney disease will have varying degrees of heart and lung function decline, muscle atrophy and physiological and psychological dysfunction, which will seriously affect the quality of life of patients. For patients with chronic kidney disease, physical activity has many benefits, such as increasing cardiopulmonary endurance, reducing the risk of cardiovascular disease, delaying the progress of chronic kidney disease, preventing muscle damage and improving muscle strength, improving quality of life and so on. In addition, scientific sports can also actively correct vitamin D deficiency, anemia and malnutrition, improve sports ability and improve the effect of sports rehabilitation. The exercise methods suitable for patients with chronic kidney disease mainly include aerobic exercise, resistance exercise and flexibility exercise. Under the guidance of doctors, they should participate in tolerable moderate intensity exercise, 30-60 minutes each time, 3-5 times a week. In order to reduce the risk of sports related adverse events, we should do a good job in the evaluation before sports rehabilitation with the help of doctors and formulate individualized sports prescriptions. The amount of exercise depends on the patient's exercise ability, and the principle of "low initial amount, slow dosage" should be followed. Recommended exercise prescription for patients with chronic kidney disease (fitt principle): Frequency of exercise: Patients with chronic kidney disease, regardless of the stage of renal function, should carry out exercise training at least 3 times a week on the basis of daily physical activity. Intensity of exercise: Patients with chronic kidney disease, regardless of the stage of renal function, are recommended to carry out moderate intensity endurance and strength exercise on the premise of safety and effectiveness. Exercise time: it is recommended to control the exercise time at 30-60 minutes each time. The goal is to accumulate 150 minutes per week, which can be carried out in several times according to your own situation. For hemodialysis patients, it is recommended to exercise 2 hours after meals or at least 1 hour before going to bed. During dialysis treatment, exercise is suitable 2 hours before treatment. Type of exercise: including aerobic exercise, resistance exercise, flexibility and nerve action exercises. Aerobic exercise refers to the exercise training carried out by the human body under the condition of sufficient oxygen supply. It requires that the main muscle groups of the whole body can participate in the exercise, and the exercise lasts for a long time and has rhythm, which can improve the cardiopulmonary function. Common aerobic exercises include walking, jogging, swimming, cycling, aerobics, etc. Resistance movement refers to the active movement of muscles against their own gravity or external resistance. Resistance movement can restore and enhance muscle strength. Common resistance sports include sit ups, push ups, elastic band training, etc. Flexibility exercise refers to soft muscle stretching and slow motion exercises to increase the flexibility of muscles and the range of joint activity, which helps to prevent muscle damage in sports. Common flexibility exercises include: active or passive static stretching, dynamic stretching, Taijiquan, qigong, yoga, etc. The exercise mode of dialysis patients should be adjusted appropriately according to the position of dialysis pathway. If patients have the following conditions, they should consider temporarily stopping exercise training. Absolute contraindications: recent acute myocardial infarction, persistent unstable angina pectoris, uncontrolled arrhythmia, active endocarditis, symptomatic severe aortic stenosis, decompensated heart failure, acute pulmonary embolism, pulmonary infarction or deep venous thrombosis, acute myocarditis or pericarditis, acute aortic dissection, physical disability with safety hazards, etc. Relative contraindications: confirmed coronary artery stenosis, uncontrolled ventricular premature beats, acquired heart block, recent stroke or cerebral ischemia attack, mental damage can not cooperate, high blood pressure in quiet state (systolic pressure > 200 mm Hg or diastolic pressure > 110 mm Hg), uncorrected severe anemia, electrolyte disorder, hyperthyroidism, etc. (the author is a nephrologist of East China Hospital Affiliated to Fudan University) Tips In the process of sports rehabilitation training, the exercise should be stopped immediately in case of the following conditions: 1. Chest tightness, chest pain, dyspnea; 2. Dizziness, headache, blurred vision; 3. Palpitations, sweating, rapid self-test pulse, serious arrhythmia; 4. Obvious fatigue, which cannot be relieved after rest; 5. Muscle spasm, joint pain, etc. Safety precautions for sports rehabilitation: 1. Pay attention to monitor the changes of blood pressure and pulse before and after exercise. In case of serious edema and abnormal blood pressure, exercise should be suspended. Generally, the appropriate heart rate during exercise should be controlled at 60%-80% of the maximum heart rate (maximum heart rate =220 age); 2. When blood glucose is too high or too low, exercise needs to be suspended (usually refers to blood glucose > 13.9 mmol / L or < 5.6 mmol / L); 3. Patients with diabetes or hypoglycemia tendency should prepare candies and snacks. Once hypoglycemia is suspected, monitor blood glucose in fingers in time and eat sweets; 4. If there are open wounds and unhealed ulcers, swimming and weight-bearing exercises should be avoided; 5. During resistance exercise, keep breathing normally throughout the whole process, and don't hold your breath; 6. Peritoneal dialysis patients had better exercise when the abdomen is dry. In order to prevent fluid leakage at the outlet of the peritoneal dialysis tube, it is necessary to avoid the action of significantly increasing abdominal pressure during exercise; 7. Avoid exercising on an empty stomach and when you have a cold; 8. If you have hypotension and any discomfort after exercise, you need to inform your doctor in time. (outlook new era)
Edit：Yuanqi Tang Responsible editor：Xiao Yu
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