1	Exercise and me! …Let’s get it started … Suzie Jane Burford Head Clinical Research & Education FMC-AP HK Suzie. Burford@fmc-asia.com
2	Standards for Rehabilitation Life Outcomes Research Group –LORAC standards for Renal Rehabilitation – guide for people with renal disease 5 “E” for effective Rehabilitation Education Employment Encouragement Evaluation Exercise www.lifeoptions
3	Do you believe exercise is good for you? How many of you have exercised this week? 5 or more times for more than 30 accumulated minutes per day? work not counted!
4	Benefits of Regular physical activity -exercise ESRD population Improved exercise capacity Improved muscle strength Improved blood pressure control (Less medication) Improved lipid profile (é HDL ê LDL) Increased Hb Improved glucose regulation Improved psychological profile (reduced anxiety, depression, & é participation in pleasant activities) You feel GOOD about YOU! Painter 1995
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7	BENEFITS OF EXERCISE Haemodynamic Musculoskeletal Metabolic Psychological Others
8	HAEMODYNAMIC Increase Heart muscle contractility Aerobic capacity Haematocrit (+ EPO therapy)
9	MUSCULO-SKELETAL Increase Lean muscle mass Strength, flexibility and endurance Work capacity Posture Ability to achieve ADL
10	METABOLIC Decrease Abdominal fat tissue and percentage body fat Requirement for insulin and hypoglycemic medication Low-density lipoproteins, cholesterol and triglycerides (Bad fats)
11	PSYCHOLOGICAL Increase perceived well being and happiness Release endorphins - with just 15 minutes of exercise self esteem and sense of independence relaxation and sleep quality mental concentration
12	Other Possible BENEFITS Combat Restless Leg Syndrome Improve sleeping patterns Improved general well-being - Decreased feeling of fatigue and general malaise Increase exercise tolerance (predictor of survival among ambulatory) Increased adherence to ESRD therapy – more positive attitude Decreased morbidity related to dialysis therapy; reduced hypotension and cramps
13	Ok, Exercise is good… How much is enough?
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19	Exercise Prescription - Dialysis days Pre-dialysis status; BP, Fluid assessment, general well-being.
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21	Special considerations for DIABETES & Exercise. Medical clearance Insulin / Hypoglycemic Medication titration Blood glucose check before & after exercise Hypoglycemia recognition & Rx Regular medical checks and medication compliance Diet management 7. F: most days I : low-mod. T: accumulate 30 minutes/day T: low-impact
22	Special considerations for Hypertensive patients & Exercise. Medical clearance BP check before and after exercise Light loads, more repetitions Avoid strain especially if working out using weights Monitor progress & changes in BP Regular medical checks and medication compliance 7. F: most days I : low-mod. T: accumulate 30 minutes/day T: all types
23	Exercise/Physical Activity – Pre and Non-Dialysis days
24	Motivation to drive the process Challenge Appearance / Aesthetic Social
25	Getting Started … ACTION PLAN Start Flexibility exercises … do them during first hour of dialysis & non-dialysis days Go for walks … get active Want to do more? Ask your Doctor and Nurses … Assess ability for exercise strengthening & aerobics programs Keep a journal of your activities … pedometers … set goals Patient education seminars Educating the Patient and their family Am I ready? …