Fit for Dialysis: a prospective 2-site parallel intervention trial of a filmed research-based drama to increase exercise amongst older hemodialysis patients.

PURPOSE: The present study aimed to evaluate the impact of a filmed research-based drama-Fit for Dialysis-and an exercise program on patients' physical activity and fitness outcomes. METHODS: Nineteen (10 at the intervention site, 9 at the control site) older patients with a medical diagnosis of hemodialysis-dependent end-stage renal disease were recruited from two acute care hospitals in urban central Canada where they were receiving out-patient hemodialysis care. Participants at the intervention site viewed Fit for Dialysis prior to participating in a 16-week exercise program. Participants at the control site participated only in the 16-week exercise program. Physical activity, measured by total intradialytic exercise time (TIDE), and physical fitness, measured by the Two-Minute Walk Test (2MWT). Secondary measures included: Timed Up and Go (TUG), Grip Strength, Duke Activity Status Index (DASI), Godin Leisure-Time Exerciser Questionnaire (GLTEQ), and pedometer step count. RESULTS: TIDE, TUG, and GLTEQ were better at the intervention site compared to the control site at all time points measured. However, the change over time was not different between the sites. The 2MWT improved over time at the intervention site for those who exercised consistently. No significant differences between sites, or over time were found for any of the other measures. CONCLUSIONS: Further research is needed to determine the effectiveness of this intervention to facilitate the incorporation of exercise into the care and treatment of HD patients.

Using graphic illustrations to uncover how a community of practice can influence the delivery of compassionate healthcare.

Our modern-day frenetic healthcare culture has progressed to a state where healthcare professionals tend to detach themselves from the emotions of their patients/clients, rather than embed compassion into their daily practice. The AMS Phoenix Project: A Call to Caring was implemented with the goal to instil and sustain empathy and compassion in environments where clinicians learn and work. The purpose of this study is to report on how an interprofessional community of practice (CoP) of healthcare educators can contribute to a cultural shift in promoting and delivering compassion in healthcare through health professionals education. Using an imaginative creative autoethnography that adopts a narrative design through graphic illustrations, data were collected from 25 members of the Phoenix@Queen's CoP during a 1-day retreat. Data collection included a graphic recorder who visually depicted all retreat dialogue, field notes that highlighted emergent themes and artefacts produced during the day. Audio recordings of the discussions were used as secondary sources of data. Using thematic analysis, three themes emerged: the call to caring is a long and winding road with many barriers and rewards; CoP members experienced personal growth in and through the community; and the Phoenix@Queen's CoP matters in terms of professional relationships, leadership and moving forward a shared agenda about practising compassionate healthcare. This study describes the development of a CoP that moves away from traditional committees and discussions to an experiential creation of connections and shared meaning by its members. By using autoethnography, and by demonstrating how graphic illustration can be an innovative and creative method for recording and interpreting group discussions, we have demonstrated the accelerated development of an authentic CoP. With a richer and more authentic community, the shared goals of healthcare professional educators are more likely to be achieved.

A concerns report survey of physical activity support needs of people with moderate-to-severe MS disability and family caregivers.

Purpose: To identify the most pressing needs for community resources to support physical activity participation, determinants of perceived need, and barriers to co-participation in physical activity among people with multiple sclerosis (MS) who have moderate-to-severe disability and the family caregivers providing assistance to such individuals.Methods: Seventy-eight people with MS and 46 family caregivers participated in this cross-sectional survey study, guided by the Concerns Report Methodology.Results: The results show differences between groups in rankings for some need items. However, three need items were prioritized by both people with MS and the family caregivers: (1) information about available resources to support physical activity participation, with Need Indexes of 76.6% and 52.3%, respectively; (2) programs that support joint participation of people with MS together with their caregivers in physical activity, with Need Indexes of 62.0% and 68.9%, respectively; and (3) programs that have affordable total cost of participation, with Need Indexes of 50.7% and 52.3%, respectively. A broad range of factors (i.e., education, living situation, type of community, marital status, employment, and income, as well as comorbidity status) was significantly associated with one or more of these need items. Several modifiable impairment-related, personal and logistical factors were identified by both groups as barriers to co-participation in physical activity.Conclusions: The findings highlight the complexity of developing community resources that target physical activity promotion in MS dyads. Importantly, our findings suggest that resources designed to influence dyadic physical activity participation need to include content that are responsive and tailored to both the needs of the person with MS and the unique needs of the family caregiver. The results also underscore the importance of reinforcing physical activity as a shared behavior and providing information about affordable options for exercising together to the benefit of each individual and the dyad (i.e., partnership). Overall, our findings provide a possible starting point to guide the identification of potential participants that might benefit the most from future intervention development work.Implications for rehabilitationMS has life-altering consequences for people with the disease and the family caregivers who support such individuals.Rehabilitation professionals need to reinforce physical activity as a shared behavior and provide information about affordable options for exercising together to the benefit of each individual and the dyad.A "one-size-fits-all" approach is not appropriate, therefore, clinicians need to identify flexible and pragmatic strategies to increase dyadic participation in the presence of unique caregiver and care-recipients barriers that might impede such an increase.

"A Learned Soul to Guide Me": The Voices of Those Living with Kidney Disease Inform Physical Activity Programming.

Purpose: The purpose of this study was to (a) confirm the barriers to and facilitators of physical activity (PA) among persons living with chronic kidney disease (CKD) in Ontario and (b) inform the design of a Kidney Foundation of Canada Active Living for Life programme for persons living with CKD. Method: Adults living with CKD in Ontario were invited to participate in a cross-sectional survey investigating opinions about and needs for PA programming. The 32-item survey contained four sections: programme delivery preferences, current PA behaviour, determinants of PA, and demographics. Data were summarized using descriptive statistics and thematic coding. Results: A total of 63 respondents participated. They had a mean age of 56 (SD 16) years, were 50% female, and were 54% Caucasian; 66% had some post-secondary education. The most commonly reported total weekly PA was 90 minutes (range 0-1,050 minutes). Most respondents (84%) did not regularly perform strength training, and 73% reported having an interest in participating in a PA programme. Conclusion: Individuals living with CKD require resources to support and maintain a physically active lifestyle. We identified a diversity of needs, and they require a flexible and individualized inter-professional strategy that is responsive to the episodic changes in health status common in this population.

Objectif : la présente étude visait à a) confirmer les obstacles et les incitatifs à l'activité physique (AP) chez les personnes atteintes d'une néphropathie chronique (NPC) en Ontario et b) étayer la conception du programme Une vie active pour la vie de la Fondation canadienne du rein pour les personnes atteintes d'une NPC. Méthodologie : des adultes de l'Ontario atteints d'une NPC ont été invités à participer à un sondage transversal sur leurs avis et leurs besoins liés aux programmes d'AP. Le sondage de 32 questions était divisé en quatre parties : préférences quant à la prestation du programme, comportements actuels en matière d'AP, déterminants de l'AP et démographie. Les chercheurs ont résumé les données à l'aide de statistiques descriptives et de codes thématiques. Résultats : au total, 63 répondants ont participé. Ils avaient un âge moyen de 56 ans (ÉT de 16 ans), 50 % étaient des femmes, 54 % étaient blancs et 66 % avaient une certaine éducation postsecondaire. L'AP physique hebdomadaire totale la plus déclarée était de 90 minutes (plage de 0 à 1 050 minutes). La plupart des répondants (84 %) ne faisaient pas d'entraînement musculaire régulier, et 73 % se sont dit intéressés à participer à un programme d'AP. Conclusion : les personnes atteintes d'une NPC ont besoin de ressources pour maintenir un mode de vie actif. Les chercheurs ont repéré une diversité de besoins et la nécessité d'une stratégie interprofessionnelle personnalisée qui tient compte des changements épisodiques de l'état de santé, courants dans cette population.

Fit for Dialysis: a qualitative exploration of the impact of a research-based film for the promotion of exercise in hemodialysis.

BACKGROUND: Exercise improves functional outcomes and quality of life of older patients with end-stage renal disease undergoing hemodialysis. Yet exercise is not promoted as part of routine care. Health care providers and family carers rarely provide encouragement for patients to exercise, and the majority of older patients remain largely inactive. There is thus the need for a shift in the culture of hemodialysis care towards the promotion of exercise for wellness, including expectations of exercise participation by older patients, and encouragement by health care providers and family carers. Film-based educational initiatives hold promise to effect cultures of best practice, but have yet to be utilized in this population. METHODS: We developed a research-based film, Fit for Dialysis, to promote exercise for wellness in hemodialysis care. Using a qualitative approach, we evaluated the effects that resulted from engagement with this film (e.g. knowledge/attitudes regarding the importance of exercise-based principles of wellness) as well as the generative mechanisms of these effects (e.g. realism, aesthetics). We also explored the factors related to patients, family carers, and health care providers that influenced engagement with the film, and the successful uptake of the key messages of Fit for Dialysis. We conducted qualitative interviews with 10 patients, 10 health care providers, and 10 family carers. Data were analyzed using thematic analysis. RESULTS: The film was perceived to be effective in increasing patients', family carers' and health care providers' understanding of the importance of exercise and its benefits, motivating patients to exercise, and in increasing encouragement by family carers and health care providers of patient exercise. Realism (e.g. character identification) and aesthetic qualities of the film (e.g. dialogue) were identified as central generative mechanisms. CONCLUSIONS: Fit for Dialysis is well-positioned to optimize the health and wellbeing of older adults undergoing hemodialysis. TRIAL REGISTRATION: NCT02754271 ( ClinicalTrials.gov ), retroactively registered on April 21, 2016.

Correlating the Physical Activity Patterns of People with Moderate to Severe Multiple Sclerosis Disability and Their Family Caregivers.

Purpose: People with multiple sclerosis (PwMS) and their family caregivers often react to the impact of the disease as an interdependent dyad. The aim of this exploratory study was to examine interdependence in the physical activity (PA) patterns of dyads affected by moderate to severe MS disability. Method: A total of 15 pairs of PwMS and their family caregivers wore accelerometers for 7 days. By collecting data simultaneously from both partners, we tested interdependence using the dyad as the unit of analysis. Results: PwMS and caregivers averaged 4,091.3 (SD 2,726.3) and 6,160.2 (SD 1,653.0) steps per day, respectively. The mean number of minutes per day of sedentary, light, and moderate to vigorous activity for PwMS was 566.3 (SD 97.7), 167.4 (SD 94.0), and 7.6 (SD 12.4), respectively, and 551.9 (SD 92.4), 199.6 (SD 63.4), and 21.4 (SD 18.2), respectively, for caregivers. Interdependence between dyads for sedentary, light, moderate to vigorous activity, and step count was low and non-significant (rs=0.20, 0.26, 0.13, and -0.27, respectively; p>0.05). Conclusions: Although our findings do not support the interdependence of PA between caregivers and care recipients with MS, they do show that both partners are not engaging in sufficient PA to achieve important health benefits. These findings are important because they indicate that the dyads are likely to benefit from interventions for changing PA behavior.

Objectif : les personnes atteintes de sclérose en plaques (PaSP) et leur proche aidant de la famille réagissent souvent aux effets de la maladie comme une dyade interdépendante. La présente étude exploratoire visait à examiner les modes d'interdépendance des dyades touchées par une incapacité modérée à grave liée à la SP lorsqu'elles faisaient de l'activité physique (AP). Méthodologie : au total, 15 paires de PaSP et leur proche aidant familial ont porté des accéléromètres pendant sept jours. En amassant des données simultanément auprès des deux partenaires, les chercheurs ont examiné l'interdépendance en faisant de la dyade l'unité d'analyse. Résultats : les PaSP et les proches aidants faisaient une moyenne de 4091,3 (ÉT 2726,3) et 6160,2 (ÉT 1653,0) pas par jour, respectivement. Les PaSP faisaient un nombre moyen de 566,3 (ÉT 97,7), 167,4 (ÉT 94,0) et 7,6 (ÉT 12,4) minutes d'activité sédentaire, légère et modérée à vigoureuse par jour, respectivement, et les proches aidants, 551,9 (ÉT 92,4), 199,6 (ÉT 63,4), et 21,4 (ÉT 18,2) minutes par jour, respectivement. L'interdépendance entre les dyades pour ce qui est de l'activité sédentaire, légère et modérée à vigoureuse et le compte de pas était faible et non significative (r=0,20, 0,26, 0,13 et ­0,27, respectivement; p >0,05). Conclusions : même si nos observations n'appuient pas l'interdépendance de l'AP dans la dyade aidant-aidé de SP, elles révèlent toutefois que les deux partenaires ne font pas assez d'AP pour en tirer des avantages importants pour leur santé. Ces observations sont importantes, car elles indiquent que les dyades sont susceptibles de profiter d'interventions pour modifier leur comportement en matière d'AP.

Understanding leisure-time physical activity: Voices of people with MS who have moderate-to-severe disability and their family caregivers.

BACKGROUND: Physical activity (PA) is beneficial for all people, yet people affected by multiple sclerosis (MS) find regular PA challenging. These people may include individuals with the disease who have moderate-to-severe disability and their family caregivers. For researchers and clinicians to effectively promote PA among caregiver/care-recipient dyads with moderate-to-severe MS, a comprehensive understanding of the shared PA experiences of these dyads would be beneficial. OBJECTIVE: We explored shared experiences of caregiver/care-recipient dyads affected by moderate-to-severe MS about PA and directions for intervention. METHODS: Six focus groups with 23 people with moderate-to-severe MS and 12 family caregivers were conducted. Data were analysed using a constant comparative approach. RESULTS: Three major themes emerged as follows: (i) PA is a continuum, (ii) cycle of disengagement and (iii) cycle of adjustment. The first theme captured the dyads understanding that PA falls along a continuum ranging from highly structured to unstructured activities. Cycle of disengagement captured the experiences of dyads engaging in little or no PA. These dyads perceived internal and external issues as drivers of the cycle of disengagement, while availability of supportive programmes and services or people helped the dyads to break out of the cycle. When the cycle of disengagement was broken, the dyads described moving towards the cycle of adjustment, where they were able to learn skills and take action to incorporate PA into daily routines. CONCLUSION: This research highlights the need to adopt an integrative approach that acknowledges the caregiver/care-recipient dyad with moderate-to-severe MS as a focus for PA intervention.

A prospective 2-site parallel intervention trial of a research-based film to increase exercise amongst older hemodialysis patients.

BACKGROUND: Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease. METHODS/DESIGN: This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients' exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community. DISCUSSION: This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation's guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients. TRIAL REGISTRATION: NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016.

The Canadian Cardiac Rehabilitation Registry: Inaugural Report on the Status of Cardiac Rehabilitation in Canada.

Introduction. There are over 200 Cardiovascular Rehabilitation (CR) programs in Canada, providing services to more than 50,000 new patients annually. The objective of this study was to describe the impact of CR in Canada. Methods. A retrospective analysis of Canadian CR Registry data is presented. There were 12 programs participating, with 4546 CR participants. Results. The average wait time between patient referral and CR admission was 68 ± 64 days. Participants were 66.3 ± 11.5 years old, 71% male, and 82% White. The three leading referral events were coronary artery bypass graft surgery, percutaneous coronary intervention, and acute coronary syndrome. At discharge, data were available for ~90% of participants. Significant improvements in blood pressure (systolic pre-CR 123.5 ± 17.0, post-CR 121.5 ± 15.8 mmHg; p < .001), lipids, adiposity, and exercise capacity (peak METs pre-CR 6.5 ± 2.8, post-CR 7.2 ± 3.1; p < .001) were observed. However, target attainment for some risk factors was suboptimal. Conclusions. This report provides the first snapshot of the beneficial effects of CR in Canada. Not all patients are equally represented in these programs, however, leaving room for more referral of diverse patients. Greater attainment of risk reduction targets should be pursued.

Intradialytic Laughter Yoga therapy for haemodialysis patients: a pre-post intervention feasibility study.

BACKGROUND: Laughter Yoga consists of physical exercise, relaxation techniques and simulated vigorous laughter. It has been associated with physical and psychological benefits for people in diverse clinical and non-clinical settings, but has not yet been tested in a haemodialysis setting. The study had three aims: 1) to examine the feasibility of conducting Laughter Yoga for patients with end stage kidney disease in a dialysis setting; 2) to explore the psychological and physiological impact of Laughter Yoga for these patients; and 3) to estimate the sample size required for future research. METHODS: Pre/post intervention feasibility study. Eighteen participants were recruited into the study and Laughter Yoga therapists provided a four week intradialytic program (30-min intervention three times per week). Primary outcomes were psychological items measured at the first and last Laughter Yoga session, including: quality of life; subjective wellbeing; mood; optimism; control; self-esteem; depression, anxiety and stress. Secondary outcomes were: blood pressure, intradialytic hypotensive episodes and lung function (forced expiratory volume). Dialysis nurses exposed to the intervention completed a Laughter Yoga attitudes and perceptions survey (n = 11). Data were analysed using IBM SPSS Statistics v22, including descriptive and inferential statistics, and sample size estimates were calculated using G*Power. RESULTS: One participant withdrew from the study for medical reasons that were unrelated to the study during the first week (94 % retention rate). There were non-significant increases in happiness, mood, and optimism and a decrease in stress. Episodes of intradialytic hypotension decreased from 19 pre and 19 during Laughter Yoga to 4 post Laughter Yoga. There was no change in lung function or blood pressure. All nurses agreed or strongly agreed that Laughter Yoga had a positive impact on patients' mood, it was a feasible intervention and they would recommend Laughter Yoga to their patients. Sample size calculations for future research indicated that a minimum of 207 participants would be required to provide sufficient power to detect change in key psychological variables. CONCLUSIONS: This study provides evidence that Laughter Yoga is a safe, low-intensity form of intradialytic physical activity that can be successfully implemented for patients in dialysis settings. Larger studies are required, however, to determine the effect of Laughter Yoga on key psychological variables. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry - ACTRN12614001130651 . Registered 23 October 2014.

The quality of cardiac rehabilitation in Canada: a report of the Canadian Cardiac Rehab Registry.

Cardiac rehabilitation (CR) significantly reduces morbidity and mortality compared with usual care. CR quality indicators (QIs) have recently been established in Canada. This article presents an assessment of real-world CR program achievement of process and outcome QIs in Canada, using the Canadian Cardiac Rehab Registry (CCRR). The CR QIs were developed through the Canadian Cardiovascular Society's Best Practice Methodology. After reconciling the QI with CCRR definitions, it was identified that 14 (46.7%) of the 30 QIs could be assessed through the CCRR. There were 5447 patient records from 11 CR programs in the CCRR. Wait times exceeded the 30-day QI target, at a median of 84 days from referral to enrollment. Assessment of QIs of blood pressure (90%) and adiposity (85%) were high, however assessment of QIs for lipids (41%), blood glucose among patients with diabetes (23%), and depression overall (13%) were low. A majority of the participants (68%) achieved the half metabolic equivalent increase in the exercise capacity QI from CR program entry to exit. Of smokers, only 61% were offered smoking cessation therapy. Thirty percent of participants were offered stress management. The CR program completion QI was met in 90% of patients. Areas for care and quality improvement have been identified for the CR community in Canada. Efforts to engage more CR programs assess a greater number of QIs, and to feed back the findings to participating programs quarterly are currently under way.

Laughter and humor therapy in dialysis.

Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis patient population. Studies from other groups such as children, the elderly, and persons with mental health, cancer, and other chronic conditions are included to inform potential applications of laughter therapy to the dialysis population. Therapeutic interventions could range from humorous videos, stories, laughter clowns through to raucous simulated laughter and Laughter Yoga. The effect of laughter and humor on depression, anxiety, pain, immunity, fatigue, sleep quality, respiratory function and blood glucose may have applications to the dialysis context and require further research.

High and low contact frequency cardiac rehabilitation programmes elicit similar improvements in cardiorespiratory fitness and cardiovascular risk factors.

AIM: Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health and decreases death and disability following a cardiovascular event. Traditional CR typically involves 36 on-site exercise sessions spanning a 12-week period. To date, the optimal dose of CR has yet to be determined. This study compared a high contact frequency CR programme (HCF, 34 on-site sessions) with a low contact frequency CR programme (LCF, eight on-site sessions) of equal duration (4 months). METHODS: A total of 961 low-risk cardiac patients (RARE score <4) self-selected either a HCF (n = 469) or LCF (n = 492) CR programme. Cardiorespiratory fitness and cardiovascular risk factors were measured on admission and discharge. RESULTS: Similar proportions of patients completed HCF (n = 346) and LCF (n = 351) (p = 0.398). Patients who were less fit (<8 METs) were more likely to drop out of the LCF group, while younger patients (<60 years) were more likely to drop out of the HCF group. Both groups experienced similar reductions in weight (-2.3 vs. -2.4 kg; p = 0.779) and improvements in cardiorespiratory fitness (+1.5 vs. +1.4 METs; p = 0.418). CONCLUSIONS: Patients in the LCF programme achieved equivalent results to those in the HCF programme. Certain subgroups of patients, however, may benefit from participation in a HCF programme, including those patients who are predisposed to prematurely discontinuing the programme and those patients who would benefit from increased monitoring. The LCF model can be employed as an alternative option to widen access and participation for patients who are unable to attend HCF programmes due to distance or time limitations.

Changes in waist circumference following haemodialysis: a brief report.

BACKGROUND: Waist circumference (WC) is a known indicator of cardiovascular disease in the haemodialysis (HD) population. However it is not known if HD results in clinically significant changes in WC. OBJECTIVE: The study purpose was to quantify the degree of change in WC induced by HD. METHODS: This was a prospective cohort study with 27 patients on HD. Height, body weight, WC, hip circumference (HC), body mass index (BMI) and waist to hip ratio (WHR) were measured immediately prior to and following HD over three consecutive treatments. Differences between three-day average pre- and post-HD weight, BMI, WC, HC and WHR were assessed. RESULTS: Post-HD WC was significantly lower than that measured pre-HD. Differences in pre-post HD body weight, BMI, HC and WHR were also observed. CONCLUSIONS: All of the traditional clinical indicators of body composition (WC, HC, WHR, body weight and BMI) were lower following HD.

The availability of exercise rehabilitation programs in hemodialysis centres in Ontario.

BACKGROUND: Exercise training is effective at promoting physical fitness, cardiovascular outcomes, and quality of life amongst persons with chronic kidney disease. To our knowledge, no published data exist to date on the prevalence of exercise programs offered to Canadians undergoing dialysis. The study purpose was to characterize existing exercise programs in hemodialysis centres in the province of Ontario. METHODS: An online survey was created and distributed to 95 dialysis facilities across Ontario. RESULTS: There was a 61% survey response rate. Only eight facilities offered exercise programs, which included intradialytic and cardiac rehabilitation programs. Lack of funding (n = 22), lack of human resources (n = 18), and lack of equipment (n = 17) were reported as the most commonly perceived barriers of offering an exercise program. CONCLUSION: Although exercise has been shown to be effective, prevalence of programs is low. Work is underway to administer the online survey tool to dialysis programs across Canada.

Exercise and end-stage kidney disease: functional exercise capacity and cardiovascular outcomes.

This review examined published reports of the impact of extradialytic and intradialytic exercise programs on physiologic aerobic exercise capacity, functional exercise endurance, and cardiovascular outcomes in individuals with ESKD. Studies spanning 30 years from the first published report of exercise in the ESKD population were reviewed. Studies conducted in the first half of the publication record focused on the efficacy of exercise training programs performed "off"-dialysis with respect to the modification of traditional cardiovascular risk factors, aerobic capacity, and its underlying determinants. In the latter half of the record, there had been a shift to include other client-centered goals such as physical function and quality of life. There is evidence that both intra- and extradialytic programs can significantly enhance aerobic exercise capacity, but moderate-intensity extradialytic programs may result in greater gains in those individuals who initially have extremely poor aerobic capacity. Functionally, substantive improvements in exercise endurance in excess of the minimum clinical significant difference can occur following either low- or moderate-intensity exercise regardless of the initial level of performance. Reductions in blood pressure and enhanced vascular functioning reported after predominantly intradialytic exercise programs suggest that either low- or moderate-intensity exercise programs can confer cardiovascular benefit. Regardless of prescription model, there was an overall lack of evidence regarding the impact of exercise-induced changes in exercise capacity, endurance, and cardiovascular function on a number of relevant health outcomes (survival, morbidity, and cardiovascular risk), and, more importantly, there is no evidence on the long-term impact of exercise and/or physical activity interventions on these health outcomes.

Exercise training during hemodialysis improves dialysis efficacy and physical performance.

OBJECTIVE: To determine the impact of a 20-week intradialytic exercise program, consisting of 60 minutes of cumulative duration, low-intensity exercise during the first 2 hours of dialysis, on dialysis efficacy, physical performance, and quality of life in self-care hemodialysis (HD) patients. DESIGN: One-group repeated measures. SETTING: Satellite HD units affiliated with a Canadian teaching hospital. PARTICIPANTS: A convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac, pulmonary, and/or musculoskeletal pathology that would preclude exercise. INTERVENTION: A 5-month intradialytic exercise program in which subjects exercised 3 times a week (cycle ergometer, mini-stepper) for 30 minutes in each of the first 2 hours of HD. MAIN OUTCOME MEASURES: Dialysis efficacy (in single-pool model of urea kinetics [spKt/V]) was assessed prior to and at the end of each month of the exercise program. Physical function (6-minute walk test [6MWT]), and quality of life. (Kidney Disease Quality of Life-Short Form [KDQOL]) were determined at baseline and at weeks 10 and 20 of the exercise program. RESULTS: SpKt/V increased 11% at the end of the first month of the program (P<.05) and remained elevated for the duration of the program (18%-19%). Distance walked on the 6MWT increased by 14% at both weeks 10 and 20 (P<.05). No changes were noted in KDQOL scores. CONCLUSIONS: A low-intensity intradialytic exercise program is a viable adjunctive therapy, which improves HD efficacy and physical function in HD patients.

Quality of life and exercise rehabilitation in end stage renal disease.

Using a qualitative approach, this study explored the perceptions of individuals with end stage renal disease (ESRD) regarding their physical, emotional, and social well-being after having participated in an eight-week hospital-based intra-dialytic exercise program. Individual semi-structured interviews (approximately 60 min. duration) were conducted with hemodialysis (HD) patients (n= 7) during their regular dialysis sessions, two weeks immediately following the completion of the exercise program. Interviews were audio-taped, transcribed verbatim, and content analysis was used to identify emerging themes. Data management was assisted by NVivo software. Using the interpretive paradigm, three primary themes emerged: improved performance in activities of daily living (ADL), positive change in HD experience, and enhanced sense of control. Participants reported an overall positive experience with the intra-dialytic exercise program and felt that their quality of life was enhanced to such an extent that they would choose to continue exercising while on HD.