A Patient’s View on Exercise and ESKD

As a patient with CKD for over 15 years, this article (1) resonated with me on different levels. When reviewing studies, I often attempt to think of how I felt at different levels of my journey with kidney disease. At this point of the journey (transplanted but going through failure), I have found myself questioning the status quo. As a society, we are becoming more sedentary due to the technological revolution that has taken over. For the most part, the days of physical labor are gone, and we are in the midst of nonmovement as we go about our day. Because of this change, exercise has become an overwhelming theme in health care as well as a trending topic. No matter the illness or condition, the immediate response from health care professionals is to exercise. Although there has been an abundance of studies to justify this, often I have left a doctor’s appointment feeling inadequate. I felt this way, because I did not feel as though I was living up to the standards set forth for exercise. Although I have been constantly advised to exercise, not once has any health care professional asked me how I felt physically and emotionally while attempting to exercise.

This article (along with many others) states that exercise has been known to increase energy and longevity. However, most studies are completed with somewhat healthy adults. As a patient with kidney disease, most of my days I am in a constant fatigued state. How can I exercise when I am already tired and short of breath? During those times, my body will not allow me to exercise when simply walking from one room to the next has already elevated my heart rate. Reading this article and the surveys used made me realize that maybe we need to redefine exercise. Although there are standards that have been set forth, we also have to consider that some activity is better than none. Additionally, maybe the terms mild, moderate, and rigorous should be categorized differently for a person suffering an illness that causes extreme fatigue and often limits mobility. As a person who has suffered with ESKD since at least 2003, I can say that there have been various times in the past 16 years that I have viewed exercise in different terms. There have been days that I could walk a mile, and other days, I could barely make it out of bed. In each instance, my heart rate was elevated, and it took an enormous amount of energy. I have not read a study that takes these factors into account.

I appreciate the inclusion of various dialysis modalities in this article, because home therapies are often excluded in dialysis discussions. However, I noticed that only small numbers of these patients were factored into the numbers. Although the study states that modality was not a factor in the results, most of the participants wanted an exercise program at home. When I was an in-center patient, I spent an extraordinary amount of time away from home dealing with dialysis-related activities. The average time spent on such activities was approximately 20 hours, not including recovery time from treatments. On the basis of this experience, I can fully understand patients wanting to be at home. After it has been determined that patients would like a program to be completed at home, in addition to barriers, we should look at education. It was stated that, despite patients knowing that there are benefits in exercise, they still do not exercise as they should. On the basis of this information, do patients truly understand the stated benefits, or has this exercise doctrine been implanted in their minds by health care professionals? Again, here I believe in questioning the status quo. One of the most important sentences in this article is, “For patients burdened with fatigue and weakness, anything beyond maintenance of activities of daily living may be overwhelming” (1). This one sentence provides justification that we may need to redefine exercise for patients living with CKD.

Disclosures

None.