This article takes an in-depth look at the implementation of sports therapy in dialysis centres. From the establishment of therapeutic exercise clubs to the integration of training programmes during dialysis – find out more about the significant advances and hurdles in this area.

Organising exercise therapy with dialysis patients at the centre, on a broad and permanent basis, is not easy. But it rewards us with more active, more mobile patients who are happy to be able to do something for their own health. It lifts the spirits – it’s not just about holding out your arm for the puncture, but about actively practising and training together with others, competing and having fun.

The dialysis centre shows that it goes above and beyond what is necessary for its patients. But how can you organise all that? Just get started! That means finding qualified, motivated exercise instructors (sometimes the local disabled sports association, cardiac sports groups, physiotherapists or similar can provide or arrange contacts). Get a bed ergometer and small equipment (dumbbells, resistance bands, balls, etc.), start a training programme and let people know about it.
If the patients take to it and want to train even more – start a dialysis sports club! Invite them to the inaugural meeting (preferably in the centre itself, a Wednesday between the morning and midday shifts would be ideal, so that most patients can attend). Clarify beforehand who can take on administrative roles – chair, treasurer, secretary, deputy chair, two auditors. Prepare draft articles of association so that they can be discussed and, if possible, adopted at the general meeting. Comply with association law. Register the association, apply for charitable status after registration (tax office) – the association is only authorised to issue donation receipts once charitable status has been established. Apply for membership of the German Disabled Sports Association, and an institute indicator (prerequisite for support from funding bodies).

Gain clarity about funding beforehand: start-up funding, e.g. from the dialysis centre, membership fees; support from health insurance companies as part of the rehabilitation sports agreement in accordance with Section 44 (1) No. 3 of Book 9 of the German Social Code (SGB IX) (see application for cost coverage for rehabilitation sports and functional training) is only possible after the institute indicator has been issued. The prescription is then issued on form 56 – limited to 120 exercise units within three years.

Unfortunately, according to the current inter­pretation, this prescription only applies to training outside dialysis. Subsequent prescriptions are possible, they must again be justified on form 56 (page 1, last line): Rehabilitation through structured training is a therapy that accompanies treatment for the entire duration of the dialysis requirement. Training without the support and guidance of qualified trainers is practically impossible during dialysis treatment – most dialysis patients also need external motivation from trainers, doctors and the training group.

Finding a sponsor

Various models can be followed here. Income from study funds from the dialysis practice can, for example, go in whole or in part to dialysis exercise programmes. Time frame: even with persistent commitment, it will take at least six months – realistically even a year – to overcome all the organisational hurdles. The reward should be a functioning, structured training programme and organisational concept.

The dialysis sports club belongs to the patients, and wherever possible the chairperson and treasurer should be selected from among the patients themselves. Often, however, no patient will be found who is able to take on these tasks, in which case they can be handled by a dedicated doctor at the centre. Even a well-functioning association, under current conditions, relies on donations for more than half of its funding. Experience has shown that at most the other half can be covered by membership fees and health insurance subsidies.

The non-profit status of the organisation ensures that donors can at least deduct their commitment from their taxes. Joining an existing disabled sports club is easier. However, there are various obstacles to this:

- In many sports clubs, indoor or outdoor exercise sessions for many disabled people at a time contribute to the financing of the club as a whole – but exercise programmes during dialysis require considerable supervision and equipment while only serving smaller groups of patients, making it difficult to cover the costs. Willingness to support dialysis sports groups is therefore unfortunately very low among both non-disabled and disabled sports clubs.
- These problems restrict the availability of exercise opportunities, as the altruism of sports clubs is limited. And what happens if an external association decides to no longer support the training programme during dialysis?

Need help?

It is often helpful to take a look at functioning exercise programmes in other dialysis centres – sitting in on exercise instructors’ sessions is a good way to exchange experiences and boost motivation. You can find out about suitable centres via ReNi e. V.