Therapy & Practice

Movement is medicine, or in other words: lack of exercise kills.

This not only goes for healthy people, but especially for groups of people whose physical performance and health are already under strain due to illness. Despite this, one in three women and one in four men worldwide already do far too little exercise and do not meet the WHO’s minimum requirements for physical activity (PA). This rising trend is leading to an increase in “diseases of affluence”, which can be directly attributed to lack of exercise. These include diseases such as diabetes, obesity, cardiovascular diseases and psychological complaints.

Lack of exercise among dialysis patients

The lack of exercise and its effects are even more drastic in haemodialysis patients. They are mostly immobilised on the treatment couch for an average of 600–1,000 hours per year. As a result, this group of patients faces an especially high risk of concomitant diseases.

Despite the clearly proven effectiveness of PA among dialysis patients, experience reports from the past 30 years show that many patients are unable to participate in exercise programmes conducted during dialysis-free days. According to a study published in Germany in 2018, 47.7% of 240 dialysis patients surveyed reported the duration of their weekly PA as 0 minutes (Fig. 1). The reasons for this range from fatigue to a lack of suitable exercise groups and exercise equipment.

Almost 48% of patients do not perform any physical activity, even though every person should actually be performing a minimum of 150 minutes a week.

But how is a patient who is already weakened by the multiple-times-a-week treatment supposed to be able to achieve a healthy level of PA if even the healthy population is falling short of these requirements?

The solution is “exercise during dialysis”

Why not combine the necessary with the useful and use the time on the treatment couch as exercise time?

Experts assume that almost all patients, regardless of age or concomitant diseases, can be integrated into exercise programmes or sports therapy measures during dialysis treatment (Source 5). Based on this assumption, numerous training programmes have already been developed, with the highest effectiveness shown in a combination of endurance and strength training. In these training programmes, optimal training control is essential to avoid overload and underload.

In-bed exercise equipment such as the THERA-Trainer bemo can help here to provide patients with the training intensity to suit them, regardless of their performance capacity. In addition, it relieves the burden on nursing staff in the facilities, as the patient can perform the exercise independently without supervision.

Activity level and quality of life are directly related

“There is so much that exercise can do.” And it doesn’t always have to be a marathon or the Tour de France. In general, it can be said that more exercise also leads to an improved quality of life. Nevertheless, even a small amount of exercise can have a positive impact on quality of life.

Especially for patients who exercise during dialysis, this positive effect goes far beyond the prevention of “diseases of affluence”. Several studies have shown that exercise during treatment reduces the risk of falls, increases heart rate variability and reduces arterial stiffness. In addition, exercise also has a direct positive influence on the effectiveness of dialysis, with increased urea and phosphate elimination (Source 2).

Psychological factors can also be directly influenced positively by PA. Results of American studies indicate that dialysis patients have an 84% higher risk of suicide than the general population and that depression is significantly more common. Exercise can help to counteract these depressions and anxieties and increase mental well-being. (Source 3)

A win-win, not just for the patient but also for the dialysis facility

In mostly profit-oriented health systems, the implementation of such a proven effective therapeutic approach often fails due to doubts about profitability. What at first sounds like additional personnel and financial expenditure turns out to be quite profitable. For example, training during dialysis can reduce the risk of falling or mitigate the consequences of falling, leading to a reduction in the hospitalisation rate, which experience shows to be around 10%.

Initial conservative calculations show that training with the THERA-Trainer bemo can reduce the hospitalisation rate and the associated dialysis treatment failure from ten to nine per cent. For a facility with 100 treatments per week, this already means an additional turnover of about 25,000 euros per year.

In addition, new customers can be better recruited with the additional training offer in the highly competitive market.

Lars Timm

Studied Sport Science with focus on rehablititation in Freiburg i.BR. and M.Sc. Sports Engineering at KIT Karlsruhe.