K LAMBERT 1,2, C LIGHTFOOT 3, D JEGATHEESAN 4, I GABRYS 5
1University Of Wollongong, Wollongong, Australia, 2Illawarra Health and Medical Research Institute, Wollongong, Australia, 3University of Leceister, Leceister, United Kingdom, 4Princess Alexandra Hospital, Woolloongabba , Australia, 5Alberta Health Services, Sherwood Park, Canada
Aim: Summarise and compare physical activity (PA) and exercise (EX) guidelines and recommendations for people with kidney failure undertaking dialysis. The research questions were:
- What recommendations or guidelines exist for PA and/or EX in dialysis patients?
- What aspects of these recommendations or guidelines require further research or clarification?
Background: Low levels of PA and EX in dialysis patients are associated with negative health outcomes and poorer quality of life.
Methods: Systematic search of Medline, Scopus, Web of Science, CINAHL and SPORTDiscus databases; the first twenty quartile 1 journals listed on SCImago for nephrology and exercise; and the home pages of key societies and organisations in sports medicine and nephrology. Documents providing PA or EX recommendations by key organisations or experts at the national or international level were included. Grey literature searches were conducted in English, Spanish and Polish.
Clinically-accredited WGS analysis was undertaken with a curated “KidneyOme” virtual panel of genes associated with Mendelian kidney disorders. A genomic diagnosis constituted a KidneyOme result of pathogenic or likely pathogenic variant/s of appropriate zygosity.
Results: In total, 1451 records from database searches and 24 records from the grey literature were retrieved. The final synthesis included 19 publications. This review identified inconsistencies in PA and EX recommendations including type, level of intensity, and duration of EX. Most publications agreed on recommending aerobic EX. Resistance and flexibility EX were less frequently recommended. Many publications lacked details regarding safety precautions, monitoring, and contraindications to EX. Of the limited EX recommendations for dialysis patients, those undertaking PD are severely underrepresented.
Conclusion: Future EX and PA guidelines for the dialysis population should include standardized reporting with explicit detail regarding exercise principles including the timing, duration, intensity, frequency and the progression of these principles. Evaluating suitability to EX and a comprehensive set of safety guidelines, including dialysis access and fluid overload considerations should be addressed.
Dr Kelly Lambert is an Advanced Accredited Practising Dietitian with qualifications in knowledge translation, health economics and management, and two decades of experience as a renal dietitian and a doctorate investigating health literacy and cognitive impairment in end stage kidney disease. Dr Lambert is the Academic Program Director for the Nutrition and Dietetics Program at the University of Wollongong. Dr Lambert’s research interests are intended to support people with kidney disease to live better lives and to progress the science about developing better patient education materials.