Exercise interventions in dialysis patients

Abstract

Approximately 70% of patients receiving dialysis in Japan at the end of 2016 were over 65 years of age. Based on the survey the author and colleagues conducted, approximately 70% of Japanese elderly hemodialysis patients were in a state of frailty or prefrailty, and physical functions (muscle strength, walking speed, standing balance and flexibility) of elderly patients attending the dialysis clinic for outpatient care decreased to approximately 60-70% of those of healthy persons, respectively, and physical activity level (steps) was under 50%. This subsequent follow-up study revealed that a clear decline in physical functions and physical activity level could be a significant and independent risk factor that worsens prognosis. The authors also developed the questionnaire on perceived mobility difficulty to accurately grasp limitations in activities of daily living (ADL) and revealed that the ADL difficulty evaluation is a simple alternative method to assess the functional status and to predict subsequent prognosis in elderly hemodialysis patients. Moreover, the author and colleagues have introduced a disease management system consisting of periodic assessment and exercise therapy in a period of roughly 10 years, and clarified that the high attendance group (attended >75% of all available sessions in the management program) had significantly better survival and lower incidence of cardiovascular disease than the low attendance group. These findings suggest that periodic physical function assessment and encouragement for participation in physical activity should be part of disease management for frail hemodialysis patients.