Hemodialysis: How to exercise? What should I pay attention to?

Author: Wang Ying, Chief Nurse, Peking University People's Hospital

Reviewer: Mao Yonghui, Chief Physician, Beijing Hospital

We know that many dialysis patients are bedridden for a long time.

In order to improve the patient's physiological function, we recommend that patients start exercise early, gradually increase the amount of exercise, and combine various exercise modes to improve the patient's quality of life.

Generally speaking, it can be divided into exercise during dialysis and exercise between dialysis periods. Common exercises for patients during dialysis include gymnastics and supine exercises. Patients can also do Tai Chi while lying on the bed. In addition, lying down and pedaling a bicycle in the air is also a good way to exercise.

It is important to remind everyone that there are some precautions when exercising during dialysis.

For example, it is usually performed 1-2 hours before dialysis treatment to avoid complications such as hypotension, muscle cramps, and hypoglycemia.

Secondly, ensure that the arm with vascular access does not have the problem of vascular puncture needle slipping.

Also, pay attention to monitoring the patient's heart rate and blood pressure levels, especially before and after exercise. Of course, for diabetic patients, we also need to monitor blood sugar.

In addition, we also need to evaluate the subjective fatigue score of the patient. For example, we ask the patient, are you tired after doing this set of exercises? This score ranges from 1 to 20, and the patient describes the fatigue level in the range. It is a quantitative indicator. Therefore, it can be intuitively evaluated whether the intensity of the exercise prescription is suitable for the patient's physical fitness.

The intensity of exercise should be gradually increased, allowing the patient to go from a relatively relaxed state to a slightly tired state. For patients with better physical strength, they can gradually transition to a state of slight fatigue, so as to gradually improve their cardiopulmonary endurance.

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Generally speaking, exercise during dialysis is supervised by medical staff, who can assess the patient's exercise risk at any time. If the risk is high, the patient will be asked to stop exercising. Therefore, it is relatively safe and can also increase patient compliance.

Patients on dialysis can do more exercise. When there are two days between dialysis sessions, it is recommended to do exercise training on the first day after dialysis.

Young patients with good physical strength can do exercises, swim, or even run and climb mountains.

For elderly and weak patients, they can start by increasing daily activities, which is also a good exercise. Although the intensity is low and may not achieve the effect of muscle training, it can improve the quality of life and reduce functional disabilities, so it is also beneficial for patients.

Some patients who need to use wheelchairs should try to do upper limb exercises, such as lifting dumbbells, to exercise the upper limb muscles through resistance exercises.

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Of course, we must also point out that exercise has risks. Even for healthy people, any exercise has risks.

There are many risks of exercise for dialysis patients. For example, direct impacts include strain or injury to joints and muscles. In addition, because you have to hold your breath when doing resistance exercise, it will disrupt your breathing rhythm, etc., so exercise also has a certain impact on breathing.

Therefore, patients should also know about these issues. We need to weigh the pros and cons and adopt appropriate exercise methods and intensity.

It is important to remind everyone that dialysis patients should stop exercising immediately if they experience the following symptoms during exercise:

First, if you feel burning, soreness, or a feeling of narrowing or fullness in your chest, arms, neck, or jaw, stop immediately.

Second, if you experience obvious shortness of breath or difficulty talking, you should not continue exercising.

Third, if the heart rate is particularly fast and arrhythmia occurs, it is not allowed.

Fourth, if you experience symptoms similar to hypoglycemia, such as blurring, dizziness, general fatigue, or feeling like you’re about to faint, stop immediately.

In addition, if you experience muscle cramps or swollen and painful joints, you should stop exercising immediately.

While exercising, pay attention to these abnormal symptoms and stop immediately once they occur.

Of course, before starting exercise, we should also pay attention to eliminating some contraindications to exercise.

For example, if the blood pressure is too high, higher than 180/100 mmHg; or too low, lower than or equal to 90/60 mmHg; or the heart rate is too fast, exceeding 100 beats/minute, then this is the target value that is primarily prohibited.

There are also serious cardiopulmonary diseases, such as severe heart failure, unstable angina, aortic dissection, uncontrollable pulmonary hypertension, etc., which are also contraindications to exercise.

Another possibility is that some acute clinical events occur, such as systemic inflammatory response, or deep vein thrombosis has already occurred, and the calf has abnormal manifestations, such as redness, swelling, and pain. At this time, exercise should also be prohibited.

In addition, when severe edema or joint disease occurs, the patient cannot cooperate with exercise and is therefore not suitable for exercise.