**8. References**

Ayus JC, Varon J, Arieff AI. Hyponatremia, cerebral edema, and noncardiogenic pulmonary edema in marathon runners. Ann Intern Med 2000; 132:711

Fats are needed, in the first hand, the essential fatty acids. But any fat to get the important

Fruit and vegetables are recommended to sportsmen and sportswomen. However, due to risk of hyperpotassemia and high water content in fruits, caution is needed for patients in

Vitamins are needed. Especially C-vitamins since they are removed at hemodialysis or hemofiltration (Fehrman-Ekholm et al 2008). D-vitamins are needed for the skeleton and in treatment of secondary hyperparathyroidism. Iron is necessary in anemia treatment and

General recommendation is to eat often and to eat after the exercise to fill up the glycogen

In co work with other team members the physical therapist works to motivate the patient to continue exercises for the rest of life. Regular check-ups by physiotherapist with knowledge of renal medicine and transplant medicine are of greatest importance to maintain maximal physical performance whatever CKD treatment the patient has. We also know that there are several national guidelines that include exercise training and physical activity as part of the treatment for problems that are common in patients with CKD, i.e. high blood pressure, hyperlipidemia and cardiovascular diseases. Within renal care and -medicine we spend a lot of time trying to find ways to optimise the outcome of the care that is given to our patients. But there is already an easy, low-tech intervention that has multiple advantages for these patients' health and well-being, but which hasn't been implemented as a part of the standard care for patients with CKD: Exercise training and physical activity in daily living! Another question is if aerobic exercise and strength training starting early in renal disease could play an important role in prevention or progression of CKD (Moinuddin et al 2008).

 The physical fitness is severely reduced among adults with haemodialysis treatment Physical exercise programs should be initiated with gentle start and preferably non-

 Exercise training including various programs improves aerobic capacity, muscular strength and endurance, physical functioning, physical- and psychological well-being if

Exercise training has positive effects on the cardiovascular risk profile, oxidative stress

 Exercise training improves protein intake (PCR), dialysis effects (KT/V), haemoglobin and the endothelial function which are important treatment parameters in hemodialysis

We need to encourage our patients with CKD to get more physically active and to start exercising. We need to refer them to physiotherapists with special knowledge in renal medicine that can give them adequate, individually adapted exercise recommendations.

Ayus JC, Varon J, Arieff AI. Hyponatremia, cerebral edema, and noncardiogenic pulmonary

edema in marathon runners. Ann Intern Med 2000; 132:711

dialysis. The patients should have lists from dieticians to find the most proper fruits.

today most patients have intravenous iron supply at dialysis sessions.

energy balance is important.

stores again.

**7. Conclusion** 

and inflammation

patients.

**8. References** 

dialysis days or before dialysis treatment

the program is regular and monitored


The Importance of Exercise Programs in Haemodialysis Patients 443

Nilsen T, Hermann M, Eriksen CS, Dagfinrud et al. Grip force and pinch grip in adult

Pagels A, Heiwe S, Hylander B. Nutritional status and handgrip strength in pre-dialysis

Painter P, Messer-Rehak D, Hanson P, Zimmerman SW, Glass NR. Exercise capacity in hemodialysis, CAPD, and renal transplant patients. Nephron. 1986;42(1):47-51. Painter PL, Hector L, Ray K, Lynes L, Dibble S, Paul SM, et al. A randomized trial of exercise training after renal transplantation. Transplantation. 2002 Jul 15;74(1):42-8. Pechter U, Ots M, Mesikepp S, Zilmer K, Kullissaar T, Vihalemm T, et al. Beneficial effects of

Pecoits-Filho R, Heimburger O, Barany P, Suliman M, Fehrman-Ekholm I, Lindholm B and

Ritz E, Boland R, Kreusser W. Effects of vitamin D and parathyroid hormone on muscle:

Sakkas GK, Ball D, Mercer TH, Sargeant AJ, Tolfrey K, Naish PF. Atrophy of non-locomotor

Sakkas GK, Sargeant AJ, Mercer TH, Ball D, Koufaki P, Karatzaferi C, et al. Changes in

Sonn U, Frändin K, Grimby G. Instrumental activities of dailys living related to impairments

Thompson CH, Kemp GJ, Taylor DJ, Ledingham JG, Radda GK, Rajagopalan B. Effect of

van Vilsteren MC, de Greef MH, Huisman RM. The effects of a low-to-moderate intensity

Venkataraman R, Sanderson B, Bittner V. Outcomes in patients with chronic kidney disease undergoing cardiac rehabilitation. American heart journal. 2005 Dec;150(6):1140-6. Welch JL, Austin JK. Factors associated with treatment-related stressors in hemodialysis

Yao Q, Pecoits-Filho R, Lindholm B, Stenvinkel P. Traditional and non-traditional risk

disease. Scandinavian Journal of urology and nephrology. 2004;38(5):405-16.

clinical trial. Nephrol Dial Transplant. 2005 Jan;20(1):141-6.

Ther 2011 Feb 28 (Epub ahead of print).

2003 Jun;26(2):153-6.

6: 1212-1218.

Jul 33(7):1522-9.

Oct;18(10):2074-81.

1993;8(3):218-22.

patients. Journal of Renal Care. 2006;XXXII:151-55.

Nephrol Dial Transplant. 2003 Sep;18(9):1854-61.

age. Scand J Rehabil Med 1995;27: 119-28.

Jun;26(3):318-25; discussion 26.

population: Reference values and factors associated with grip force. Scand J Occup

water-based exercise in patients with chronic kidney disease. International journal of rehabilitation research Internationale Zeitschrift fur Rehabilitationsforschung.

Stenvinkel P. Associations between circulating inflammatory markers and residual renal function in CRF patients. American Journal of Kidney Diseases. 2003 Vol 41,

potential role in uremic myopathy. The American journal of clinical nutrition. 1980

muscle in patients with end-stage renal failure. Nephrol Dial Transplant. 2003

muscle morphology in dialysis patients after 6 months of aerobic exercise training.

and functional limitations in 70-year-olds and changes between 70 and 76 years of

chronic uraemia on skeletal muscle metabolism in man. Nephrol Dial Transplant.

pre-conditioning exercise programme linked with exercise counselling for sedentary haemodialysis patients in The Netherlands: results of a randomized

patients. ANNA journal / American Nephrology Nurses' Association. 1999

factors as contributors to atherosclerotic cardiovascular disease in end-stage renal


Heiwe S, Clyne N, Dahlgren MA. Living with chronic renal failure: patients' experiences of their physical and functional capacity. Physiother Res Int. 2003;8(4):167-77. Heiwe S, Clyne N, Tollback A, Borg K. Effects of regular resistance training on muscle

Johansen KL, Shubert T, Doyle J, Soher B, Sakkas GK, Kent-Braun JA. Muscle atrophy in

Jones D, Round J. Skeletal muscle in health and disease. Manchester: University Press 1990. Kettner-Melsheimer A, Weiss M, Huber W. Physical work capacity in chronic renal disease.

Klitgaard H, Mantoni M, Schiaffino S, Ausoni S, Gorza et al. Function, morphology and

Kraemer WJ, Ratamess NA. Hormonal responses and adaptations to restistance exercise and

Kramer J, Stone M, O´bryant H et al. Effects of single vs multiple sets of weight training: impact of volume, intensity, and variation. J Strength Cond Res 1997;11: 143-147.

Lok P. Stressors, coping mechanisms and quality of life among dialysis patients in Australia.

Marlowe E. Rehabilitation concerns in the treatment of patients with chronic renal failure.

McIntyre CW, Selby NM, Sigrist M, Pearce LE, Mercer TH, Naish PF. Patients receiving

McMahon LP, McKenna MJ, Sangkabutra T, Mason K, Sostaric S, Skinner SL, et al. Physical

Moinuddin I, Leehey DJ. A comparison of aerobic exercise and resistance training in

Molsted S, Eidemak I, Sorensen HT, Kristensen JH. Five months of physical exercise in

Nielens H, Lejeune TM, Lalaoui A, Squifflet JP, Pirson Y, Goffin E. Increase of physical

American journal of physical medicine & rehabilitation /Association of Academic

maintenance dialysis have more severe functionally significant skeletal muscle wasting than patients with dialysis-independent chronic kidney disease. Nephrol

performance and associated electrolyte changes after haemoglobin normalization: a comparative study in haemodialysis patients. Nephrol Dial Transplant. 1999

patients with and without chronic kidney disease. Adv Chronic Kidney Dis 2008;

hemodialysis patients: effects on aerobic capacity, physical function and self-rated

activity level after successful renal transplantation: a 5 year follow-up study.

Lazarus R, Folkman S. Stress, Appraisal, and Coping. New York: Springer 1984.

Journal of advanced nursing. 1996 May;23(5):873-81.

with different training backgrounds. Acta Physiol Scand 1990; 140:41-54. Kouidi E, Albani M, Natsis K, Megalopoulos A, Gigis P, Guiba-Tziampiri O, et al. The

The International journal of artificial organs. 1987 Jan;10(1):23-30.

Physiatrists. 2005 Nov; 84(11):865-74.

Dial Transplant. 1998 Mar;13(3):685-99.

training. Sports Med 2005;35; 339-61.

Physiatrists. 2001 Oct;80(10):762-4.

May;14(5):1182-7.

15: 83-89

Dial Transplant. 2006 Aug;21(8):2210-6.

health. Nephron Clin Pract. 2004; 96(3): 76-81.

Nephrol Dial Transplant. 2001 Jan;16(1):134-40.

physical function. Kidney Int. 2003 Jan;63(1):291-7.

histopathology and morphometry in elderly patients with chronic kidney disease. American journal of physical medicine & rehabilitation /Association of Academic

patients receiving hemodialysis: effects on muscle strength, muscle quality, and

protein expression of ageing skeletal muscle: a cross-sectional study of elderly men

effects of exercise training on muscle atrophy in haemodialysis patients. Nephrol


Zamojska S, Szklarek M, Niewodniczy M, Nowicki M. Correlates of habitual physical activity in chronic haemodialysis patients. Nephrol Dial Transplant. 2006 May;21(5):1323-7.

Zamojska S, Szklarek M, Niewodniczy M, Nowicki M. Correlates of habitual physical

May;21(5):1323-7.

activity in chronic haemodialysis patients. Nephrol Dial Transplant. 2006
