Physical functioning and health-related quality-of-life changes with exercise training in hemodialysis patients


      The Renal Exercise Demonstration Project was designed to test the effects of two different approaches to exercise programming on the levels of physical activity, physical functioning, and self-reported health status in hemodialysis patients. Two hundred eighty-six patients were recruited for participation. Intervention patients were given individually prescribed exercise for 8 weeks of independent home exercise, followed by 8 weeks of incenter cycling during dialysis. Physical performance testing was performed at baseline and after each intervention using gait speed, sit-to-stand test, and 6-minute walk. The Medical Outcomes Study Short Form 36-item (SF-36) questionnaire was used to assess self-reported health status. The intervention group showed increased participation in physical activity. There were significant differences between the intervention and nonintervention groups in change over time in normal and fast gait speed, sit-to-stand test scores, and the physical scales on the SF-36, including the physical component scale. The intervention group improved in these test results, whereas the nonintervention group either did not change or declined over the duration of the study. It is clear that improvements in physical functioning result from exercise counseling and encouragement in hemodialysis patients. Because self-reported physical functioning is highly predictive of outcomes in hemodialysis patients, more attention to patients' levels of physical activity is warranted.


      To read this article in full you will need to make a payment


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Office of the US Surgeon General: Physical Activity and Health
        A Report of the Surgeon General.
        US Department of Health and Human Services, Public Health Service, Rockville, MD1996
        • Goldberg AP
        • Geltman EM
        • Hagberg JM
        • Delmez JA
        • Haynes ME
        • Harter HR
        Therapeutic benefits of exercise training for hemodialysis patients.
        Kidney Int. 1983; 16: S303-S309
        • Lundin AP
        • Stein RA
        • Frank F
        Cardiovascular status in long-term hemodialysis patients: An exercise and echocardiographic study.
        Nephron. 1981; 28: 234-238
        • Painter PL
        • Messer-Rehak D
        • Hanson P
        • Zimmerman S
        • Glass NR
        Exercise capacity in hemodialysis, CAPD and renal transplant patients.
        Nephron. 1986; 42: 47-51
        • Painter PL
        • Nelson-Worel JN
        • Hill MM
        • Thornbery DB
        • Shelp WR
        • Harrington AR
        • Weinstein AB
        Effects of exercise training during hemodialysis.
        Nephron. 1986; 43: 87-92
        • Painter PL
        • Moore GEM
        The impact of rHu erythropoietin on exercise capacity in hemodialysis patients.
        Adv Ren Replace Ther. 1994; 1: 55-65
        • Painter P
        Exercise in end-stage renal disease.
        Exerc Sports Sci Rev. 1988; 16: 305-339
        • Robertson HT
        • Haley NR
        • Guthrie M
        Recombinant erythropoietin improves exercise capacity in anemic hemodialysis patients.
        Am J Kidney Dis. 1990; 15: 325-332
        • Shalom R
        • Blumenthal JA
        • Williams RS
        Feasibility and benefits of exercise training in patients on maintenance dialysis.
        Kidney Int. 1984; 25: 958-963
        • Zabetakis PM
        • Gleim GW
        • Pasternak FL
        • Saraniti A
        • Nicholas JA
        • Michelis MF
        Long-duration submaximal exercise conditioning in hemodialysis patients.
        Clin Nephrol. 1982; 8: 17-22
        • Curtin RB
        • Lowrie EG
        • DeOreo PB
        Self-reported functional status: An important predictor of health outcomes among end-stage renal disease patients.
        Adv Ren Replace Ther. 1999; 6: 133-140
        • DeOreo PB
        Hemodialysis patient-assessed functional health status predicts continued survival, hospitalization and dialysis-attendance compliance.
        Am J Kidney Dis. 1997; 30: 204-212
        • Lowrie EG
        • Zhang H
        • LePaine N
        • Lew NL
        • Lazarus JM
        Health-related quality of life (QoL) among dialysis patients: Associations with contemporaneous measures and future mortality.
        J Am Soc Nephrol. 1998; 9 (abstr): 219A
        • Painter PL
        • Stewart AL
        • Carey S
        Physical functioning: Definitions, measurement, and expectations.
        Adv Ren Replace Ther. 1999; 6: 110-123
        • Guralnik JM
        • Simonsick EM
        • Ferrucci L
        • Glynn RJ
        • Berkman LF
        • Blazer DG
        • Scherr PA
        • Wallace RB
        A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-M94
        • Guralnik J
        • Ferrucci L
        • Simonsick EM
        • Salive ME
        • Wallace RB
        Lower-extremity function in persons over the age of 70 as a predictor of subsequent disability.
        New Engl J Med. 1995; 43: 845-854
        • Painter P
        • Blagg C
        • Moore GE
        Exercise for the Dialysis Patient: A Comprehensive Program.
        Medical Education Institute, Madison, WI1995
        • Bohannon RW
        Comfortable and maximum walking speed of adults aged 20-79 years: Reference values and determinants.
        Age Ageing. 1997; 26: 15-19
        • Bohannon RW
        Sit-to-stand test for measuring performance of lower extremity muscles.
        Percept Mot Skills. 1995; 80: 163-166
        • Csuka M
        • McCarty DJ
        Simple method for measurement of lower extremity muscle strength.
        Am J Med. 1985; 78: 77-81
        • Rejeski WJ
        • Ettinger WH
        • Schumaker S
        • James P
        • Burns R
        • Elam JT
        Assessing performance-related disability in patients with knee osteoarthritis.
        Osteoarthritis Cartilage. 1995; 3: 1-11
        • Guyatt GH
        • Sullivan MJ
        • Thompson PJ
        • Fallen EL
        • Pubsley SO
        • Taylor DW
        • Berman LB
        The 6- minute walk: A new measure of exercise capacity in patients with chronic heart failure.
        Can Med Assoc J. 1985; 132: 919-923
        • Fitts SS
        • Guthrie MR
        Six-minute walk by people with chronic renal failure: Assessment of effort by perceived exertion.
        Am J Phys Med Rehab. 1995; 74: 54-58
        • Gunnarsson OT
        • Judge JO
        • Earles DR
        • Marcella GR
        A comparison of walking programs for older adults: Effects on six-minute walking distance.
        Gerontologist. 1997; 37: 126-130
        • Cahalin LP
        • Mathier MA
        • Semigran MJ
        • Dec GW
        • DiSalvo TG
        The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.
        Chest. 1996; 110: 325-332
        • Lipkin DP
        • Scriven AJ
        • Crake T
        • Poole-Wilson PA
        Six-minute walking test for assessing exercise capacity in chronic heart failure.
        BMJ. 1986; 292: 653-655
        • Peters P
        • Mets T
        The 6-minute walk as an appropriate exercise test in elderly patients with chronic heart failure.
        J Gerontol Med Sci. 1996; 51A: M147-M151
        • Ware JE
        • Sherbourne CD
        The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Ware J
        SF-36 Health Survey: Manual and Interpretation Guide.
        Health Institute, Boston, MA1993
        • Ware JE
        • Kosinski M
        • Keller SD
        SF-36 Physical and Mental Health Summary Scales: A User's Manual.
        ed 2. Health Institute, Boston, MA1994
        • Renal Data System US
        USRDS 1991 Annual Data Report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
        (Bethesda, MD)1991
        • Blair SN
        • Kohl HW
        • Paffenbarger RS
        • Clark DG
        • Cooper KH
        • Gibbons LW
        Physical fitness and all-cause mortality: A prospective study in healthy men and women.
        JAMA. 1989; 262: 2395-2401