Johansen_subbed.qxp 31/7/09 02:59 Page 72
patients with ESRD. Older patients and those with more advanced after the home-based activity portion of the intervention. In addition,
kidney disease appear to have worse physical functioning, but these the authors noted that those who reported the lowest functioning at
factors cannot be easily modified. However, there is some suggestion the beginning of the study derived the most benefit from
that a higher dose of dialysis or more frequent dialysis may be participation.
This study suggests that it is possible to increase the
associated with better function,
and studies are under way to level of physical activity among patients receiving dialysis and that
determine whether more frequent dialysis can improve physical doing so can have an impact on their poor functioning.
On the other hand, participation in physical activity is a
behavior that can be measured and has the potential to be modified. In summary, patients on dialysis, particularly those who are older, have
However, the nephrology community is not focusing on sedentary poor physical functioning and low participation in physical activity.
behavior as a target for improving outcomes. Few nephrologists Increasing the level of participation in moderate intensity physical
routinely assess the levels of physical activity of their dialysis patients activity has been shown to improve functioning in the dialysis
and counsel inactive patients to become more active.
population, but nephrologists are not implementing programs to
address this concern. The recent emphasis on measurement of quality
Increasing physical activity in this population is by no means an easy of life, including physical functioning, is a promising beginning. Given the
proposition, given the advanced age and high level of comorbidity association between sedentary behavior and poor physical functioning
and frailty that have been discussed, but higher levels of physical and the evidence that those who have low physical functioning are at
activity have the potential to improve physical functioning, quality of risk for bad outcomes, the next steps should be an assessment of
life, and possibly even survival.
It is surprising that although there physical activity and counseling to increase activity. Physician
have been numerous studies involving vigorous exercise training involvement increases the chances that patients will increase and
among dialysis patients, there are very few studies of increasing sustain their level of physical activity. There have been few studies of the
physical activity in a way that could be accessible to the frail or experience of CKD patients with physical activity, but some patients cite
disabled patients who may benefit most. lack of encouragement from their healthcare team as a barrier to
Patients often receive subtle or not-so-subtle
A notable exception is a study by Painter et al. that included a home- messages from their physicians that they are not capable of being
based exercise intervention followed by a dialysis-unit-based active. Asking about and encouraging physical activity should be part of
The home-based exercise included some flexibility our routine care for these patients. ■
exercises and light weight-lifting, but was mostly centered around
cardiovascular exercise, which was primarily walking, though some
Kirsten L Johansen, MD, is an Associate Professor of Medicine in Residence at the
participants used a stationary cycle. Self-reported physical functioning
University of California, San Francisco (UCSF) and Director of Dialysis at the San Francisco
and physical performance were assessed at the beginning, after the VA Medical Center. She is Director of the US Renal Data System Nutrition Special Studies
home-based regimen, and at the end of the study. The exercise group
Center and the Deputy Director of the Rehabilitation/Quality of Life Special Studies Center.
Dr Johansen’s research interests focus on physical functioning, muscle function, nutrition,
increased their participation in physical activity and improved their
and quality of life among patients with chronic kidney disease.
functioning. Most of the benefit in functioning was already evident
1. Johansen KL, Shubert T, Doyle J, et al., Kidney Int, 2003;63: 2006;21:2210–16. 2007;71:349–9.
201–7. 17. Ogawa T, Spina RJ, Martin WH 3rd, et al., Circulation, 1992;86: 32. Johansen KL, Sakkas GK, Doyle J, et al., Am J Kidney Dis,
2. Painter P, Messer-Rehak D, Hanson P, et al., Nephron, 494–503. 2003;41:171–8.
1986;42:47–51. 18. Johnston APW, De Lisio M, Parise G, Appl Physiol Nutr Metab, 33. Goldberg AP, Geltman EM, Hagberg JM, et al., Kidney Int,
3. Barnea H, Drory Y, Iaina A, et al., Isr J Med Sci, 1980;16:17–21. 2007;33:191–9. 1983;24:S303–S309.
4. Beasley C, Smith D, Neale T, Aust NZ J Med, 1986;16:5–10. 19. Lexell J, J Gerontol A Biol Sci Med Sci, 1995;50:11–16. 34. Zabetakis PM, Gleim GW, Pasternack FL, et al., Clin Nephrol,
5. Moore GE, Brinker KR, Stray-Gundersen J, et al., Med Sci Sports 20. Larsson L,Ramamurthy, B, Drugs Aging, 2000;17:303–16. 1982;18:17–22.
Exerc, 1993;25:18–23. 21. Singh MA, Clin Geriatr Med, 2004;20:201–21. 35. Shalom R, Blumenthal JA, Williams RS, et al., Kidney Int,
6. Moore GE, Parsons DB, Stray-Gundersen J, et al., Am J Kidney 22. Office of the US Surgeon General, Physical Activity and 1984;25:958–63.
Dis, 1993;22:277–87. Health: A report of the Surgeon General, Washington, DC, US 36. Painter PL, Nelson-Worel JN, Thornbery MM, et al., Nephron,
7. Violan MA, Pomes T, Maldonado S, et al., Transplantation Proc, Department of Health and Human Services, National Center 1986;43:87–92.
2002;34:417–18. for Chronic Disease Prevention and Health Promotion 1996. 37. Painter P, Moore G, Carlson L, et al., Am J Kidney Dis, 2002;39:
8. Johansen KL, Chertow GM, Silva M da, et al., Kidney Int, 23. Johansen KL, Chertow GM, Ng AV, et al., Kidney Int, 2000;57: 257–65.
2001;60:1586–91. 2564–70. 38. Lennon DLF, Shrago E, Madden M, et al., Metabolism, 1986;35:
9. Brodin E, Ljungman S, Hedberg M, et al., Scand J Urol Nephrol, 24. United States Renal Data System Annual Data Report, 2008. 728–35.
2001;35:71–8. 25. O’Hare AM, Tawney K, Bacchetti P, et al., Am J Kidney Dis, 39. Ross DL, Grabeau GM, Smith S, et al., Am J Nephrol, 1989;9:
10. Johansen KL, Painter P, Kent-Braun JA, et al., Kidney Int, 2001; 2003;41:447–54. 376–83.
59:1121–7. 26. Fried LP, Ferrucci L, Darer J, et al., J Gerontol A Biol Sci Med Sci, 40. Akiba T, Matsui N, Shinohara S, et al., Artificial Organs, 1995;19:
11. DeOreo PB, Am J Kidney Dis, 1997;30:204–12. 2004;59:255–63. 1262–8.
12. Lowrie EG, Curtin RB, LePain N, et al., Am J Kidney Dis, 27. Fried LP, Tangen CM, Walston J, et al., J Gerontol A Biol Sci Med 41. Koufaki P, Mercer TH, Naish PF, Clin Physiol Funct Imaging, 2002;
2003;41:1286–92. Sci, 2001;56A:M146–M156. 22:115–24.
13. Diesel W, Noakes TD, Swanepoel C, et al., Am J Kidney Dis, 28. Shlipak MG, Stehman-Breen C, Fried LF, et al., Am J Kidney Dis, 42. Painter P, Carlson L, Carey S, et al., Am J Kidney Dis, 2000;35:
1990;16:109–14. 2004;43:861–7. 482–92.
14. Sala E, Noyszewski EA, Campistol JM, et al., Am J Physiol Regul 29. Johansen KL, Chertow GM, Jin C, et al., J Am Soc Nephrol, 43. Painter P, Carlson L, Carey S, et al., Am J Kidney Dis, 2000;36:
Integr Comp Physiol, 2001;280:R1240–R1248. 2007;18:2960–67. 600–608.
15. Kouidi E, Albani M, Natsis K, et al., Nephrol Dial Transplant, 30. Woods NF, LaCroix AZ, Gray SL, et al., J Am Geriatr Soc, 44. Goodman ED, Ballou MB, Nephrol Nurs J, 2004;31:23–9.
16. McIntyre CW, Selby NM, Sigrist M, et al., Nephrol Dial Transplant, 31. Suri RS, Garg AX, Chertow GM, et al., Kidney Int,
72 US NEPHROLOGY
| Page 2
| Page 3
| Page 4
| Page 5
| Page 6
| Page 7
| Page 8
| Page 9
| Page 10
| Page 11
| Page 12
| Page 13
| Page 14
| Page 15
| Page 16
| Page 17
| Page 18
| Page 19
| Page 20
| Page 21
| Page 22
| Page 23
| Page 24
| Page 25
| Page 26
| Page 27
| Page 28
| Page 29
| Page 30
| Page 31
| Page 32
| Page 33
| Page 34
| Page 35
| Page 36
| Page 37
| Page 38
| Page 39
| Page 40
| Page 41
| Page 42
| Page 43
| Page 44
| Page 45
| Page 46
| Page 47
| Page 48
| Page 49
| Page 50
| Page 51
| Page 52
| Page 53
| Page 54
| Page 55
| Page 56
| Page 57
| Page 58
| Page 59
| Page 60
| Page 61
| Page 62
| Page 63
| Page 64
| Page 65
| Page 66
| Page 67
| Page 68
| Page 69
| Page 70
| Page 71
| Page 72
| Page 73
| Page 74
| Page 75
| Page 76
| Page 77
| Page 78
| Page 79
| Page 80
| Page 81
| Page 82
| Page 83
| Page 84
| Page 85
| Page 86
| Page 87
| Page 88
| Page 89
| Page 90
| Page 91
| Page 92