nkf 2006

The “Dummies” Guide to Starting an Exercise Program in your Dialysis Unit : The “Dummies” Guide to Starting an Exercise Program in your Dialysis Unit Dan Bayliss, MS CES Debbie Cote, RN CNN University of Virginia Renal Services University of Virginia Medical Center Charlottesville, VA


Based on the Life Options Unit Self-Assessment Manual for Renal RehabilitationModule 4: ExercisePractical Guide to Renal Rehabilitationwww.lifeoptions.org : Based on the Life Options Unit Self-Assessment Manual for Renal Rehabilitation Module 4: Exercise Practical Guide to Renal Rehabilitation www.lifeoptions.org


Topics of Discussion : Topics of Discussion UVA SitFit Exercise Program Why exercise? Benefits of exercise to the staff Components needed to start a program Obstacles to starting a program Cost of Equipment Patient Interest programs Documentation Testing Questions


UVA SitFit Exercise Program : UVA SitFit Exercise Program Started by Kline Bolton, MD in 1998 Full-time Master’s-trained Exercise Physiologist 8 dialysis units Over 740 patients 30-35% of patients have exercise orders


Why Exercise?? : Why Exercise?? Renal failure is a significant health care concern now and in the coming years The USRDS predicts significant growth in the prevalence of ESRD Researchers predict the ESRD population to reach >600,000 by 2010 Hypertension and diabetes rates are on the rise as well Patients who exercise during dialysis have fewer episodes of low systolic blood pressure that require treatment during dialysis


NUMBER OF INCIDENT & POINT PREVALENT PATIENTSfigure 1.3, projected to 2010 : NUMBER OF INCIDENT & POINT PREVALENT PATIENTS figure 1.3, projected to 2010


PROJECTED COST FOR ESRD CARE : Year PROJECTED COST FOR ESRD CARE


Why Exercise cont. : Why Exercise cont. Recent research indicates the positive effects of exercise for dialysis patients Improves Kt/V Improves phosphorus levels Stabilizes blood pressure and reduces the number of low blood pressure episodes Improves blood glucose levels Improves lipid and carbohydrate metabolism Improves strength, endurance, flexibility Improves energy levels, QOL Increases exercise capacity by 21 to 25%


Why Exercise, cont. : Why Exercise, cont. Help patients get back to work Improve their ability to care for themselves May prolong life IMPROVES QUALITY OF LIFE


Benefits to the Staff : Benefits to the Staff Dialysis staff benefit when patients exercise through improved patient relationships, time savings (faster transfers), and reduced risk of work-related injuries (fewer lifts) May actually improve their PA levels!!


Obstacles to Exercise : Obstacles to Exercise Who’s going to pay for it?? Hospital/medical center grants Patient memorial funds donations Staff dedication/involvement MD clearance Patient noncompliance


Components needed : Components needed Administrative support Exercise “Champion(s)” Similar to anemia management person Strategies for identifying champion Solicit interest from staff, patients, or community volunteers Have staff in-services Call local college about internship program Equipment Patient involvement programs


Essential Guides : Essential Guides Life Options Rehabilitation booklets Unit Self-Assessment Tool for Renal Rehabilitation (USAT) Guide for the Nephrologist Prescribing Guide Guide for Patients on Dialysis www.lifeoptions.org


Administrative Requirements : Administrative Requirements Exercise Physiologist/Physical Therapist (?) Exercise “champion” (RN, Tech, SW) Administrative support Training staff Job descriptions including exercise program Billing Referrals (cardiac rehab, PT, social work)


Floor Staff is the Key : Floor Staff is the Key Exercise “champion” should not do all the work. Each staff member has the responsibility to encourage the patients If the staff is dedicated, patient exercise participation will be high Don’t ask the patients if you want to exercise Most patients will automatically say “no” Instead, bring them the exercise equipment and ask how long do they want to go today


Staff Strategies : Staff Strategies Don’t ask, just bring the equipment to the patients Get involved with the patients Encourage other staff to get involved Have a pod/bay book


Documentation : Documentation Unit Exercise Bay/Pod Book Exercise daily set-up sheet Pertinent research papers Exercise Decision Tree Exercise bike protocol Potential problems Stretching guide Weight training guide Exercise Prescriptions Exercise progress/communication notes


Equipment : Equipment Stationary Cycle Monarch 881E CHAMP cycle Treadmill NuStep® (www.nustep.com) OxyStepper® Hand Weights Leg Weights TheraBands®


Cost of Equipment : Cost of Equipment General Equipment Fitness, free weights $20.00 Hand, ankle weights (per lb) $1.00 Thera-Bands® $1.30 Stationary bike (CHAMP) $350.00 Pedal exerciser $42.00 Total $409.30


Cost of Equipment cont. : Cost of Equipment cont. Exercise Room Equipment Treadmill $1300.00 NuStep® $3500.00 AirDyne® $465.00


CHAMP Cycle : CHAMP Cycle Designed for dialysis chairs Inexpensive ($300-500) Bulky (~ 60lbs)


Monarch 881E Rehab Trainer : Monarch 881E Rehab Trainer Clinically designed Easy to transport Tip and roll Expensive (~$1300) Breaks down often


LifeCare OxyStepper : LifeCare OxyStepper Inexpensive Light and mobile Does not give cardiovascular exercise effect similar to cycling May be hard to reach


Patient Interest Programs : Patient Interest Programs Pod Exercise Information sessions, or “classes” Cycle across America 12 Days of Exercise (Christmas holiday) “Buddy Up” program Exerciser of the Month Patient-Staff Match-up Program Wellness Programs including social work and nutrition


Testing : Testing Two and Six-min walk test Sit-to-Stand test Stair Climbing test Lift-Reach test


Closing : Closing If unit staff works together, and exercise program can be successful It does NOT have to come down to lack of money for a unit to have an exercise program Exercise should NOT be “cutting edge” anymore, it NEEDS to become a standard treatment for all dialysis units! “Every patient should be asked, ‘What are you doing for regular exercise?’” -- Patricia Painter, PhD


Slide28 : Surgeon General’s Warning: PHYSICAL INACTIVITY MAY BE HAZARDOUS TO YOUR HEALTH Patricia Painter, Ph.D.


Contact Information : Contact Information UVA SitFit Exercise Program Website: http://www.healthsystem.virginia.edu/ Contact Person: Dan Bayliss, MS CES Clinical Exercise Physiologist djb2c@virginia.edu 434-243-6218


Questions?? : Questions?? “Give about two hours every day to exercise, for health must not be sacrificed to learning.” Thomas Jefferson, 1789