Hemodialysis exercise pilot proving a success

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Excitement fills the air in the Dialysis Unit at the Saint John Regional Hospital as both patients and health-care professionals witness the changes beginning to take place as a result of an innovative project undertaken by two nurses. After four months of planning, meetings, research and protocol development, the Hemodialysis Exercise Pilot Project at Atlantic Health Sciences Corporation (AHSC) officially kicked into gear in April 2006. The project sees dialysis patients become pedaling recumbent cyclers while they receive their dialysis treatment.

The project is being led by Dawson King and Anita Fenn, both RNs in the Hemodialysis Unit. While attending the annual Nephrology New Brunswick conference, King was intrigued by a lecture given by guest speaker, Dr. Patricia Painter, an exercise physiologist from California. Dr. Painter spoke about the benefits and importance of exercise among dialysis patients to improve their quality of life and physical functioning. “I saw this presentation and knew it was something I wanted to try in our unit,” said King. She enlisted Anita Fenn as her partner in the project, and there’s been no turning back.

The pair began by choosing eight hemodialysis patients who receive dialysis on a regular (three times per week) schedule. The project is being monitored by Dr. Martin MacKinnon, a physician in the Nephrology Department, who completed a medical review of the patients and assessed their suitability for the project. He also provided safety guidelines and procedures for the patients to follow while cycling. Steve Mundle, AHSC physiotherapist with the Cardiovascular Rehabilitation Program developed an individual exercise prescription for each patient after conducting individual walk tests. The prescriptions incorporate gradual increases in exercise duration and intensity over a four month period. Patients also completed a quality of life questionnaire that addressed how they felt about their health and how they felt about the care they were receiving.

There has been significant research that suggests that people receiving dialysis can greatly benefit from regular exercise. Therefore, the main objective of the pilot is to use the health benefits of exercise to help improve the quality of life of dialysis patients in this region. “Dialysis takes a toll on the body,” explained Fenn. “After four hours of dialysis treatment, patients are very tired.” Until now, the only way patients passed the time was by sleeping, reading or watching television.

After only two months of the four-month pilot, exciting results are being noticed. When you walk into the dialysis unit you see patients talking, laughing and encouraging each other to do a little more. The attitude and morale of patients is improving dramatically and they are going home after treatment with more energy, a more positive outlook and a sense of feeling stronger and more in control. Some improvements in heart rate and blood pressure have been recorded and the project physiotherapist has also identified enhancements in patients’ mobility levels. Patients have been overheard making statements like, “I feel a lot better, I have more energy,” and one patient was even heard saying that he felt “exhilarated” after cycling!

Excitement and enthusiasm is evident as King and Fenn talk about their patients. “These people spend so much of their life with us. It’s encouraging to see that they are eager to take part. They feel a sense of accomplishment and success.” King marvels at the patients’ attitude towards the project. “Some patients are already competing with themselves; trying to improve upon their last time.” Most patients average approximately 45 minutes to 1 hour of pedaling time, however several patients, are pedaling for up to one hour and 40 minutes.

One of the biggest roadblocks to a dialysis patient’s health is the difficulty in keeping them motivated. Therefore, Fenn and King have started clipping articles and motivational material and are even providing recipes for healthy cooking. “It’s all part of improving quality of life for our patients,” said King. They have also prepared binders with information on exercises they can do at home and provided each participant with a pedometer to track their activity levels.

King and Fenn hope that as the project continues, both their own enthusiasm and the patient’s enthusiasm will be infectious among the other hemodialysis patients and team members. Their vision is to have an exercise program available to most of the hemodialysis population in the Southwestern New Brunswick health region.

Their unique project has begun to generate a buzz and has already led to an enquiry from another Atlantic health region. “The changes we have begun to see in our patients since beginning this project are thrilling.” says Fenn. “Our hope is that we can continue to develop the exercise program and make a difference in the lives of our dialysis patients.” The phrase now heard daily in the Hemodialysis Unit at the Saint John Regional Hospital is “let’s get moving!!”