"A Learned Soul to Guide Me": The Voices of Those Living with Kidney Disease Inform Physical Activity Programming.

Purpose: The purpose of this study was to (a) confirm the barriers to and facilitators of physical activity (PA) among persons living with chronic kidney disease (CKD) in Ontario and (b) inform the design of a Kidney Foundation of Canada Active Living for Life programme for persons living with CKD. Method: Adults living with CKD in Ontario were invited to participate in a cross-sectional survey investigating opinions about and needs for PA programming. The 32-item survey contained four sections: programme delivery preferences, current PA behaviour, determinants of PA, and demographics. Data were summarized using descriptive statistics and thematic coding. Results: A total of 63 respondents participated. They had a mean age of 56 (SD 16) years, were 50% female, and were 54% Caucasian; 66% had some post-secondary education. The most commonly reported total weekly PA was 90 minutes (range 0-1,050 minutes). Most respondents (84%) did not regularly perform strength training, and 73% reported having an interest in participating in a PA programme. Conclusion: Individuals living with CKD require resources to support and maintain a physically active lifestyle. We identified a diversity of needs, and they require a flexible and individualized inter-professional strategy that is responsive to the episodic changes in health status common in this population.

Objectif : la présente étude visait à a) confirmer les obstacles et les incitatifs à l'activité physique (AP) chez les personnes atteintes d'une néphropathie chronique (NPC) en Ontario et b) étayer la conception du programme Une vie active pour la vie de la Fondation canadienne du rein pour les personnes atteintes d'une NPC. Méthodologie : des adultes de l'Ontario atteints d'une NPC ont été invités à participer à un sondage transversal sur leurs avis et leurs besoins liés aux programmes d'AP. Le sondage de 32 questions était divisé en quatre parties : préférences quant à la prestation du programme, comportements actuels en matière d'AP, déterminants de l'AP et démographie. Les chercheurs ont résumé les données à l'aide de statistiques descriptives et de codes thématiques. Résultats : au total, 63 répondants ont participé. Ils avaient un âge moyen de 56 ans (ÉT de 16 ans), 50 % étaient des femmes, 54 % étaient blancs et 66 % avaient une certaine éducation postsecondaire. L'AP physique hebdomadaire totale la plus déclarée était de 90 minutes (plage de 0 à 1 050 minutes). La plupart des répondants (84 %) ne faisaient pas d'entraînement musculaire régulier, et 73 % se sont dit intéressés à participer à un programme d'AP. Conclusion : les personnes atteintes d'une NPC ont besoin de ressources pour maintenir un mode de vie actif. Les chercheurs ont repéré une diversité de besoins et la nécessité d'une stratégie interprofessionnelle personnalisée qui tient compte des changements épisodiques de l'état de santé, courants dans cette population.

The Canadian Cardiac Rehabilitation Registry: Inaugural Report on the Status of Cardiac Rehabilitation in Canada.

Introduction. There are over 200 Cardiovascular Rehabilitation (CR) programs in Canada, providing services to more than 50,000 new patients annually. The objective of this study was to describe the impact of CR in Canada. Methods. A retrospective analysis of Canadian CR Registry data is presented. There were 12 programs participating, with 4546 CR participants. Results. The average wait time between patient referral and CR admission was 68 ± 64 days. Participants were 66.3 ± 11.5 years old, 71% male, and 82% White. The three leading referral events were coronary artery bypass graft surgery, percutaneous coronary intervention, and acute coronary syndrome. At discharge, data were available for ~90% of participants. Significant improvements in blood pressure (systolic pre-CR 123.5 ± 17.0, post-CR 121.5 ± 15.8 mmHg; p < .001), lipids, adiposity, and exercise capacity (peak METs pre-CR 6.5 ± 2.8, post-CR 7.2 ± 3.1; p < .001) were observed. However, target attainment for some risk factors was suboptimal. Conclusions. This report provides the first snapshot of the beneficial effects of CR in Canada. Not all patients are equally represented in these programs, however, leaving room for more referral of diverse patients. Greater attainment of risk reduction targets should be pursued.

The quality of cardiac rehabilitation in Canada: a report of the Canadian Cardiac Rehab Registry.

Cardiac rehabilitation (CR) significantly reduces morbidity and mortality compared with usual care. CR quality indicators (QIs) have recently been established in Canada. This article presents an assessment of real-world CR program achievement of process and outcome QIs in Canada, using the Canadian Cardiac Rehab Registry (CCRR). The CR QIs were developed through the Canadian Cardiovascular Society's Best Practice Methodology. After reconciling the QI with CCRR definitions, it was identified that 14 (46.7%) of the 30 QIs could be assessed through the CCRR. There were 5447 patient records from 11 CR programs in the CCRR. Wait times exceeded the 30-day QI target, at a median of 84 days from referral to enrollment. Assessment of QIs of blood pressure (90%) and adiposity (85%) were high, however assessment of QIs for lipids (41%), blood glucose among patients with diabetes (23%), and depression overall (13%) were low. A majority of the participants (68%) achieved the half metabolic equivalent increase in the exercise capacity QI from CR program entry to exit. Of smokers, only 61% were offered smoking cessation therapy. Thirty percent of participants were offered stress management. The CR program completion QI was met in 90% of patients. Areas for care and quality improvement have been identified for the CR community in Canada. Efforts to engage more CR programs assess a greater number of QIs, and to feed back the findings to participating programs quarterly are currently under way.

High and low contact frequency cardiac rehabilitation programmes elicit similar improvements in cardiorespiratory fitness and cardiovascular risk factors.

AIM: Cardiac rehabilitation (CR) is a proven intervention that substantially improves physical health and decreases death and disability following a cardiovascular event. Traditional CR typically involves 36 on-site exercise sessions spanning a 12-week period. To date, the optimal dose of CR has yet to be determined. This study compared a high contact frequency CR programme (HCF, 34 on-site sessions) with a low contact frequency CR programme (LCF, eight on-site sessions) of equal duration (4 months). METHODS: A total of 961 low-risk cardiac patients (RARE score <4) self-selected either a HCF (n = 469) or LCF (n = 492) CR programme. Cardiorespiratory fitness and cardiovascular risk factors were measured on admission and discharge. RESULTS: Similar proportions of patients completed HCF (n = 346) and LCF (n = 351) (p = 0.398). Patients who were less fit (<8 METs) were more likely to drop out of the LCF group, while younger patients (<60 years) were more likely to drop out of the HCF group. Both groups experienced similar reductions in weight (-2.3 vs. -2.4 kg; p = 0.779) and improvements in cardiorespiratory fitness (+1.5 vs. +1.4 METs; p = 0.418). CONCLUSIONS: Patients in the LCF programme achieved equivalent results to those in the HCF programme. Certain subgroups of patients, however, may benefit from participation in a HCF programme, including those patients who are predisposed to prematurely discontinuing the programme and those patients who would benefit from increased monitoring. The LCF model can be employed as an alternative option to widen access and participation for patients who are unable to attend HCF programmes due to distance or time limitations.

Changes in waist circumference following haemodialysis: a brief report.

BACKGROUND: Waist circumference (WC) is a known indicator of cardiovascular disease in the haemodialysis (HD) population. However it is not known if HD results in clinically significant changes in WC. OBJECTIVE: The study purpose was to quantify the degree of change in WC induced by HD. METHODS: This was a prospective cohort study with 27 patients on HD. Height, body weight, WC, hip circumference (HC), body mass index (BMI) and waist to hip ratio (WHR) were measured immediately prior to and following HD over three consecutive treatments. Differences between three-day average pre- and post-HD weight, BMI, WC, HC and WHR were assessed. RESULTS: Post-HD WC was significantly lower than that measured pre-HD. Differences in pre-post HD body weight, BMI, HC and WHR were also observed. CONCLUSIONS: All of the traditional clinical indicators of body composition (WC, HC, WHR, body weight and BMI) were lower following HD.

The availability of exercise rehabilitation programs in hemodialysis centres in Ontario.

BACKGROUND: Exercise training is effective at promoting physical fitness, cardiovascular outcomes, and quality of life amongst persons with chronic kidney disease. To our knowledge, no published data exist to date on the prevalence of exercise programs offered to Canadians undergoing dialysis. The study purpose was to characterize existing exercise programs in hemodialysis centres in the province of Ontario. METHODS: An online survey was created and distributed to 95 dialysis facilities across Ontario. RESULTS: There was a 61% survey response rate. Only eight facilities offered exercise programs, which included intradialytic and cardiac rehabilitation programs. Lack of funding (n = 22), lack of human resources (n = 18), and lack of equipment (n = 17) were reported as the most commonly perceived barriers of offering an exercise program. CONCLUSION: Although exercise has been shown to be effective, prevalence of programs is low. Work is underway to administer the online survey tool to dialysis programs across Canada.

Exercise and end-stage kidney disease: functional exercise capacity and cardiovascular outcomes.

This review examined published reports of the impact of extradialytic and intradialytic exercise programs on physiologic aerobic exercise capacity, functional exercise endurance, and cardiovascular outcomes in individuals with ESKD. Studies spanning 30 years from the first published report of exercise in the ESKD population were reviewed. Studies conducted in the first half of the publication record focused on the efficacy of exercise training programs performed "off"-dialysis with respect to the modification of traditional cardiovascular risk factors, aerobic capacity, and its underlying determinants. In the latter half of the record, there had been a shift to include other client-centered goals such as physical function and quality of life. There is evidence that both intra- and extradialytic programs can significantly enhance aerobic exercise capacity, but moderate-intensity extradialytic programs may result in greater gains in those individuals who initially have extremely poor aerobic capacity. Functionally, substantive improvements in exercise endurance in excess of the minimum clinical significant difference can occur following either low- or moderate-intensity exercise regardless of the initial level of performance. Reductions in blood pressure and enhanced vascular functioning reported after predominantly intradialytic exercise programs suggest that either low- or moderate-intensity exercise programs can confer cardiovascular benefit. Regardless of prescription model, there was an overall lack of evidence regarding the impact of exercise-induced changes in exercise capacity, endurance, and cardiovascular function on a number of relevant health outcomes (survival, morbidity, and cardiovascular risk), and, more importantly, there is no evidence on the long-term impact of exercise and/or physical activity interventions on these health outcomes.

Exercise training during hemodialysis improves dialysis efficacy and physical performance.

OBJECTIVE: To determine the impact of a 20-week intradialytic exercise program, consisting of 60 minutes of cumulative duration, low-intensity exercise during the first 2 hours of dialysis, on dialysis efficacy, physical performance, and quality of life in self-care hemodialysis (HD) patients. DESIGN: One-group repeated measures. SETTING: Satellite HD units affiliated with a Canadian teaching hospital. PARTICIPANTS: A convenience sample of 13 self-care HD patients who were stable on dialysis for a minimum of 6 months and were medically screened for significant cardiac, pulmonary, and/or musculoskeletal pathology that would preclude exercise. INTERVENTION: A 5-month intradialytic exercise program in which subjects exercised 3 times a week (cycle ergometer, mini-stepper) for 30 minutes in each of the first 2 hours of HD. MAIN OUTCOME MEASURES: Dialysis efficacy (in single-pool model of urea kinetics [spKt/V]) was assessed prior to and at the end of each month of the exercise program. Physical function (6-minute walk test [6MWT]), and quality of life. (Kidney Disease Quality of Life-Short Form [KDQOL]) were determined at baseline and at weeks 10 and 20 of the exercise program. RESULTS: SpKt/V increased 11% at the end of the first month of the program (P<.05) and remained elevated for the duration of the program (18%-19%). Distance walked on the 6MWT increased by 14% at both weeks 10 and 20 (P<.05). No changes were noted in KDQOL scores. CONCLUSIONS: A low-intensity intradialytic exercise program is a viable adjunctive therapy, which improves HD efficacy and physical function in HD patients.

Quality of life and exercise rehabilitation in end stage renal disease.

Using a qualitative approach, this study explored the perceptions of individuals with end stage renal disease (ESRD) regarding their physical, emotional, and social well-being after having participated in an eight-week hospital-based intra-dialytic exercise program. Individual semi-structured interviews (approximately 60 min. duration) were conducted with hemodialysis (HD) patients (n= 7) during their regular dialysis sessions, two weeks immediately following the completion of the exercise program. Interviews were audio-taped, transcribed verbatim, and content analysis was used to identify emerging themes. Data management was assisted by NVivo software. Using the interpretive paradigm, three primary themes emerged: improved performance in activities of daily living (ADL), positive change in HD experience, and enhanced sense of control. Participants reported an overall positive experience with the intra-dialytic exercise program and felt that their quality of life was enhanced to such an extent that they would choose to continue exercising while on HD.