Aerobic physical activity is strongly linked with better health-related quality of life, fewer depressive symptoms and prolonged life in kidney failure patients on dialysis, according to new research.
The study, which will be published in an upcoming issue of the Clinical Journal of the American Society of Nephrology, suggests dialysis facilities have an opportunity to improve patients health by providing exercise programs.
Physical activity can provide a number of benefits for diverse populations, but its effects in patients on hemodialysis are unclear. Antonio Alberto Lopes, MD, PhD, of the Federal University of Bahia in Brazil, Ronald Pisoni, PhD, MS, senior research scientist, Arbor Research Collaborative for Health, Ann Arbor, Mich., and their colleagues conducted a study to investigate those effects.
The researchers studied data for 5,763 patients enrolled in the Dialysis Outcomes and Practice Patterns Study. The patients were classified into five aerobic physical activity categories ranging from never or rarely active to very active and according to muscle strength or flexibility activity using the Rapid Assessment of Physical Activity questionnaire.
Among the major findings:
About 29% of the patients were classified as never or rarely active and 20% as very active. Of the patients, 20.5% reported participating in strength or flexibility activities.
After a median follow-up of 1.6 years, aerobic activity, but not strength or flexibility activity, was linked positively with health-related quality of life and inversely with depressive symptoms and premature death. Those who were very active were 40% less likely to die during the follow-up period than those who were never or rarely active, researchers found.
Similar associations with aerobic activity were observed in subgroups defined by age, sex, time on dialysis and diabetes status.
In dialysis patients who also had heart failure, aerobic activity was not linked with prolonged survival, but it was associated positively with health-related quality of life and inversely with depressive symptoms.
In addition, aerobic physical activity levels were found to be higher for patients treated in dialysis units offering an exercise program compared with units not offering an exercise program, pointing to the possibility to improve patient physical activity levels through greater availability of such programs for hemodialysis patients, Lopes said in a news release. Our results call attention to opportunities for potentially improving the health of patients on hemodialysis through counseling for physical activity and the promotion of exercise programs in nephrology clinics.
Two other new CJASN studies link kidney function with depression and other health measures. One study found dialysis patients with depressive symptoms were at increased risk of being hospitalized. The second study discovered among U.S. adults age 75 or older, the presence of multiple nondisease-specific problems including cognitive impairment, depressive symptoms, exhaustion, falls and impaired mobility was higher in individuals with kidney dysfunction, and individuals with these problems had a higher risk of premature death, hospitalizations and ED visits.
The authors of an accompanying editorial wrote that if we could aggregate these three studies, elderly patients with CKD would have higher risk of depressive symptoms, depression is associated with more hospitalization when patients start maintenance hemodialysis, and a higher physical activity during hemodialysis is associated with better quality of life and lower depressive symptoms.
Study abstract: http://cjasn.asnjournals.org/content/early/2014/10/01/CJN.12371213.abstract