P67
SUCCESS OF AN OUTPATIENT EXERCISE PROGRAMME FOR PATIENTS WITH
CHRONIC KIDNEY DISEASE
Pursey V, Worth D, Betts M
York Hospitals NHS Foundation Trust
PURPOSE: To establish an outpatient exercise programme inclusive to those with CKD stages
3-5, including transplanted, haemodialysis and peritoneal dialysis patients. Evaluation of the
effects on patients’ exercise capacity and functional performance, patients’ satisfaction with the
programme, and resource use.
DESIGN: The programme is based on a pulmonary rehabilitation model. Participation has
been previously by mailed invite to patients in the local area, but for the last group was via
MDT and self referral. Patients were excluded if any of the following applied: recent MI,
unstable angina, acute infection or orthopaedic condition, uncontrolled arrhythmia or
hypertension. The exercises are delivered twice weekly in outpatient sessions of one hour
duration for 10 weeks under supervision of a specialist physiotherapist and physiotherapy
assistant. Each session consists of a warm-up; 12 circuit-style exercises mixing resistance and
aerobic exercise, with focus on proximal muscle strengthening, functional activities and
exercise tolerance; and a cool-down. Initially there was no educational element included but
this has since been routinely provided following feedback from the pilot group.
Physical function is assessed by sit-to-stand 10 (STS10), 3m timed-up-and-go (TU&G), stair
climb and descent, and shuttle walk tests, and quality of life by the SF-12 questionnaire, before
and after the programme. Feedback on the programme is obtained by a questionnaire developed
from the pilot study.
FINDINGS: 71 people have started the programme to date; 10 have repeated the programme.
41 complete data sets have been analysed using Wilcoxon matched pairs (18 females, age range
43-94 years, CKD stages 3b-5). Mean STS10 improved from 32 seconds to 25 seconds, and
mean TU&G from 10 seconds to 8 seconds (both p<=0.0001). Mean shuttle improved from 44
to 48 shuttles (p<=0.0024). Stair climb & descent has not been analysed as this has only
recently been included as part of the assessment tests. SF-12 data showed physical component
scores increasing from 38.1 to 41.8 (p<=0.0068), mental component scores increasing from 47.2
to 49.2 (p<=0.0934). 31 feedback questionnaires reflect the majority of patients responding
positively to questions relating to benefit gained, suitability of the exercises, usefulness of MDT
education, and efficiency and professionalism of the programme. Overall, the programme was
rated as ‘excellent’ (n=25), ‘good’ (n=5) and ‘average’ (n=1).
Resources used were 3 hours of physiotherapy assistant time, 3 hours of physiotherapist time,
and 45 minutes from each MDT member participating, per week over the 10 weeks of the
course, excluding administration time and that for the pre- and post-programme assessments.
Equipment used was simple, e.g. chairs, exercise bike, dumbbells, small stairs, exercise elastic.
One adverse event was noted where a diabetic patient arrived to the session having a
hypoglycaemic attack and was managed safely.
CONCLUSIONS: We have shown significant improvements in tests of muscle power and
aerobic capacity after 10 weeks of exercise. The majority of participants, who were keen to
exercise, welcomed the programme and rated it highly. We have shown that it is possible to
introduce patients to exercise using physical resources available in many physiotherapy
departments, with modest input from physiotherapy staff. We have not encountered any serious
adverse events during exercise. The flexibility of the programme means that patients who were
originally excluded from the pilot as being too frail would now be included.
RELEVANCE: The pulmonary rehabilitation model provides a successful method of
introducing exercise to those with chronic renal disease in a patient-friendly, effective, resourceacceptable way. With support from the renal physiotherapist and nephrologist a group of
previous participants have set up their own user group which currently provides exercise twice
weekly in a community gym setting to those with CKD of all stages.