Experienced physical functioning and effects of resistance training in patients with chronic kidney disease

University dissertation from Stockholm : Karolinska Institutet, Department of Medicine

Abstract: Physical fitness declines as chronic kidney disease progresses, and is approximately 50% of the expected norm when starting dialysis therapy This means that physical fitness in these patients is so reduced that it impinge on their ability and capacity to perform activities of daily livings. Muscular weakness, caused by for instance abnormal protein metabolism, is one of the main reasons for this decline in physical functioning. Therefore, it was of interest to study effects of resistance training initiated already in the pre-dialysis phase in purpose of reducing the loss of physical functioning. Studies have shown that patients with chronic kidney disease have a lower ’health-related quality of life’, especially within the physical domain, compared to the general population. However, these results are based on different ‘health-related quality of life’ questionnaires, which are based on predetermined assumptions of what is important to measure, and it is not self-evident that the choice of items for measurements reflects the perspective of the individual whose ‘health-related quality of life’ is being assessed. Another limitation is that these questionnaires result in sub-scores or total scores, and therefore do not provide information about the various ways in which patients with chronic kidney disease experience their physical functioning. Therefore, it was of interest to use semi-structured interviews to study patients’ experiences of their physical functioning and to analyse the various coping strategies used in order to be able to perform physical activities in the daily living. I. Elderly patients in the pre-dialysis phase had a lower muscular strength/endurance and physical functioning compared with elderly healthy subjects, but improved both after 12 weeks of low intensive resistance training to the same extent as in elderly healthy subjects. Thus, resistance training, already in the pre-dialysis phase, may provide patients with chronic kidney disease with a physical basis for maintaining functional autonomy, also after maintenance dialysis becomes necessary. To maintain the patient’s ability to continue caring for her-/himself is of personal benefit, but also of importance to society in reducing costs for medical- and social care. II. There was no indication that the resistance training programme has disadvantage effects on muscle fibre histopathology in elderly patients in the pre-dialysis phase. Further, there were no differences in either muscle fibre areas or in muscle fibre proportions in the healthy exercise group and the CKD exercise group, respectively, following regular resistance training. Thus, a workload of 60% of one repetition maximum seems to be sufficient to increase muscular strength and endurance in elderly patients in the pre-dialysis phase, but not to increase muscle fibre area or change muscle fibre type proportions. III. Patients with chronic kidney disease experienced mental and physical fatigue, reduced physical functioning in terms of impact on performance and endurance, and they also experienced temporal stress in terms of lack of time as well as lack of peace, from the health-care system, in their daily life situation. IV. Three components of coping activities were used by patients with chronic kidney disease to be able to perform physical activities in their daily living: scheduling, adjusting pace, and avoiding. The coping activities were mainly problem-focused, and the patients use active-, avoidant- and social-support coping strategies. However, emotional and cognitive coping strategies were also used. An interesting finding was that none of the informants mentioned using physical exercise as a coping activity, despite the fact that regular physical exercise has been shown to improve psychosocial well-being as well as physical functioning in patients with chronic kidney disease.

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