Exercise - Different Levels Match Everyone’s Needs

By Shannon Selle, B.A.

When developing an exercise program for your facility, it’s important to have one that will work for all of your patients, regardless of their current activity level. At Purity Dialysis Centers, after medical clearance from a nephrologist (and a cardiologist, if applicable), patient care staff refer patients to the health and fitness program director. The program director meets with the patient, reviews the medical history, determines goals, and determines the appropriate activity level. An ongoing evaluation is documented in the progress notes.

Our patients start at a level that is appropriate for their physical ability and current medical condition. We developed five phases (levels):

• Phase I: Pain Management — For the new patient, it’s important to focus on stress management and relaxation, therapy ball exercises to develop the fistula, and stretching exercises to do at home.
• Phase II: Activities of Daily Living — The focus at this level is to increase functioning at home by adding strength training for upper and lower body to the Phase I activities.
• Phase III: Cardiorespiratory Endurance — At this point we like to focus on adding our cycling program in the unit or walking/biking at home. After in-unit cycling, progress is documented in the patient flow sheet, showing the number of minutes cycled for the day, along with the resistance level.
• Phase IV: Independent Activities — We encourage social/community activities in addition to patients’ current exercises.
• Phase V: Health Enhancement — This is our prevention stage, so that we can work with predialysis patients and emphasize the importance of being as strong and healthy as possible before they need dialysis.
  Outcomes/Benefits
  All patients—no matter what their current activity levels are—can do something in this exercise rehabilitation program. With these five phases in place, sedentary individuals have the opportunity to progress gradually and eventually begin cardiovascular, strength, and flexibility exercises.

The levels provide an easy transition and continual progression, so as individuals become stronger, they can improve and achieve new levels. Participants feel better and gain satisfaction from realizing the progress they’ve made.

Name: Shannon Selle, B.A.
Title: Health & Fitness Director
Organization: Purity Dialysis Centers
Waukesha, WI
Date: December 1999