Dialysis exercise team: the way to sustain exercise programs in hemodialysis patients.

Patients affected by end-stage renal disease (ESRD) show quite lower physical activity and exercise capacity when compared to healthy individuals. In addition, a sedentary lifestyle is favoured by lack of a specific counseling on exercise implementation in the nephrology care setting. Increasing physical activity level should represent a goal for every dialysis patient care management. Three crucial elements of clinical care may contribute to sustain a hemodialysis exercise program: a) involvement of exercise professionals, b) real commitment of nephrologists and dialysis professionals, c) individual patient adaptation of the exercise program. Dialysis staff have a crucial role to encourage and assist patients during intra-dialysis exercise, but other professionals should be included in the ideal "exercise team"for dialysis patients. Evaluation of general condition, comorbidities (especially cardiovascular), nutritional status and physical exercise capacity are mandatory to propose an exercise program, in either extra-dialysis or intra-dialysis setting. To this aim, nephrologist should lead a team of specialists and professionals including cardiologist, physiotherapist, exercise physiologist, renal dietician and nurse. In this scenario, dialysis nurses play a pivotal role since they guarantee a constant and direct approach. Unfortunately dialysis staff may often lack of information and formation about exercise management while they take care patients during the dialysis session. Building an effective exercise team, promoting the culture of exercise and increasing physical activity levels lead to a more complete and modern clinical care management of ESRD patients

Refletindo sobre idosos institucionalizado

Trata-se de uma pesquisa qualitativa, descritiva que teve por objetivo identificar como vem sendo o relacionamento idoso-família, identificando os motivos que levaram os familiares a optarem pela institucionalização do seu idoso, obtendo-se também a visão da família sobre o cuidado no lar. Para coleta dos dados utilizou-se um instrumento com perguntas abertas. A coleta dos dados efetivou-se nos meses de agosto de 2002 a julho de 2003, sendo sujeitos da pesquisa, familiares de idosos de uma instituição asilar em um município da região noroeste do Rio Grande do Sul. Através da análise de conteúdo constatou-se que a maior dificuldade encontrada pela família, visando dispensar cuidados ao idoso é a "falta de tempo para cuidar" do seu familiar idoso, pois a maioria deles exige cuidados em tempo integral

Physical excercise programs in CKD: lights, shades and perspectives

In the general population, moderate exercise is associated with several health benefits including a decreased risk of obesity, coronary heart disease, stroke, certain types of cancer and all-cause mortality. In chronic kidney disease (CKD), physical inability is an independent risk of death. Health benefits of regular exercise in CKD patients include improvements in functional and psychological measures such as aerobic and walking capacity and health-related quality of life. Nonetheless, in CKD patients exercise rehabilitation is not routinely prescribed. Renal patients are heterogeneous across the different stages of CKD so that the assessment of physical capability is mandatory for a correct exercise program prescription. To plan appropriate exercise programs in the CKD setting, targeted professional figures should be actively involved as many psychological or logistic barriers may hamper exercise implementation in these subjects. Different approaches, such as home exercise rehabilitation programs, supervised exercise training or in-hospital gym may theoretically be proposed. However, physical exercise should always be tailored to the individual capacity and comorbidities and each patient should ideally be involved in the decision-making proces