International Urology and Nephrology

, Volume 42, Issue 4, pp 1125–1130 | Cite as

Exercise program to enhance physical performance and quality of life of older hemodialysis patients: a feasibility study

  • Mika L. Nonoyama
  • Dina Brooks
  • Alexandra Ponikvar
  • S. Vanita Jassal
  • Pia Kontos
  • Gerald M. Devins
  • Lily Spanjevic
  • Carol Heck
  • Judi Laprade
  • Gary NaglieEmail author
Nephrology – Original Paper



Evaluate the feasibility of implementing a combined in-hospital and home-based exercise program in older hemodialysis (HD) patients.


A prospective longitudinal 12-week pilot study.


A university hospital HD unit and patients’ homes.


A convenience sample of nine older (>55 years) patients undergoing HD.


An individualized exercise program performed on HD days (3/week) and at home (2–3/week), including aerobic, flexibility, strength exercises and patient education.

Main outcome measures

Feasibility measure: patient participation. Exercise performance: Duke Activity Status Index (DASI); 2-min walk test (2MWT); Timed-up-and-go (TUG). Quality of life: The Illness Intrusiveness Ratings Scale (IIRS); The Kidney Disease Quality of Life Questionnaire (KDQOL).


The mean (SD) age of the patients was 68.1 (7.1). Participation in the in-hospital supervised exercise program was high, with patients exercising during 89% of HD sessions, but was lower for the unsupervised home-based component (56% exercised ≥ 2 times/week). Patients showed a gradual increase in the amount of exercise performed over 12 weeks. The 2MWT, TUG, IIRS and the KDQOL physical composite score demonstrated moderate responsiveness, while the DASI score exhibited only limited responsiveness.


This exercise program and the outcome measures were feasible for older HD patients: in-hospital participation was high, and physical performance and QOL measures exhibited moderate levels of responsiveness. Future, larger studies are needed to demonstrate whether intra-dialysis exercise, with or without home exercise, can lead to improved outcomes in this population.


Aged Exercise Physical fitness Quality of life Renal dialysis 



This study received funding from the Canadian Institutes of Health Research Institute of Aging Pilot Project (IAP-73373). Dr. Naglie is supported by the Mary Trimmer Chair in Geriatric Medicine Research, University of Toronto. Dr. Brooks is supported by The Canada Research Chair in Rehabilitation for Chronic Obstructive Pulmonary Disease. Dr. Kontos is supported by a Canadian Institutes of Health Research New Investigator Award (2009–2014, MSH-87726).


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Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Mika L. Nonoyama
    • 1
  • Dina Brooks
    • 1
    • 2
  • Alexandra Ponikvar
    • 1
  • S. Vanita Jassal
    • 1
    • 3
    • 4
  • Pia Kontos
    • 1
    • 5
  • Gerald M. Devins
    • 6
    • 7
    • 8
  • Lily Spanjevic
    • 9
    • 10
  • Carol Heck
    • 11
  • Judi Laprade
    • 12
  • Gary Naglie
    • 1
    • 3
    • 13
    • 14
    • 15
    Email author
  1. 1.Toronto Rehabilitation InstituteTorontoCanada
  2. 2.Department of Physical TherapyUniversity of TorontoTorontoCanada
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada
  4. 4.Division of NephrologyUniversity Health NetworkTorontoCanada
  5. 5.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  6. 6.Ontario Cancer InstituteTorontoCanada
  7. 7.Psychosocial Oncology and Palliative Care Program, Princess Margaret HospitalTorontoCanada
  8. 8.Departments of Psychiatry and PsychologyUniversity of TorontoTorontoCanada
  9. 9.Acute Medicine Program, Joseph Brant Memorial HospitalBurlingtonCanada
  10. 10.Faculty of NursingUniversity of TorontoTorontoCanada
  11. 11.Allied Health, University Health NetworkTorontoCanada
  12. 12.Interprofessional Research, Women’s College HospitalTorontoCanada
  13. 13.Department of Health Policy Management and EvaluationUniversity of TorontoTorontoCanada
  14. 14.Division of General Internal MedicineUniversity Health NetworkTorontoCanada
  15. 15.Toronto General Research InstituteTorontoCanada

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