By Philip Cade, MSW

As dialysis patients we all want to feel more energetic, but how do we achieve this? Erythropoietin, or EPO, is helpful because it enables the body to create more red blood cells, which help to aid in oxygen transport to the muscles of the body. However, what can we do as patients to increase our energy levels? I would suggest that leg training is the key. The legs are the largest muscles in the body consisting of the quadriceps, the leg biceps or hamstrings, calves and gluteus muscles. These muscles comprise approximately 60 percent of the body’s overall muscle mass. Consequently, this muscle group is the hardest to train and the result is rapid oxygen deficit. Large oxygen reserves are not only required for proper lung function but also are essential to power the legs and to aid in the transportation of lactic acid.  

If your experience was similar to mine, one of the most notable effects of dialysis was a marked decrease in the size and muscularity of your legs. This process is known as muscle atrophy and it is most often caused by prolonged periods of inactivity. Muscular atrophy is common in dialysis patients and can occur in almost every muscle in the body, but the effects are most keenly seen and felt in the legs. Because these muscles are so large and comprise so much of the body’s total mass, the legs are the first muscles to suffer from decreased activity and the resultant decrease in oxygen transport.

Here are a few tips for starting a leg training program:

1. Consult your doctor before starting any exercise program and if possible talk to an exercise professional to help you develop an activity schedule.

2. Set reasonable goals.

3. Learn to listen to your body. If you need to rest, do so. The best gains are incremental.

4. Find a friend for support. Leg training is hard work, but a friend to share the load can make all the difference.

5. Have fun! Have fun! Have fun! Whatever workout you choose, keep it varied and interesting so you will stick with it.

The good news is that muscular atrophy is reversible, even for dialysis patients. I still remember the day I first saw my high school baseball coach about a year into my dialysis treatments. I still remember him choking back tears as he looked at my atrophied legs. “What happened?” he said, “You used to have legs like tree trunks.” Disheartened, I went home and cried, but then I vowed to return to the trained, muscular athlete I was before I was stricken with kidney failure. I did my homework and learned some important facts about how the body works. Human beings have three energy systems that have varying effects on leg development.

1. The Phosphagen System
This system generates energy by breaking down ATP (adenosine triphosphate) and another molecule called PCR (phospho-creatine). This is useful in short duration, high burst exercises such as heavy weight lifting and sprinting. While effective, this type of activity is not recommended for people who have been sedentary for long periods. It should be noted that short duration high burst exercises are most effective for encouraging muscle hypertrophy or growth, but does little for cardiovascular improvement.

2. The Lactic Acid System If you have ever done an activity for a minute or more continuously and felt a mild burn in the muscles you were using, then you were using the lactic acid system to provide energy. When athletes speak of “feeling the burn” that is lactic acid accumulating in the muscles and the blood. This effect is most keenly felt in dialysis patients because of already elevated BUN (blood urea nitrogen) and creatinine levels that are a part of kidney failure. While uncomfortable, this can be worked through with sufficient rest between exercises.

3. The Aerobic System
The term aerobic means literally “in the presence of oxygen.”  This system is used when doing activities of long duration. This type of activity is ideal for improving cardiovascular conditioning, which aids in the transport of blood and oxygen to the legs. However, do not expect a great deal of muscular hypertrophy (growth) from this type of activity, but I bet you will look great in a pair of hiking shorts! In addition, you will feel better to boot.

Which system should you choose? How do you tailor your workouts to achieve your goals? We as human beings are blessed with three energy systems, how we utilize them is up to us. Remember that leg training is tough for even the most well conditioned athletes.

After 18 years of dialysis, I am convinced more than ever that exercise is the key to longevity and a better quality of life. The reality is that life, in all forms, is about growth. We can stagnate or we can choose to grow and contribute. Let us not be defined by our disability.

By the way, two years later, I beat my high school coach for the league batting title. Now it’s your turn, go get ‘em.

Phillip Cade, MSW, is a legislative liaison for the state of Washington Department of Social and Health Services. Mr. Cade is also a consultant for the Northwest Renal Network, a certified personal trainer and serves on the board of the National Kidney Foundation Patient and Family Services Committee.

This article originally appeared in the May 2004 issue of aakpRENALIFE Vol. 19, No. 6.

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