By Maria Karalis, RD, LD, CSR

Like most Americans, you probably made several new year's resolutions such as to eat better, lose weight or start an exercise program. How are you doing?

Studies have shown that no matter how old you are exercise can make you stronger and give you more energy. People on dialysis that exercise do more, feel better and have a greater sense of control over their lives. There are numerous other benefits too.

Exercise:

• Helps to maintain or decrease your body weight
• Increases strength, endurance and flexibility
• Keeps your heart healthy
• Improves your sense of well-being
• Lifts your mood and helps fight depression
• Helps control blood pressure (you may even be able to cut down on blood pressure medication)
• Lowers blood sugar (if you are diabetic)
• Reduces your risk of having a heart attack
• Helps you sleep better
• Keeps your bones healthy

Recent studies have shown that senior citizens who exercise can be in better shape than a couch potato in their twenties. How old you are does not determine how fit you are. What counts is what you are doing to improve your fitness level. So how do you "just do it?"

Consult your doctor and start out slowly.

First, talk to your doctor to see what types of exercises are best for you. Questions to ask are "what exercises are best to improve my strength and endurance?" or "what exercises are best to improve my heart health?" When you start, start slowly. Don't try to do too much too fast. If you have mobility problems, your doctor may refer you to a physical therapist. Physical therapists can help you with stretching and strengthening exercises. In addition, a registered dietitian can help you plan a healthy diet. No matter what your physical condition, your healthcare team can help design a fitness program to work for you.

If you are on dialysis, ask if specially designed exercise bikes are available so that you can exercise while you are dialyzing. If your dialysis center doesn't have a specialized exercise bike, contact Champion Manufacturing LLC at 800-998-5018 or visit their website at www.championchair.com. They have a bike called "Champ-Cycle" that you can secure to any chair, including your dialysis chair. (Or use it in front of your favorite couch or recliner.) The newest way for dialysis patients to exercise is the Stider excercise combination cycle/stepper made by Osborn Medical in Minnesota. While you are sitting, you can walk or stride at your own pace. Even if you have a limited range of motion, this machine works great. The Strider can be adjusted for each leg for maximal comfort and flexibility. To obtain more information about the Strider call 1-800-535-5865 or check their website at www.osbornmedical.com.

Make it fun.

Choose something that is easy and that you will enjoy. Most people quit exercising because they are bored. If you are a very social person, consider recruiting a buddy to exercise with you. Or find an exercise group in your neighborhood. You may want to start a mall walking group or some other activity. Build variety in your exercise plan. Change the activities and where you engage in these activities. If you'd rather exercise on your own, try walking, yoga or tai chi. You don't have to run a marathon to improve your health. Simply folding the laundry or doing a few stretching exercises or arm lifts counts.

Keep at it and add some variety.

Get moving and stick with it! No matter how small you start out (even if it's only waving your arms or swinging your legs for a few minutes, resting and doing it again), whatever you are doing is more than you were doing before and that is great! Be sure to set some small goals for yourself and celebrate your successes!

Make it a lifetime.

Seeing you get fit will help inspire others to follow in your footsteps. A journey of a thousand miles starts with just one step. Remember it's the long run that counts. You don't have to race to the finish line first, you just have to show up to the starting line and do the best you can.

Work closely with a registered dietitian.

If your goal is to lose some weight, work closely with the registered dietitian at the dialysis center. It is well known that extra weight worsens diabetic control, blood pressure and is a major risk factor for heart disease. The formula for weight control seems easy but actually trying to cut back on calories and including exercise in a busy lifestyle can be a real challenge. The dietitian can give you some general guidelines on where to cut back without compromising the overall quality of your diet. Here are some general tips to get you started:

• Think "healthy" eating instead of "dieting." Dieting is an on again-off again thing; healthy eating is a life- long process.
• Make sure to select a wide variety of foods from each food group depending on your calorie needs.
• Eat the suggested serving size. Weigh or measure what you eat until you can estimate a serving.
• Choose high fiber foods; this helps to create a feeling of fullness.
• Eat three meals per day; don't skip any meals. Skipping meals leaves you famished and then you tend to overeat.
• Be sure to eat all your allowed fruits and vegetables every day.
• Choose lean cuts of meat, poultry and fish. Trim away any visible fats; broil, roast or boil, instead of frying. Remove skin from poultry.
• Be aware of your eating habits. Keep a food diary and jot down what you are eating and drinking for several days. Include what you are doing, where and how you were feeling. Do you see any patterns?
• Limit foods that are high in fat, such as butter, mayonnaise, oils (even olive oil), desserts/pastries, and fried foods. These are often not limited on a renal diet because they tend to be low in sodium, potassium and phosphorus. But these foods are high in calories and if eaten in excess can lead to weight gain. Your dietitian can give you a list of high fat foods and help you identify ways to cut back.
• Limit sugars and concentrated sweets. Like fats, these are "empty" calories that provide very little nutritional value but can add a lot of calories. For those of you on peritoneal dialysis, you are already receiving extra calories from the dextrose in the dialysate. Watching simple sugars in your diet becomes even more important to help manage your weight.

There are many excellent resources out there to help you get started. Here are just a few:

An Exercise Program for the Person with Chronic Renal Disease -- Published by the NKF of Eastern Missouri & Metro East, Inc. Call 314-961-2828 or write to: the National Kidney Foundation of Eastern Missouri and Metro East 1423 Hanley Industrial Court St. Louis, MO 63144.

Exercise: A Guide for People on Dialysis - Booklet, Life Options Rehabilitation Program. To request a free copy, call 1-800-468-7777.

Exercise Lite Brochure -- Booklet, American College of Sports Medicine. For a free copy, send a self-addressed business sized envelope to: American College of Sports Medicine, Public Information Department, PO Box 1440, Indianapolis, IN 46206-1440. Call 317-637-9200 for more information.

Staying Fit with Kidney Disease- Brochure, National Kidney Foundation. To request a free copy, call 1-800-622-9010.

Maria Karalis is a Registered Dietitian and Staff Developer in Staff Development with Fresenius Medical Care. She is a Board Certified Specialist in Renal Nutrition (CSR) and has been working in the renal industry for over 11 years.

The information contained herein is intended for educational purposes only. It is not intended and should not be construed as the delivery of medical care. Persons requiring diagnosis or treatment, or those with specific questions, are urged to contact their local healthcare provider for appropriate care.

This article originally appeared in the January 2003 issue of aakpRENALIFE, Vol. 18, No. 4.

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