By Phillip Cade

As I observe my 17th year on hemodialysis, I realize that one of the few things that I have been longer than a patient is an athlete. As such, I know the value of having a year-round fitness regimen. I find that my body responds much better to consistent year-round activity than to sporadic bursts of exercise or just playing one sport. (For example, just playing baseball in the spring).

However, I spent the past winter doing very little in the way of physical activity. Between the constraints of a demanding job and a lack of energy from a bleeding ulcer combined with the rigors of the holiday season, I found myself struggling to keep up with my usual training schedule. My level of conditioning suffered and it was readily apparent as I ran my kids through their first practice. It was deeply distressing to see the look on my kids faces as I labored to lead them through early season drills. But worse than that was the stiffness and discomfort I felt the following morning. How truly humbling it was to have to learn a lesson I had learned so many years ago.

Fitness takes time! No matter how much we wish it otherwise, the human body does not reach a state of fitness in a few days or after one or two workouts. Current infomercials aside, fitness is achieved through a thoughtful, consistent and reasoned lifestyle approach. Fitness is not about the latest exercise video, protein drink or exercise product on the market. Fitness is about making good choices daily, especially if you’re a dialysis patient.

Let me suggest that the spring is a fantastic time to start a fitness regimen. The days are getting warmer as well as longer. More outdoor activities are available and easily accessible and since spring is a period of renewal, you will find that other people are also interested in getting active. So find yourself a kindred spirit and start getting active today. Maybe we will see each other on the baseball diamond.

Here are some tips for getting started on a fitness regimen:

1. Consult your physician - Let your doctor know what kinds of activities you are planning. This way you can proceed safely and with confidence. I cannot stress this enough! When it comes to matters of your health, your doctor is your partner and your best resource. Quite often an exercise program that seems basic and easy to implement may cause problems for you that you did not foresee.

I was faced with severe anemia at least twice during my 17 years of dialysis. The first time was when I started to lose kidney function. I was in training camp for the San Diego Padres when I was informed by the team doctors that I had approximately six percent function left in my kidneys. Being just 20 years old and so close to my dream of being a major leaguer, I told the doctors that I felt fine and that I could continue through training camp. That was the day that I first learned what a hematocrit was and how dangerous it was to continue heavy training with a hematocrit of only 18! As I soon learned, it was just not possible for me to function at a high level even less than a month later. My physician helped me to gain an appreciation for the importance of pacing myself and not trying to do too much.

Later, when my hematocrit dropped once again, I was able to set a sensible exercise schedule that allowed for rest, regeneration and recuperation thanks to experience and close consultation with my nephrologist.

2. Train with a friend - Find someone with common goals and interests. This should be someone who brings out the best in you and can provide support.  

Just as important as including your physician in your exercise plans is to find someone to exercise with. This has many advantages, one of the most important being someone to monitor your daily progress and to make sure your program is safe and reasonable. I want to stress the word reasonable. It is important that patients realize that their program is going to be as individual as they are. Much depends on your current state of health as well as the state of your health before kidney failure began. As a lifetime athlete, I was in much better shape when I started exercising again then I would have been had my lifestyle been more sedentary. For some patients, simply increasing their level of activity will be a realistic goal to set. Remember we are all different and as such our needs and goals will be different. A dependable partner will not only make exercise more enjoyable, they will be able to provide instant feedback in the event that you try to do more than is reasonable or healthy. 

3. Set realistic goals - Start slow and work towards your goals daily. Trying to do too much leads to injury and disappointment.  

The good news is that improvement and progress are always within reach. I truly believe that and so should you. But progress is reached by setting short-term realistic goals and working every day to reach them. Make increased activity a conscious lifestyle choice and commit yourself to doing a little everyday. One day it may be walking around the block with your spouse or trying a new exercise video. Some dialysis units have exercise physiologists who wish to donate their time and expertise. If so, take advantage of them to work out new elements of your exercise program. 

4. Stretch, stretch and stretch both before and after physical activity - You are going to find that increased activity will cause stiffness and soreness in even the most well-conditioned muscles but there is a difference between soreness and injury and it is important to know the difference. This will be especially evident in the legs, the largest muscles in the body. Proper stretching will prepare the muscles for activity and decrease the risk of serious injury. If you do nothing else, institute a program of stretching and flexibility; it is a great way to start and can be a lot of fun!  

5. Have fun - If you don’t enjoy what you’re doing, you won’t keep it up. Whatever activity you choose, make it fun! 

I thought about including a short workout in this article but as I stated earlier, everybody is different with varying needs and limitations. As such, I feel it would be inappropriate for me to make those kinds of suggestions for someone I cannot see face-to-face. But I can say, make it fun, make it enjoyable and make it happen everyday. I look forward to hearing your thoughts and questions. Remember, we do not have to be defined by our illness when we can choose to define ourselves! 

Phillip Cade lives in Tacoma , Washington.

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

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