Chronic kidney disease (CKD) is recognized as one of the current health problem. It progresses to end-stage renal disease (ESRD) and cardiorespiratory disease thus decreasing the quality of life and function 1. There has been an increased mortality rates in the patients diagnosed with CKD, with associated complications pertaining to diabetes, hypertension, mineral bone disorders having an increased mortality rates. The cardiovascular risks related with ESRD have been well established and account to the mortality2. Deaths found due to cardio vascular disease (CVD) in those on dialysis is found to be increased, thus showing a relationship between the renal disease and cardiovascular events. The mortality in ESRD with cardiovascular disease is higher when compared with the healthy individuals3. The disease is found to be associated with greater health- related expenditures, and decrease the health related quality of life (HRQoL). There has been noted decrease in the functional status in patients with ESRD setting a greater demand for activities of daily living (ADL) 4. Patients with CKD are often overlooked when it comes to exercise programs5. Physical inactivity also shows significant reduction in ADL and HRQoL.
Adherence is defined as “the extent to which a person’s behavior corresponds with agreed recommendations from a health care provider” and is considered to be an important prerequisite for the success of exercise programs for musculoskeletal disorders6. Patients who adhere to regular exercise programs are less likely to progress to recurrent musculoskeletal problems and reduce the risk of illness. It promotes functional ability and may improve the quality of life.
Regular physical activity plays an important role in the prevention of chronic diseases; it can prevent and reduce the risk of complication of chronic diseases. Exercises and physical activity has benefitted to improve the HRQoL in people with Ischemic heart disease, hypertension, CKD and diabetes. By enhancing the strength of the muscles, bones, and joints through exercising, people with CKD can improve their balance and coordination. Increasing the physical activity levels of individuals with CKD, it is possible to decrease their risk of CVD and improve their physical functioning, thus preventing premature death.
In spite of the benefits of exercise, patients are not exposed to the exercise regime during haemodialysis or at home. In spite of the decreased physical activity levels among the CKD, the prescription of exercise for CKD patients undergoing dialysis is lesser than normally compared with prescribed exercise for other chronic diseases. Moreover, exercise can improve the strength and aerobic capacity. In view of the noted benefits of physical activity, the exercise is considered as a major component of renal rehabilitation7.
Another notable factor to be considered in administering a resisted exercise programme for patients with CKD is evaluating the adherence to the exercise programme. Studies have shown that non adherence can also be another remarkable factor which leads to faulty decision making by the physiotherapist on the outcome of the therapy. Adherence to exercise programme is enhanced by family support, goal setting and guidance from healthcare professionals, facilities to perform exercise, enjoyment and social interaction8.
The lack of awareness among the population and few evident studies in Indian population has made less use of the exercise guidelines for patients with CKD. Barriers to exercise during hemodialysis have been reported by the patients, staff and nephrologist, some which can be modified 9. Some of the factors leading to lesser participation by the haemodialysis patients are the patient’s reluctance in understanding that the exercise can alleviate the symptoms, lack of motivation, frequent hospitalizations and time10,11. Hence, there is a need to check the adherence to exercise programme in the Indian population.