Multifactorial Intervention to Optimize Cardiovascular Health and Physical Activity

The Volume Control and Exercise Study

Cardiovascular disease (CVD) is a major cause of death in hemodialysis patients. Chronic fluid volume overload contributes to the development of CVD related co-morbidities including: hypertension, cardiac hypertrophy, heart failure, and cardiovascular mortality. Reducing fluid volume overload is currently a significant research topic and several groups are starting comprehensive patient and staff initiatives to address contributing factors and improve health and quality of life outcomes. Since 1993, Dr. Ercan Ok & colleagues (Izmir, Turkey) have practiced comprehensive volume control strategies to address several outcomes: interdialytic weight gains, post-dialysis and estimated dry weights, blood pressure, antihypertensive medications, cardiac structure & function, hospitalizations, and mortality.

While addressing chronic fluid volume overload alone is important, increasing physical activity and function is equally important in the frail hemodialysis population. Physical activity may improve cardiovascular health and reduce the risk for falls, however compliance with any type of activity program remains low in hemodialysis patients due to a lack of infrastructure and support to maintain these programs. Furthermore, before beginning any type of exercise program, it is crucial to address the renal dietary concerns that may be associated with fluid overload such as salt and fluid intake. Our study is a 12-month intervention in HD patients aimed at addressing these three major components: 1) chronic fluid overload, 2) physical activity, and 3) diet. This study employs a lifestyle interventionist designed to motivate patients and coordinate with the health professional staff (dialysis technicians, renal dietitians, social workers, registered nurses, and nephrologists) to address these major components. In addition, researchers educate participants about dietary sodium and counsel them on healthy choices. Some participants also receive exercise training during dialysis and have an exercise program designed for them to do at home.