End stage kidney failure patients require dialysis treatment to do what the kidneys are now incapable of doing. Besides the potential physical health concerns faced by dialysis patients, many people may not realize they can also face symptoms of depression due to an unhealthy quality of life and bleak long-term survival outlook. A recent study published in the Clinical Journal of the American Society of Nephrology has revealed that aerobic physical activity can not only improve a dialysis patient’s physical health, but also their mental health.

"In addition, aerobic physical activity levels were found to be higher for patients treated in dialysis units offering an exercise program compared with units not offering an exercise program, pointing to the possibility to improve patient physical activity levels through greater availability of such programs for hemodialysis patients," Dr. Antonio Alberto Lopes said in a statement. "Our results call attention to opportunities for potentially improving the health of patients on hemodialysis through counseling for physical activity and the promotion of exercise programs in nephrology clinics."

Lopez and his colleague Dr. Ronald Pisoni led a research team that gathered data using 5,763 patients enrolled in the Dialysis Outcomes and Practice Patterns Study. Researchers also used the Rapid Assessment of Physical Activity questionnaire to assess the muscle strength/flexibility activity of each participant. Each patient was grouped into five physical activity categories, including never, rarely active, and very active. There’s no denying the benefit physical activity provides heath people, but experts are unclear what purpose it would serve for a person suffering from kidney failure.

When patients were assessed during a follow-up a little over one and a half years after the start of the study, researchers noted that aerobic activity was associated with a healthier quality of life and a lower risk for depressive symptoms and premature death, but not strength/flexibility activity. Patients who were very active were 40 percent less likely to die during the follow-up compared to those who were never or rarely active. Benefits of aerobic activity were observed across subgroups, such as age, gender, time on dialysis, and diabetes status. Although aerobic activity did not prolong survival for dialysis patients with heart disease, it did lead to a healthier quality of life and decreased depressive symptoms.

Two similar studies published in the CJASN also found an association between depressive symptoms caused by kidney failure and health measures. One study revealed that dialysis patients who experience depressive symptoms are at an increased risk for being hospitalized. The second study found a bevy of nondisease-related health concerns faced by older people with poor kidney function, including cognitive impairment, symptoms of depression, exhaustion, falls, and impaired mobility. These people were also at a higher risk for hospitalizations, emergency department visits, and premature death.

"If we could aggregate these three studies, elderly patients with CKD would have higher risk of depressive symptoms, depression is associated with more hospitalization when patients start maintenance hemodialysis, and a higher physical activity during hemodialysis is associated with better quality of life and lower depressive symptoms," Dr. Denise Mafra Fluminense Federal University, in Brazil and Dr. Denis Fouque, Université de Lyon, in France said in an accompanying editorial.

Source: Pisoni R, Lopes A, et al. Clinical Journal of the American Society of Nephrology. 2014.