It is pretty well accepted all over the planet that being fit helps you to enjoy life more and is a major driving force for a longer life. Not just BigD-ers; everyone. And the two biggest challenges to our fitness are getting fit and staying fit. We all face the same problems getting fit. But staying fit can be a little trickier for people on dialysis.
This is because those of us who have made the effort to get fit between dialysis runs can get our legs cut out from under us by a spectrum of medical dramas that pounce on us from nowhere. Dramas that people with full kidney function would either barely notice, or not need.
I am sure my example is typical.
In my early, sunny, blue-sky days before dialysis, I was in the Navy. I boxed and played rugby, and by the measures of the 70s, I was fairly fit. Those measures were pretty sophisticated: I could run a fairly long way and do enough push ups to impress myself (though if others were, they didn’t say).
Then one and a half of my kidneys went south and my resulting 20-year decline in kidney function was matched by a gradual decline in running and exercise. By the time I started dialysis, my fitness and any concerns I had about it were at ground zero.
After six months of dialysis, I felt better. I’d begun exercising and running and was strong enough to handle a transplant (donated by my wife). However, despite heroic bouts of and with anti-rejection drugs, “our” precious kidney became infected, and after three months was removed. At that point, I went back to dialysis, and to fitness ground zero.
As everyone who has been there knows recovery is not quick from ground zero.
It took about a year to recover, by which time I was taking short jogs, initially around the bed, gradually progressing to around the block. Over the next few years, regular gym and running sessions got me to a point where I was strong enough to try another transplant should one come along. It did, this time from a deceased donor. However, like the first one, my ungrateful body rejected and damaged it over the first couple of weeks. But it still sort-of worked and I cherished it until it died after three years. By then I was bloated and exhausted, so it was back to BigD and to fitness ground zero.
It took another year to recover. This time, I wasn’t up for something very physical. I needed to get fit again, but I was over the gym: I needed a fresh way to fitness. Julie suggested Pilates, which is a gentler approach to regaining flexibility and some muscle tone. It was a great, and it revived my moxie. I didn’t mind that I was weak and creaky; I knew I was on the way back! After six months, I was ready to show the world (Ok, just the gym) my new body, and maybe take on a few wimps. So back I went (but no more running, my knees refuse to play).
Cue the modern era. Julie and I have been going to the gym off and on (between my various bugs and hospital stays) for about six years. But over the last year, unwittingly I started to slow down (my joint were giving me stick). So I gradually swapped the weight bearing exercises in favour of cardio (mostly the cross fitness machine) and stretches and bends. Still good healthy exercise, yes?.
No. I was kidding myself. Things were not improving: my body was seizing up, I couldn’t do any push ups, my sit-ups were wimpy and I ran out of breath walking to the local shop. Then one day the thought hit me: dread of dreads, was I becoming a girly-man?
Then the gods of fitness and enthusiasm intervened – twice.
At the gym
One of the trainers at the gym rang me out of the blue and suggested I come in for a new program. I agreed in a flash and met her the next morning. She took one look at me and said I in needed to start again: heavy on the resistance training (weights) to build up my muscles to support weak joints. Then cardio.
For the technical amongst us: lateral pull-downs for my shoulders, vertical chest press to get strong enough to do push ups, incline sit-ups to help me locate my abs and squats. Squats! I was sure I couldn’t do squats (my knees will collapse!), but after a little instruction and some gentle bullying, I found I could.
And it is working. On my last visit, I raised some of my weights from puny to ordinary – after just three weeks. I am very excited and quite motivated. I actually look forward to each session.
On my wrist
The other thing was even more of a revelation: Julie bought me a Fitbit. I’m sure you have heard of them. You wear it all day and (among other things) it counts your steps. It doesn’t sound much, and secretly, I was underwhelmed. Julie has had one for a year or two and loved it, so we set mine up via the App on my phone and off I went. The first day (just to make an impression), we decided to walk to our coffee shop (all of 10 minutes by foot) instead of driving. Quick check: 3,234 steps! Wow. I only needed to do 10,000 steps a day, and I was a third there already. That night we decided to walk around our block (we used to do this nearly every day, but gradually faded out of the habit): we stacked up 4,700 steps. Hmm; not too difficult and pretty satisfying.
That was then. Day by day I got just a little more hooked. It’s pretty easy to clock up a few hundred steps, just doing stuff around the house. And I can build on that with simple strategies like walking to my lunch shop, rather than driving (10 minute walk vs 5 minute drive – not including parking), or not bothering to look for the closest parking spot when I go to town; I just walk for a few minutes and clock up the steps.
The fact is that against all expectations, my Fitbit has actually changed my behaviour. I make sure I have it on every day, and look for opportunities to walk for both the step count and the achievement.
Brisk walking is good, low stress, low impact, weight-bearing cardio exercise. Ten thousand steps a day is generally recommended as ideal. But that can be a challenge for many BigD-ers, especially on dialysis days.
My totals vary. Most dialysis days, I walk maybe 8,000 steps. On non-BigD days I usually manage 10,000 or even 15,000 steps, especially if we get out and about, like to our local library, the Sunday Flea Market or around the city looking for bargains.
(I absolutely recommend a Fitbit or some other fitness band (mine is a Fitbit Flex, but there are many others including the newest Microsoft Band 2). They start at around $100 up to some stratospheric levels, but I’d go for the basic model. In fact, there is an excellent Chinese one, called the MIBand, which costs around $20 delivered. I just bought one for my daughter, and it’s pretty cool (especially the price).)
But the real message here is that while it takes a long time and quite some effort to get fit on dialysis, the big challenge is to stay fit. And you can do that by keeping it new: new kinds of exercise, new gadgets, recharged mindset. Then, like Chumbawamba, we can all say:
I get knocked down
But I get up again
You’re never going to keep me down