Hemodialysis (HD) patients are less active than their healthy counterparts; this is associated with higher mortality. Healthcare workers observe their patients only during HD, which accounts for about 7% of the week. Knowing more about what occurs in between sessions, particularly with respect to physical activity, may improve patient care and prognosis. Yet without a standard method to measure interdialytic activity, it is difficult to compare the effect of interventions. However, it is unclear how interdialytic activity can be accurately measured. Since activity associated with quality of life is multi-dimensional, objective and subjective tools should be used in conjunction. While commercially available tracking devices can be seamlessly incorporated into everyday life and can increase awareness of user's activity, their validation is needed in the HD population. Fertile topics for research should include the relationship between objective and subjective measures in HD patients, and the investigation of physical activity in non-ambulatory HD patients.

1.
World Health Organization: Physical activity, World Health Organization, 2014.
2.
World Health Organization: Global recommendations on physical activity for health, 2010.
3.
Yates T, Haffner SM, Schulte PJ, Thomas L, Huffman KM, Bales CW, Califf RM, Holman RR, McMurray JJ, Bethel MA, Tuomilehto J, Davies MJ, Kraus WE: Association between change in daily ambulatory activity and cardiovascular events in people with impaired glucose tolerance (NAVIGATOR trial): a cohort analysis. Lancet 2014;383:1059-1066.
4.
Foley RN, Gilbertson DT, Murray T, Collins AJ: Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 2011;365:1099-1107.
5.
Anand S, Johansen KL, Grimes B, Kaysen GA, Dalrymple LS, Kutner NG, Chertow GM: Physical activity and self-reported symptoms of insomnia, restless legs syndrome, and depression: the comprehensive dialysis study. Hemodial Int 2013;17:50-58.
6.
Gordon PL, Doyle JW, Johansen KL: Postdialysis fatigue is associated with sedentary behavior. Clin Nephrol 2011;75:426-433.
7.
Williams A, Stephens R, McKnight T, Dodd S: Factors affecting adherence of end-stage renal disease patients to an exercise programme. Br J Sports Med 1991;25:90-93.
8.
Goodman ED, Ballou MB: Perceived barriers and motivators to exercise in hemodialysis patients. Nephrol Nurs J 2004;31:23-29.
9.
Moattari M, Ebrahimi M, Sharifi N, Rouzbeh J: The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: a randomized controlled trial. Health Qual Life Outcomes 2012;10:115.
10.
Hays RD, Kallich JD, Mapes DL, Coons SJ, Amin N, Carter WB, Kamberg C: Kidney Disease Quality of Life Short Form, 1997.
11.
Delgado C, Johansen KL: Deficient counseling on physical activity among nephrologists. Nephron Clin Pract 2010;116:c330-c336.
12.
Painter P, Clark L, Olausson J: Physical function and physical activity assessment and promotion in the hemodialysis clinic: a qualitative study. Am J Kidney Dis 2014;64:425-433.
13.
Cheema BS, Singh MA: Exercise training in patients receiving maintenance hemodialysis: a systematic review of clinical trials. Am J Nephrol 2005;25:352-364.
14.
Painter P: Implementing exercise: what do we know? Where do we go? Adv Chronic Kidney Dis 2009;16:536-544.
15.
Johansen KL: Exercise and dialysis. Hemodialysis international. International Symposium on Home Hemodialysis 2008;12:290-300.
16.
Heiwe S, Jacobson SH: Exercise training for adults with chronic kidney disease. Cochrane Database Syst Rev 2011:CD003236.
17.
Avesani CM, Trolonge S, Deleaval P, Baria F, Mafra D, Faxen-Irving G, Chauveau P, Teta D, Kamimura MA, Cuppari L, Chan M, Heimburger O, Fouque D: Physical activity and energy expenditure in haemodialysis patients: an international survey. Nephrol Dial Transplant 2012;27:2430-2434.
18.
Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD: Effect of intradialytic versus home-based aerobic exercise training on physical function and vascular parameters in hemodialysis patients: a randomized pilot study. Am J Kidney Dis 2010;55:88-99.
19.
Chen JL, Godfrey S, Ng TT, Moorthi R, Liangos O, Ruthazer R, Jaber BL, Levey AS, Castaneda-Sceppa C: Effect of intra-dialytic, low-intensity strength training on functional capacity in adult haemodialysis patients: a randomized pilot trial. Nephrol Dial Transplant 2010;25:1936-1943.
20.
Cheema B, Abas H, Smith B, O'Sullivan A, Chan M, Patwardhan A, Kelly J, Gillin A, Pang G, Lloyd B, Singh MF: Progressive exercise for anabolism in kidney disease (PEAK): a randomized, controlled trial of resistance training during hemodialysis. J Am Soc Nephrol 2007;18:1594-1601.
21.
Johansen KL, Painter PL, Sakkas GK, Gordon P, Doyle J, Shubert T: Effects of resistance exercise training and nandrolone decanoate on body composition and muscle function among patients who receive hemodialysis: a randomized, controlled trial. J Am Soc Nephrol 2006;17:2307-2314.
22.
Dong J, Sundell MB, Pupim LB, Wu P, Shintani A, Ikizler TA: The effect of resistance exercise to augment long-term benefits of intradialytic oral nutritional supplementation in chronic hemodialysis patients. J Ren Nutr 2011;21:149-159.
23.
Kopple JD, Wang H, Casaburi R, Fournier M, Lewis MI, Taylor W, Storer TW: Exercise in maintenance hemodialysis patients induces transcriptional changes in genes favoring anabolic muscle. J Am Soc Nephrol 2007;18:2975-2986.
24.
Watson EL, Kosmadakis GC, Smith AC, Viana JL, Brown JR, Molyneux K, Pawluczyk IZ, Mulheran M, Bishop NC, Shirreffs S, Maughan RJ, Owen PJ, John SG, McIntyre CW, Feehally J, Bevington A: Combined walking exercise and alkali therapy in patients with CKD4-5 regulates intramuscular free amino acid pools and ubiquitin E3 ligase expression. Eur J Appl Physiol 2013;113:2111-2124.
25.
Johansen KL, Sakkas GK, Doyle J, Shubert T, Dudley RA: Exercise counseling practices among nephrologists caring for patients on dialysis. Am J Kidney Dis 2003;41:171-178.
26.
Zamojska S, Szklarek M, Niewodniczy M, Nowicki M: Correlates of habitual physical activity in chronic haemodialysis patients. Nephrol Dial Transplant 2006;21:1323-1327.
27.
Johansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Da Silva M, Chertow GM: Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int 2001;59:1121-1127.
28.
Johansen KL, Chertow GM, Kutner NG, Dalrymple LS, Grimes BA, Kaysen GA: Low level of self-reported physical activity in ambulatory patients new to dialysis. Kidney Int 2010;78:1164-1170.
29.
Koh KP, Fassett RG, Sharman JE, Coombes JS, Williams AD: Intradialytic versus home-based exercise training in hemodialysis patients: a randomised controlled trial. BMC Nephrol 2009;10:2.
30.
Painter P, Marcus RL: Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol 2013;8:861-872.
31.
Kohl Lde M, Signori LU, Ribeiro RA, Silva AM, Moreira PR, Dipp T, Sbruzzi G, Lukrafka JL, Plentz RD: Prognostic value of the six-minute walk test in end-stage renal disease life expectancy: a prospective cohort study. Clinics (Sao Paulo) 2012;67:581-586.
32.
Majchrzak KM, Pupim LB, Chen K, Martin CJ, Gaffney S, Greene JH, Ikizler TA: Physical activity patterns in chronic hemodialysis patients: comparison of dialysis and nondialysis days. J Ren Nutr 2005;15:217-224.
33.
Painter P, Ward K, Nelson RD: Self-reported physical activity in patients with end stage renal disease. Nephrol Nurs J 2011;38:139-147; quiz 148.
34.
Nielson R, Vehrs PR, Fellingham GW, Hager R, Prusak KA: Step counts and energy expenditure as estimated by pedometry during treadmill walking at different stride frequencies. J Phys Act Health 2011;8:1004-1013.
35.
Robinson-Cohen C, Littman AJ, Duncan GE, Roshanravan B, Ikizler TA, Himmelfarb J, Kestenbaum BR: Assessment of physical activity in chronic kidney disease. J Ren Nutr 2013;23:123-131.
36.
Johansen KL, Chertow GM, Ng AV, Mulligan K, Carey S, Schoenfeld PY, Kent-Braun JA: Physical activity levels in patients on hemodialysis and healthy sedentary controls. Kidney Int 2000;57:2564-2570.
37.
Nowicki M, Murlikiewicz K, Jagodzinska M: Pedometers as a means to increase spontaneous physical activity in chronic hemodialysis patients. J Nephrol 2010;23:297-305.
38.
Matsuzawa R, Matsunaga A, Wang G, Kutsuna T, Ishii A, Abe Y, Takagi Y, Yoshida A, Takahira N: Habitual physical activity measured by accelerometer and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol 2012;7:2010-2016.
39.
Garmin: Garmin vivofit, 2014.
40.
Engadget: Nike fuelband se review: more social features, much longer battery life, 2013.
41.
Virtual. Sensoria® Fitness, Sensoria® Fitness, 2013-2014.
42.
Biometric shirts for performance improvement and sleep tracking. Hexoskin, Hexoskin, 2014.
43.
Apple: Apple Watch sport, 2014.
44.
Bennington-Castro J: Electronic Skin Moves Us Closer to Cyborgs. Scientific American Global RSS, 2014.
45.
Boyle R: Harvard's Four-Cent Paper Accelerometer Could Make Motion Sensing Ubiquitous. Popular Science, 2011.
46.
Shoaib M, Bosch S, Incel OD, Scholten H, Havinga PJ: Fusion of smartphone motion sensors for physical activity recognition. Sensors (Basel) 2014;14:10146-10176.
47.
Bohm C, Stewart K, Onyskie-Marcus J, Esliger D, Kriellaars D, Rigatto C: Effects of intradialytic cycling compared with pedometry on physical function in chronic outpatient hemodialysis: a prospective randomized trial. Nephrol Dial Transplant 2014;29:1947-1955.
48.
Malagoni AM, Catizone L, Mandini S, Soffritti S, Manfredini R, Boari B, Russo G, Basaglia N, Zamboni P, Manfredini F: Acute and long-term effects of an exercise program for dialysis patients prescribed in hospital and performed at home. J Nephrol 2008;21:871-878.
49.
Greenwood SA, Lindup H, Taylor K, Koufaki P, Rush R, Macdougall IC, Mercer TH: Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease. Nephrol Dial Transplant 2012;27(suppl 3):iii126-iii134.
50.
Kouidi E, Grekas D, Deligiannis A, Tourkantonis A: Outcomes of long-term exercise training in dialysis patients: comparison of two training programs. Clin Nephrol 2004;61(suppl 1):S31-S38.
51.
Conn VS, Hafdahl AR, Brown SA, Brown LM: Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ Couns 2008;70:157-172.
52.
Energy intake and expenditure. British Nutrition Foundation, 2009.
53.
Zhang M, Kim JC, Li Y, Shapiro BB, Porszasz J, Bross R, Feroze U, Upreti R, Martin D, Kalantar-Zadeh K, Kopple JD: Relation between anxiety, depression, and physical activity and performance in maintenance hemodialysis patients. J Ren Nutr 2014;24:252-260.
54.
Morishita Y, Kubo K, Miki A, Ishibashi K, Kusano E, Nagata D: Positive association of vigorous and moderate physical activity volumes with skeletal muscle mass but not bone density or metabolism markers in hemodialysis patients. Int Urol Nephrol 2014;46:633-639.
55.
Grip strength. Wikipedia Foundation, 2014.
56.
Janssen I, Heymsfield SB, Ross R: Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002;50:889-896.
57.
Delgado C, Johansen KL: Barriers to exercise participation among dialysis patients. Nephrol Dial Transplant 2012;27:1152-1157.
58.
Plasqui G, Westerterp KR: Physical activity assessment with accelerometers: an evaluation against doubly labeled water. Obesity (Silver Spring) 2007;15:2371-2379.
59.
Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M: A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 2008;5:56.
60.
Saint-Maurice PF, Welk GJ, Beyler NK, Bartee RT, Heelan KA: Calibration of self-report tools for physical activity research: the Physical Activity Questionnaire (PAQ). BMC Public Health 2014;14:461.
61.
Han SS, Her JJ, Kim YJ: Effects of muscle strengthening exercises using a Thera Band on lower limb function of hemiplegic stroke patients. Taehan Kanho Hakhoe Chi 2007;37:844-854.
62.
Make fitness a lifestyle with flex™. Fitbit® Flex™, 2014.
63.
Buy up by jawbone™, 2014.
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