Exercise for Kidney Failure
Recruiting in Palo Alto (17 mi)
Overseen byDeborah Zimmerman, MD, MSc
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: Ottawa Hospital Research Institute
Disqualifiers: Unstable angina, Uncontrolled hypertension, others
No Placebo Group
Approved in 1 Jurisdiction
Trial Summary
What is the purpose of this trial?This study will be conducted over a 3 year time period. This is a trial of an exercise intervention vs. standard of care in patients receiving chronic dialysis. The specific aims will be to determine feasibility of patient recruitment, adherence to the exercise program, and efficacy of the intervention on patient important outcomes.
The exercise intervention will be delivered to randomized participants for 12 months, and consist of the prescribed use of Nordic Walking poles, online resources for exercise in the home, regular use of a pedometer to monitor progress, and regular verbal encouragement to exercise (monthly) by dialysis unit staff. Both groups will receive the same standard of care co-interventions including individualized dialysis prescriptions and health-care interactions according to practices at their centre.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It focuses on exercise for patients on dialysis, so it's best to discuss your medications with the trial team or your doctor.
What data supports the effectiveness of the treatment Exercise Prescription, Physical Activity, Exercise Therapy, Exercise Intervention for kidney failure?
Research shows that exercise programs, like a simple walking routine, can improve the health and reduce hospital visits for people with kidney failure. Physical activity is also linked to better quality of life and outcomes for those with chronic kidney disease.
12345Is exercise safe for people with kidney conditions?
Exercise interventions, including resistance training and physical activity, have been shown to be safe for people with kidney conditions, such as those on dialysis or who have had a kidney transplant. Studies report no adverse events like injuries or hospitalizations related to exercise, and they often improve quality of life and physical performance.
16789How is the exercise treatment for kidney failure different from other treatments?
Exercise treatment for kidney failure is unique because it focuses on improving physical functioning and quality of life through physical activity, rather than using medications or surgical interventions. It helps reduce cardiovascular risk, inflammation, and hypertension (high blood pressure), and increases strength and exercise capacity, which are not typically addressed by standard medical treatments for kidney failure.
110111213Eligibility Criteria
This trial is for adults with end stage kidney disease who have been on dialysis for over six months, can walk, understand English or French, and are willing to use Nordic Walking poles. It's not suitable for those with conditions like unstable angina or uncontrolled high blood pressure, a daily step count over 8000 steps, an upcoming kidney transplant from a living donor, potential renal recovery, reliance on other mobility aids they feel unsafe replacing with walking poles, or participation in another conflicting trial.Inclusion Criteria
I can understand English or French.
Abuse to use Nordic Walking poles
I have severe kidney disease and can walk.
+2 more
Exclusion Criteria
I am scheduled for a kidney transplant from a living donor.
I feel unsafe using Nordic walking poles instead of my usual mobility aid.
My kidney function is expected to improve.
+3 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants receive the exercise intervention for 12 months, including Nordic Walking poles, online resources, pedometer use, and monthly encouragement
12 months
Monthly visits (in-person or virtual)
Follow-up
Participants are monitored for safety and effectiveness after treatment
12 months
Participant Groups
The study tests if exercise helps people receiving chronic dialysis. Participants will be randomly assigned to either receive standard care or add an exercise program using Nordic Walking poles and online resources for one year. Their progress will be tracked with pedometers and encouraged by staff monthly.
2Treatment groups
Experimental Treatment
Active Control
Group I: Exercise InterventionExperimental Treatment1 Intervention
Participants in this arm will receive standard of care along with the exercise prescription intervention
Group II: Standard of CareActive Control1 Intervention
This group will receive standard of care treatment including regular verbal encouragement to exercise (monthly) by dialysis unit staff.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Ottawa HospitalOttawa, Canada
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Who Is Running the Clinical Trial?
Ottawa Hospital Research InstituteLead Sponsor
Canadian Institutes of Health Research (CIHR)Collaborator
References
Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? [2023]The opportunity to review the more recent evidence for prescribing exercise-based physical rehabilitation for people living with chronic kidney disease (CKD) is timely. There has been a recent global focus evaluating how physical activity interventions might improve health-related quality of life and outcomes for people living with chronic health conditions in a post-COVID era. There is finally a long overdue commitment from the kidney research and clinical community to deliver pragmatic interventions to help people living with CKD to be able to live well with their condition.
Long-Term Effect of Physical Exercise on the Risk for Hospitalization and Death in Dialysis Patients: A Post-Trial Long-Term Observational Study. [2023]In the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested whether the same intervention was associated with a lower long-term risk of death or hospitalization (combined end point) during a follow-up extended up to 36 months.
[Association of physical activity with quality of life in patients with chronic kidney disease]. [2021]Physical activity may improve quality of life in patients with chronic kidney disease.
The role of exercise training in the management of chronic kidney disease. [2015]In this review, we summarize recent studies of exercise interventions in chronic kidney disease (CKD), potential benefits, discuss barriers to implementation and make practical recommendations for incorporating exercise training into the care of patients with CKD.
Prevalence and Correlates of Accelerometer-Based Physical Activity and Sedentary Time Among Kidney Transplant Recipients. [2022]Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life.
Physical Activity in Kidney Transplant Recipients: A Review. [2019]Physical activity has known health benefits and is associated with reduced cardiovascular risk in the general population. Relatively few data are available for physical activity in kidney transplant recipients. Compared to the general population, physical activity levels are lower overall in kidney recipients, although somewhat higher compared to the dialysis population. Recipient comorbid condition, psychosocial and socioeconomic factors, and long-term immunosuppression use negatively affect physical activity. Physical inactivity in kidney recipients may be associated with reduced quality of life, as well as increased mortality. Interventions such as exercise training appear to be safe in kidney transplant recipients and are associated with improved quality of life and exercise capacity. Additional studies are required to evaluate long-term effects on cardiovascular risk factors and ultimately cardiovascular disease outcomes and patient survival. Currently available data are characterized by wide variability in the interventions and outcome measures investigated in studies, as well as use of small sample-sized cohorts. These limitations highlight the need for larger studies using objective and standardized measures of physical activity and physical fitness in kidney transplant recipients.
Effect of Long-term Exercise Training on Physical Performance and Cardiorespiratory Function in Adults With CKD: A Randomized Controlled Trial. [2023]The safety and efficacy of long-term exercise training in reducing physical functional loss in older adults with advanced CKD and comorbidity is uncertain.
A Personalized Patient-Centered Intervention to Empower through Physical Activity the Patient in the Dialysis Center: Study Protocol for a Pragmatic Nonrandomized Clinical Trial. [2021]Sedentariness of patients affected by end-stage kidney disease (ESKD) expose them to high risk of unfavorable clinical outcomes. Exercise training is effective in improving physical function, quality of life (QoL) and long-term outcomes. However, the existing barriers related to patients, programs and dialysis staff limit patient participation and call for new strategies. This pragmatic nonrandomized trial will test the impact on ESKD population of an intervention proposed by an exercise facilitator regularly present in a dialysis center. The patient will be free to choose among three-month walking and/or resistance low-intensity training programs: (a) guided physical activity increase; (b) home-based exercise; (c) in-hospital (pre/post dialysis) supervised exercise; (d) performance assessment only. The first phase will define feasibility and the characteristics and preference of responders. The second phase will evaluate safety and patients' adherence. Outcome measures will be collected at baseline, after three-month and at six-month follow-up. They will include: aerobic capacity, QoL, gait speed, strength, depression and long-term clinical outcomes (hospitalization and mortality). The trial was approved by the Area-Vasta Emilia-Romagna Centro Ethics Committee with approval number 48/2019. Written informed consent will be obtained from all participants. The results of the study will be presented in international congresses, published in peer-reviewed journals and communicated to the patient community. Registration details: Clinicaltrials.gov NCT04282616 [Registered:24/02/2020].
Effects of a resistance training program in kidney transplant recipients: A randomized controlled trial. [2021]Kidney transplant recipients are at risk of developing important adverse effects after transplantation. The objective of this study was to investigate the effects of a 10-week supervised resistance exercise-based intervention in kidney transplant recipients. Sixteen participants were randomized to a training (n = 8, 49.7 ± 9.6 years) or control group (n = 8, 48.6 ± 10.6 years). The primary endpoint was health-related quality of life evaluated through the Kidney Disease Quality of Life-Short Form (KDQOL-SF), which includes the 36-Item Short Form Survey (SF-36), and secondary endpoints included physical performance (6-minute walk distance [6-MWD], 60-second sit to stand test [60-STS], 8-foot up and go test, and handgrip and lower limb muscle strength), muscle mass, and biochemical parameters. Endpoints were assessed at baseline and after 10 weeks. Resistance exercise significantly increased (P .05) were found for the remaining endpoints. There were no adverse events, musculoskeletal injuries, hypoglycemic episodes, cardiovascular events, or hospitalizations related to the intervention. In conclusion, 10 weeks of supervised resistance training is enough to improve quality of life and physical performance without side effects such as musculoskeletal injuries, hypoglycemic episodes, cardiovascular events, or hospitalizations related to the intervention in kidney transplant recipients.
"Exercise as medicine" in chronic kidney disease. [2022]Exercise and physical activity are increasingly becoming key tools in the treatment and prevention of several medical conditions including arthritis and diabetes; this notion has been termed "exercise as medicine". Exercise has favorable effects on reducing cardiovascular risk, inflammation, cachexia, and hypertension, in addition to increasing physical functioning, strength, and cardio-respiratory capacity. Chronic kidney disease, a condition that affects around 10% of the population, is often overlooked as a target for exercise-based therapy. Despite the vast range of severity in kidney disease (e.g., pre-dialysis, dialysis, transplant), exercise has a potential role in all patients suffering from the condition. In this review, we summarise the important role exercise may have in the clinical management of kidney disease and how this form of 'medicine' should be best administered and 'prescribed'.
Implementing exercise: what do we know? Where do we go? [2022]Exercise capacity, physical functioning, and physical activity are all low in patients with CKD treated with dialysis. Although there is robust evidence that these patients benefit from regular exercise training and/or increasing physical activity, the nephrology community has not adopted recommendations and encouragement for physical activity as a part of the routine care plan. This article reviews what is known regarding the implementation of exercise and provides suggestions as to how exercise counseling might become a routine part of the care of patients with CKD.
The importance of exercise training in rehabilitation of patients with end-stage renal disease. [2005]Exercise capacity in patients with kidney failure undergoing dialysis is low compared with age-predicted values. The level of exercise tolerance in these patients is such that the energy requirements for activities of daily living and occupational tasks impinge on their capacity to perform these tasks. Therefore, it is not surprising that many patients do not seek or are unable to work because they are physically unable to sustain the energy required for such activity. There are several ways to increase exercise tolerance in these patients--transplant, exercise training, and recombinant human erythropoietin (epoetin) therapy. Successful kidney transplant increases exercise capacity to near normal values for sedentary healthy individuals. Exercise training after transplant further increases exercise capacity and counteracts some of the negative side effects of glucocorticoid therapy, such as muscle wasting and excessive weight gain. Exercise training in patients on dialysis increases exercise tolerance approximately 25% (in studies performed before epoetin administration). Similar increases are observed after correction of the anemia of kidney failure with epoetin. However, the increase in exercise capacity is small compared with the magnitude of change in hematocrit level. It is possible that epoetin therapy unmasks a muscle limitation to exercise that may be improved by exercise training. Anecdotal evidence suggests that exercise training in patients on epoetin therapy may result in an exercise capacity similar to that of transplant recipients. However, epoetin therapy to improve hematocrit levels does not automatically make patients exercise. Active counseling and encouragement are necessary to improve physical functioning.(ABSTRACT TRUNCATED AT 250 WORDS)
Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial. [2020]It is well known from observational studies that sedentary lifestyle and reduced physical activity are common in dialysis and chronic kidney disease (CKD) patients and associate with an increased risk of morbidity and mortality in this patient population. Epidemiological studies indicate that CKD patients undergo physical activity ~9 days/month and 43.9% of dialysis patients report not exercising at all. On the basis of awareness about the strong link between sedentary lifestyle and adverse clinical outcomes, the National Kidney Foundation and Kidney Disease: Improving Global Outcomes have provided specific recommendations for physical activity in patients with kidney disease. Given the fact that CKD is a public health problem and it is still debated which type of exercise should be prescribed in these patients, this review focuses on the most robust evidence accumulated so far on the beneficial effect of various types of physical exercise on clinical outcomes in CKD and dialysis patients. This review does not treat this very important topic in another CKD category of patients, such as kidney-transplanted patients, for whom a special issue should be dedicated.