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Background Twelve weeks of renal rehabilitation (RR) have been shown to improve exercise capacity in patients with chronic kidney disease (CKD); however, survival following RR has not been examined. Methods This study included a retrospective longitudinal analysis of clinical service outcomes. Programme completion and improvement in exercise capacity, characterised as change in incremental shuttle walk test (ISWT), were analysed with Kaplan–Meier survival analyses to predict risk of a combined event including death, cerebrovascular accident, myocardial infarction and hospitalisation for heart failure in a cohort of patients with CKD. Time to combined event was examined with Kaplan–Meier plots and log rank test between ‘completers’ (attended >50% planned sessions) and ‘non-completers’. In completers, time to combined event was examined between ‘improvers’ (≥50 m increase ISWT) and ‘non-improvers’ (<50 m increase). Differences in time to combined event were investigated with Cox proportional hazards models (adjusted for baseline kidney function, body mass index, diabetes, age, gender, ethnicity, baseline ISWT and smoking status). Results In all, 757 patients (male 54%) (242 haemodialysis patients, 221 kidney transplant recipients, 43 peritoneal dialysis patients, 251 non-dialysis CKD patients) were referred for RR between 2005 and 2017. There were 193 events (136 deaths) during the follow-up period (median 34 months). A total of 43% of referrals were classified as ‘completers’, and time to event was significantly greater when compared with ‘non-completers’ (P = 0.009). Responding to RR was associated with improved event-free survival time (P = 0.02) with Kaplan–Meier analyses and log rank test. On multivariate analysis, completing RR contributed significantly to the minimal explanatory model relating clinical variables to the combined event (overall χ 2 = 38.0, P < 0.001). ‘Non-completers’ of RR had a 1.6-fold [hazard ratio = 1.6; 95% confidence interval (CI) 1.00–2.58] greater risk of a combined event (P = 0.048). Change in ISWT of >50 m contributed significantly to the minimal explanatory model relating clinical variables to mortality and morbidity (overall χ 2 = 54.0, P < 0.001). ‘Improvers’ had a 40% (hazard ratio = 0.6; 95% CI 0.36–0.98) independent lower risk of a combined event (P = 0.041). Conclusions There is an association between completion of an RR programme, and also RR success, and a lower risk of a combined event in this observational study. RR interventions to improve exercise capacity in patients with CKD may reduce risk of morbidity and mortality, and a pragmatic randomised controlled intervention trial is warranted.

Does a physical therapist-led, home-based walking exercise behavior change intervention improve walking capacity compared with usual care in adults with peripheral artery disease and intermittent claudication? FindingsIn this randomized clinical trial that included 190 participants with intermittent claudication due to peripheral artery disease, receipt of the intervention, compared with usual care, resulted in a statistically significant adjusted difference in mean six-minute walk distance at 3-months of 16.7m. MeaningAmong adults with peripheral artery disease, a home-based walking exercise behavior change intervention, compared with usual care, increased six-minute walking distance at 3-months.

Objectives. Weight gain in the first year following kidney transplantation increases the risk of adverse health outcomes. Currently, there is no recognized intervention available to prevent weight gain after kidney transplantation. An online kidney transplant-specific resource, entitled Exercise in Renal Transplant Online (ExeRTiOn), has been co-created by a multi-professional team, including patients, to assist with weight prevention. This study aimed to evaluate patient and health care professional usability and experience of the ExeRTiOn online resource. Design. Qualitative study utilizing 'Think-Aloud' and semi-structured interviews. Methods. Participants (n = 17) were purposively sampled to include new kidney transplant recipients (n = 11) and transplant health care professionals (n = 6). Kidney transplant recipient participants were from a spread of physical activity levels based on scores from the General Practice Physical Activity Questionnaire (GPPAQ). 'Think-Aloud' interviews assessed the usability of ExeRTiOn. Semi-structured interviews explored participants' experience of ExeRTiOn, weight gain, and physical activity. The data set were analysed thematically. Participant characteristics, including login data and self-reported body weight, were collected. Results. Data analyses identified valued intervention content and usability aspects which were summarized by two themes. The first theme 'You need to know how to manage yourself' included subthemes: (1) the resource filled a guidance gap, (2) expert patient content resonated, and (3) the importance of goal setting and monitoring progress. The second theme 'room for improvement' included subthemes: (2) web support and (2) content and operational change suggestions.