A Physical Activity Intervention Feasibility Study for Kidney Inpatients: A Basic Research Protocol

Abstract

Background: Low physical activity levels and poor physical functioning are strongly associated with poor clinical outcomes and mortality in adult kidney failure patients, regardless of treatment modality. Compared with the general population, individuals with chronic kidney disease are physically inactive, have reduced physical abilities and difficulties performing routine daily tasks, lower health-related quality of life, and higher cardiovascular morbidity and mortality. In addition, frail kidney failure patients have higher hospitalization and mortality rates as compared with other kidney failure patients. Evidence suggests that assessment and recommendations for physical activity should be part of standard care for kidney failure patients. Structured exercise can improve physical function and quality of life in frail older adults and may be used specifically for management of frailty in kidney failure. However, research is needed to determine best practices for implementation of physical function measurements and physical activity promotion in standard kidney failure care. Objective: The proposed Move More study will assess the feasibility of a physical activity intervention offered to the kidney failure inpatients in Calgary, Alberta. Specifically, this study is designed to examine the effects of an early physical activity/mobility intervention led by a kinesiologist, and supported by the clinical care team including physiotherapists (PT) and nurse clinicians. Methods: The Move More study is a single-arm pilot intervention examining feasibility and optimal improvement in real-world conditions. Kidney failure inpatients at the Foothills Medical Centre will be recruited to participate. Patients will receive an individualized in-hospital physical activity/mobility intervention. Frailty and physical function will be assessed at baseline and postintervention prior to hospital discharge. The goal is to recruit 24 to 36 patients. Conclusions: Evidence needed to support the inclusion of mobility and physical activity as part of standard care will be gathered, with knowledge gained used to help direct future physical activity programming for kidney failure inpatients.

Results From a Physical Activity Intervention Feasibility Study With Kidney Inpatients

“…The study protocol has been described in detail previously. 21 Ethical approval was obtained through the Conjoint Research Ethics Board of the Faculties of Medicine at the University of Calgary (REB 18-2134).…”

“…Hospital LOS, 30-day readmissions and number of falls during the intervention were assessed via EMR review. Measurement for all secondary outcomes have been described previously; 21 however, the values used for the Fried Frailty Index are provided in Table 2 . Physical activity was assessed with the Godin Leisure Time Exercise Questionnaire (GLTEQ), and a physical activity score was calculated based on the weekly activity score and the amount of strenuous, moderate, and mild activity.…”

“…Hospital LOS, 30-day readmissions and number of falls during the intervention were assessed via EMR review. Measurement for all secondary outcomes have been described previously; 21 however, the values used for the Fried Frailty Index are provided in Table 2.…”

Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease

“…The introduction of exercise programmes to prevent or allay this decline is an area of growing interest. One small study regarding four weeks of thriceweekly inpatient exercise training led to improvements in fatigue [92], whilst an ongoing study will explore the feasibility and preliminary efficacy of a tailored inpatient exercise intervention on frailty levels, length of stay, readmissions, HRQoL, and function [93]. How to effectively support frail people to regain function and fitness post-hospital discharge is also an area requiring further research.…”

A conceptual model to manage multiple chronic conditions based on PDSA theory

“…Primary health care has the call in multimorbidity management. And it's also equipped with pharmacists[26], dietitians [27], psychologists [28], physiotherapists [29], and other professional evaluators according to the population characteristics in areas.…”