Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial

Anand, Shuchi; Ziolkowski, Susan L.; Bootwala, Ahad; Li, Jianheng; Pham, Nhat M.; Cobb, Jason; Lobelo, Felipe

doi:10.1016/j.xkme.2021.04.022

Cited by 5 publications

(29 citation statements)

References 60 publications

(83 reference statements)

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“…Anand et al [ 31 ] conducted a comparative study to evaluate the impact of mHealth combined twice weekly directed exercise session versus only exercise sessions on daily step counts in 56 patients with CKD stage 3b-4. The intervention lasted eight weeks, followed by an 8-week passive follow-up period.…”

Section: Resultsmentioning

confidence: 99%

Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review

Huang,

Wang,

Bai

et al. 2024

BMC Nephrol

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Background Physical inactivity is prevalent among individuals with chronic kidney disease (CKD) and is linked to unfavorable outcomes. In recent years, daily steps have emerged as a prominent target for interventions in clinical trials. The present study endeavors to scrutinize the effectiveness and/or efficacy of various interventions on daily steps in patients with full-spectrum CKD. Methods In December 2022, a systematic search was conducted across three databases, namely PubMed, Embase, and Web of Science, and subsequently updated in June 2023. The inclusion criteria included randomized controlled studies, quasi-experimental studies, and single-arm trials that assessed an intervention’s impact on objectively measured daily steps in patients with chronic kidney disease. The Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool was used to assess the risk of bias in non-randomized controlled trials (RCT), while the Cochrane revised tool (ROB-2) was utilized for RCTs. Results Seventeen studies were deemed eligible for inclusion in this review, with a focus on examining the efficacy and/or effectiveness of exercise training-based interventions (n = 10), daily step goal-oriented interventions (n = 4), mobile health (mHealth) interventions (n = 1), different dialysis modalities (n = 1), and a “Sit Less, Interact, Move More” intervention (n = 1). The studies exhibit variability in their characteristics and assessment tools, reflecting the findings’ heterogeneity. The results indicate that increasing physical activity levels remain challenging, as only a limited number of studies demonstrated significant improvements in participants’ daily step counts from baseline to endpoint. Conclusion Clinical trials with daily steps as an outcome are still lacking in the CKD population. Well-designed clinical trials that objectively assess the physical activity of CKD patients are needed.

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Section: Resultsmentioning

confidence: 99%

Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review

Huang,

Wang,

Bai

et al. 2024

BMC Nephrol

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“…Following duplicate removal, the title and abstract of 3,934 articles were screened and the full texts of 105 articles were assessed for eligibility. Finally, eight studies (four RCT’s [ 36 – 39 ]) and four single arm [ 40 – 43 ]) with baseline sample sizes ranging from n = 17 [ 38 ] to n = 340 participants [ 39 ], resulting in 550 participants were included in the review (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The stages of CKD ranged from 1 through to haemodialysis and kidney transplant recipients (Table 1 ). Reported primary outcomes included self-management of CKD reported via self-report questionnaires [ 37 , 41 ] physical and psychological outcomes [ 36 , 39 ] and feasibility and acceptability [ 38 , 40 , 42 , 43 ] (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

Letton,

Trần,

Flower

et al. 2024

J Med Syst

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Physical activity is essential to interrupt the cycle of deconditioning associated with chronic kidney disease (CKD). However, access to targeted physical activity interventions remain under-supported due to limited funding and specialised staff. Digital interventions may address some of these factors. This systematic review sought to examine the evidence base of digital interventions focused on promoting physical activity or exercise and their effect on health outcomes for people living with CKD. Electronic databases (PubMed, CINAHL, Embase, Cochrane) were searched from 1 January 2000 to 1 December 2023. Interventions (smartphone applications, activity trackers, websites) for adults with CKD (any stage, including transplant) which promoted physical activity or exercise were included. Study quality was assessed, and a narrative synthesis was conducted. Of the 4057 records identified, eight studies (five randomised controlled trials, three single-arm studies) were included, comprising 550 participants. Duration ranged from 12-weeks to 1-year. The findings indicated acceptability and feasibility were high, with small cohort numbers and high risk of bias. There were inconsistent measures of physical activity levels, self-efficacy, body composition, physical function, and psychological outcomes which resulted in no apparent effects of digital interventions on these domains. Data were insufficient for meta-analysis. The evidence for digital interventions to promote physical activity and exercise for people living with CKD is limited. Despite popularity, there is little evidence that current digital interventions yield the effects expected from traditional face-to-face interventions. However, 14 registered trials were identified which may strengthen the evidence-base.

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“…Given the association between increased physical activity levels and mortality in the CKD population [ 81 ], there were only five studies which examined this outcome [ 41 , 62 , 66 , 68 , 73 ]. The previous review from 2019 did not include any studies reporting physical activity as an outcome [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…An RCT [73] investigated the effect of a wearable on physical activity levels, they reported that the intervention was feasible, although steps per day decreased in the intervention group, the minutes of moderate to vigorous physical activity increased. There appeared to be no effect on HRQoL and mental health measures during the study [73]. A similar study [75] found a wearable activity tracker was feasible and acceptable in encouraging physical activity in older transplant recipients.…”

Section: Other Ehealth Interventionsmentioning

confidence: 99%

Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review

Curtis,

Burton,

Butt

et al. 2024

PLoS ONE

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A method of overcoming barriers associated with implementing lifestyle interventions in CKD may be through the use of eHealth technologies. The aim of this review was to provide an up-to-date overview of the literature on this topic. Four bibliographical databases, two trial registers, and one database for conference proceedings were searched from inception to August 2023. Studies were eligible if they reported a lifestyle intervention using eHealth technologies. A narrative synthesis of the findings from the included studies structured around the type of eHealth intervention was presented. Where a sufficient number of studies overlapped in terms of the type of intervention and outcome measure these were brought together in a direction of effect plot. There were 54 included articles, of which 23 were randomised controlled trials (RCTs). The main component of the intervention for the included studies was mobile applications (n = 23), with the majority being in the dialysis population (n = 22). The majority of eHealth interventions were reported to be feasible and acceptable to participants. However, there was limited evidence that they were efficacious in improving clinical outcomes with the exception of blood pressure, intradialytic weight gain, potassium, and sodium. Although eHealth interventions appear acceptable and feasible to participants, there is insufficient evidence to make recommendations for specific interventions to be implemented into clinical care. Properly powered RCTs which not only demonstrate efficacy, but also address barriers to implementation are needed to enhance widespread adoption.

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Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial

Cited by 5 publications

References 60 publications

Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review

Objectively measured daily steps as an outcome in a clinical trial of chronic kidney disease: a systematic review

Digital Physical Activity and Exercise Interventions for People Living with Chronic Kidney Disease: A Systematic Review of Health Outcomes and Feasibility

Lifestyle interventions delivered by eHealth in chronic kidney disease: A scoping review

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