Exercise Study

Title: Development and Testing of an Innovative Patient-Centered Physical Activity Program for Hemodialysis Patients (Move More)

Sponsor: NKF

Collaborators:UIUC & RRI

Background: Individuals with kidney failure receiving maintenance hemodialysis (HD) have very low physical activity levels and poor physical function, and this contributes to a poor quality of life (QOL) and premature mortality. To help address this problem, many have implemented simplistic exercise programs that include mandated exercise prescriptions such as cycling during dialysis, light resistance training, or at home walking programs. But the benefits from these studies are often disappointing, as they are characterized by poor adherence, high dropout rates, and modest effects on physical function or other outcomes related to QOL.

The primary objective of this study is to compare the feasibility and efficacy of a standard intradialytic exercise program to an individualized patient-centered exercise prescription in HD patients. To accomplish this, hemodialysis patients will be randomly assigned to one of two groups for 6 months: 1) Intradialytic exercise; or 2) “Move More” – a personalized exercise program involving both in center and out-of-center exercise. Those in the intradialytic exercise group will undergo a variety of exercises including intradialytic cycling and resistance exercise for 6 months. Those in Move More will be asked to choose from a variety of in center and at home exercises. For Move More, we established a system in which participants will accumulate points by completing various activities of their choosing. This may include “lifestyle” activities (e.g., gardening, housework), endurance exercise, and/or strength training type activities. Points for each activity are derived from metabolic equivalent (MET) scores from the Compendium of Physical Activity. The goal of the point-based system is to apply a progressive physical activity (PA) program in which participants are increasing PA on a weekly basis. The rationale for this point system is that participants are able to choose activities that are important to them, as opposed to prescribed mandated exercises they may not value or benefit from. This may create more intrinsic motivation for patients, thus increasing adherence to their PA prescription. Similar methods have been implemented within healthy populations for dieting and PA interventions, but is untested in hemodialysis patients.