The Effect of Chronic Kidney Disease on a Physical Activity Intervention: Impact on Physical Function, Adherence, and Safety

Background: Low physical activity levels and poor physical functioning are strongly associated with poor clinical outcomes and mortality in adult End Stage Kidney Disease (ESKD) patients, regardless of treatment modality. Compared to 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, higher cardiovascular morbidity and mortality. In addition, frail ESKD patients have higher hospitalization and mortality rates than other ESKD patients. Evidence suggests that assessment and recommendations for physical activity should be part of standard care for ESKD 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 ESKD. However, research is needed to determine best practices for implementation of physical function measurements and physical activity promotion in standard ESKD care. Objective: The proposed Move More study will assess the feasibility of a physical activity intervention offered to the ESKD inpatients in Calgary, Alberta. Specifically, this study is designed to examine the effects of an early physical activity/mobility intervention led by a kinesiologist (KT), 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 preliminary efficacy. ESKD 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 post-intervention prior to hospital discharge. 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 ESKD inpatients.

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The association of physical activity and physical function with clinical outcomes in adults with chronic kidney disease

Current Opinion in Nephrology & Hypertension ◽

10.1097/mnh.0b013e328365b43a ◽

2013 ◽

Vol 22 (6) ◽

pp. 615-623 ◽

Cited By ~ 80

Author(s):

Patricia Painter ◽

Baback Roshanravan

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Function ◽

Clinical Outcomes

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Musculoskeletal pain reported by mobile patients with chronic kidney disease

Clinical Kidney Journal ◽

10.1093/ckj/sfz196 ◽

2020 ◽

Vol 13 (5) ◽

pp. 813-820

Author(s):

Stig Molsted ◽

Inge Eidemak

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Physical Function ◽

Musculoskeletal Pain ◽

Chair Stand ◽

Stand Test ◽

Chair Stand Test ◽

The Impact

Abstract Background Musculoskeletal pain has been reported as a clinical problem in patients with chronic kidney disease (CKD). The purpose of this study was to compare the frequency of musculoskeletal pain in patients with CKD and no mobility problems with a general population and to investigate the impact of pain on quality of life (QOL), physical activity and physical function. Methods Patients with CKD Stages 4 and 5 with or without a dialysis treatment and no mobility problems were included. Musculoskeletal pain in the shoulder/neck, back/low back and limbs and level of physical activity were measured using the Danish Health and Morbidity Survey and coded into dichotomous answers. QOL and physical function were measured using the kidney disease QOL questionnaire and the 30-s chair stand test, respectively. Data for the general population were collected in national registers and adjusted for age, gender and region. Results The patients (n = 539) had a mean age of 66 [95% confidence interval (CI) 65–67] years, 62% were men and they were treated with haemodialysis (HD) (n = 281), peritoneal dialysis (n = 62) or without dialysis (n = 196). The frequency of reported musculoskeletal pain in the patients did not exceed pain reported by the general population [e.g. pain in the limbs in patients undergoing HD versus a matched general population, 61% versus 63% (P = 0.533), respectively]. Pain in all measured body sites was associated with reduced QOL [e.g. pain in the limbs associated with a physical component scale β of −8.2 (95% CI −10.3 to −6.0), P < 0.001]. Pain in the limbs was associated with a reduced number of repetitions in the 30-s chair stand test [mean −1.7 (95% CI −3.0 to −0.4), P = 0.009]. Pain in the shoulder/neck was associated with reduced odds of being physically active [odds ratio 0.6 (95% CI 0.4 to 0.9); P = 0.022]. Conclusions Musculoskeletal pain was not more frequently reported by patients with CKD and no mobility problems compared with the general population. However, as musculoskeletal pain was reported by up to two-thirds of the patient sample, healthcare professionals should remember to focus on this issue. The patients’ pain was associated with negative impacts on QOL, level of physical activity and physical function.

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Factors Associated With Levels of Physical Activity in Chronic Kidney Disease Patients Undergoing Hemodialysis: The Role of Dialysis Versus Nondialysis Day

Journal of Physical Activity and Health ◽

10.1123/jpah.2016-0715 ◽

2017 ◽

Vol 14 (9) ◽

pp. 726-732 ◽

Cited By ~ 7

Author(s):

Clara Suemi da Costa Rosa ◽

Danilo Yuzo Nishimoto ◽

Ismael Forte Freitas Júnior ◽

Emmanuel Gomes Ciolac ◽

Henrique Luiz Monteiro

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Function ◽

Demographic Data ◽

Clinical Status ◽

Activity Levels ◽

Factors Associated ◽

Related Quality ◽

Health Related

Background:Patients on hemodialysis (HD) report lower physical activity (PA) levels. We analyzed factors associated with low levels of PA in patients with chronic kidney disease (CKD) and compared PA on HD day and non-HD.Methods:79 patients wore an accelerometer and were classified according to time spent on moderate-to-vigorous PA (MVPA). Demographic data, BMI, comorbidities, clinical status, and health-related quality of life (HRQoL) were checked for association with PA. In addition, PA level was compared between days of HD and non-HD.Results:Accelerometer compliance was 78.5% [33 men and 29 women (53.96 ± 15.71 yrs) were included in analysis]. 35.5% of sample achieved ≥150min/week on MVPA. Lower MVPA was associated with older age (OR = 5.80, 95% CI = 1.11 to 30.19, P = .04), and lower score of physical function HRQoL (OR = 4.33, 95% CI = 1.23 to 15.23, P = .02). In addition, patients spent 9.73% more time on sedentary behavior, 38.9% less on light PA and 74.9% less on MVPA on HD day versus non-HD day.Conclusion:Age and physical function HRQoL were the main factors associated to lower PA levels. In addition, lower time spent on PA during HD day suggest that strategies for increasing physical activity levels during HD day such exercising during HD session could help CKD patients to reach current PA recommendations.

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The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622318785575 ◽

2018 ◽

Vol 9 (11) ◽

pp. 209-226 ◽

Cited By ~ 32

Author(s):

Heather J. MacKinnon ◽

Thomas J. Wilkinson ◽

Amy L. Clarke ◽

Douglas W. Gould ◽

Thomas F. O’Sullivan ◽

...

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Function ◽

Clinical Outcomes ◽

Research Quality ◽

Measurement Tool ◽

Cochrane Central Register ◽

Renal Transplant Recipients ◽

All Cause Mortality

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function.

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Physical activity in patients with pre-dialysis chronic kidney disease is related to physical function

Clinical and Experimental Nephrology ◽

10.1007/s10157-020-01939-z ◽

2020 ◽

Vol 24 (12) ◽

pp. 1189-1190

Author(s):

Chiharu Hotta ◽

Koji Hiraki ◽

Kazuhiro P. Izawa ◽

Tsutomu Sakurada ◽

Yugo Shibagaki

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Function

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Assessing physical activity and function in patients with chronic kidney disease: a narrative review

Clinical Kidney Journal ◽

10.1093/ckj/sfaa156 ◽

2020 ◽

Author(s):

Esmée A Bakker ◽

Carmine Zoccali ◽

Friedo W Dekker ◽

Thijs M H Eijsvogels ◽

Kitty J Jager

Keyword(s):

Physical Activity ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Function ◽

Severe Disabilities ◽

Measurement Instruments ◽

Beneficial Effects ◽

Physical Activity And Exercise ◽

Method Accuracy ◽

And Function

Abstract Physical activity potentially improves health outcomes in patients with chronic kidney disease (CKD) and recipients of kidney transplants. Although studies have demonstrated the beneficial effects of physical activity and exercise for primary and secondary prevention of non-communicable diseases, evidence for kidney patients is limited. To enlarge this evidence, valid assessment of physical activity and exercise is essential. Furthermore, CKD is associated with a decline in physical function, which may result in severe disabilities and dependencies. Assessment of physical function may help clinicians to monitor disease progression and frailty in patients receiving dialysis. The attention on physical function and physical activity has grown and new devices have been developed and (commercially) launched on the market. Therefore the aims of this review were to summarize different measures of physical function and physical activity, provide an update on measurement instruments and discuss options for easy-to-use measurement instruments for day-to-day use by CKD patients. This review demonstrates that large variation exists in the different strategies to assess physical function and activity in clinical practice and research settings. To choose the best available method, accuracy, content, preferable outcome, necessary expertise, resources and time are important issues to consider.

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Women’s Health Initiative Strong and Healthy Pragmatic Physical Activity Intervention Trial for Cardiovascular Disease Prevention: Design and Baseline Characteristics

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa325 ◽

2021 ◽

Author(s):

Marcia L Stefanick ◽

Abby C King ◽

Sally Mackey ◽

Lesley F Tinker ◽

Mark A Hlatky ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Physical Function ◽

Women’S Health ◽

Women's Health ◽

Physical Activity Intervention ◽

Women's Health Initiative ◽

Women’S Health Initiative ◽

Health Initiative ◽

Race Ethnicity

Abstract Background National guidelines promote physical activity to prevent cardiovascular disease (CVD), yet no randomized controlled trial has tested whether physical activity reduces CVD. Methods The Women’s Health Initiative (WHI) Strong and Healthy (WHISH) pragmatic trial used a randomized consent design to assign women for whom cardiovascular outcomes were available through WHI data collection (N = 18 985) or linkage to the Centers for Medicare and Medicaid Services (N30 346), to a physical activity intervention or “usual activity” comparison, stratified by ages 68–99 years (in tertiles), U.S. geographic region, and outcomes data source. Women assigned to the intervention could “opt out” after receiving initial physical activity materials. Intervention materials applied evidence-based behavioral science principles to promote current national recommendations for older Americans. The intervention was adapted to participant input regarding preferences, resources, barriers, and motivational drivers and was targeted for 3 categories of women at lower, middle, or higher levels of self-reported physical functioning and physical activity. Physical activity was assessed in both arms through annual questionnaires. The primary outcome is major cardiovascular events, specifically myocardial infarction, stroke, or CVD death; primary safety outcomes are hip fracture and non-CVD death. The trial is monitored annually by an independent Data Safety and Monitoring Board. Final analyses will be based on intention to treat in all randomized participants, regardless of intervention engagement. Results The 49 331 randomized participants had a mean baseline age of 79.7 years; 84.3% were White, 9.2% Black, 3.3% Hispanic, 1.9% Asian/Pacific Islander, 0.3% Native American, and 1% were of unknown race/ethnicity. The mean baseline RAND-36 physical function score was 71.6 (± 25.2 SD). There were no differences between Intervention (N = 24 657) and Control (N = 24 674) at baseline for age, race/ethnicity, current smoking (2.5%), use of blood pressure or lipid-lowering medications, body mass index, physical function, physical activity, or prior CVD (10.1%). Conclusion The WHISH trial is rigorously testing whether a physical activity intervention reduces major CV events in a large, diverse cohort of older women. Clinical Trials Registration Number: NCT02425345

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

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120987052 ◽

2021 ◽

Vol 8 ◽

pp. 205435812098705

Author(s):

Kathryn Wytsma-Fisher ◽

Stefan Mustata ◽

Theresa Cowan ◽

Manuel Ester ◽

S. Nicole Culos-Reed

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Physical Function ◽

Kidney Failure ◽

Standard Care ◽

Physical Activity Intervention ◽

Clinical Care ◽

Activity Promotion ◽

Cardiovascular Morbidity And Mortality

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.

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