Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial
Shuchi Anand, Susan Ziolkowski, Ahad Bootwala, Jianheng Li, Nhat M. Pham, Jason Cobb, Felipe Lobelo
Abstract
Rationale & objectiveWe aimed to test interventions to improve physical activity in persons with advanced chronic kidney disease not yet on dialysis.Study DesignRandomized controlled trial with parallel group designSetting & ParticipantsWe embedded a pragmatic referral to exercise programming in high-volume kidney clinics servicing diverse populations in San Jose, California and Atlanta, Georgia. We recruited 56 participants with eGFR <45 ml/min/1.73m2.InterventionsWe randomized participants to a mobile health (mHealth) group—wearable activity trackers and fitness professional counseling, or an EIM group—mHealth components plus twice weekly small-group, directed exercise sessions customized to persons with kidney disease. We performed assessments at baseline, at eight weeks at the end of active intervention, and at 16 weeks after passive follow-up, and used multilevel mixed models to assess between group differences.OutcomesActivity tracker total daily step countResultsOf 56 participants, 86% belonged to a racial/ethnic minority group; randomized groups were well-balanced on baseline step count. In intention-to-treat analyses, the EIM and mHealth groups both experienced declines in daily step counts, but there was an attenuated reduction in light intensity physical activity (0.2 [5.8] vs. -8.5 [5.4] min/day, p=0.08) in the EIM compared to the mHealth group at eight weeks. In as-treated analyses, total daily step count, distance covered, and light and moderate-vigorous activity minutes/day improved in the EIM group and declined in the mHealth group at eight weeks (+335 [506] vs -884 [340] steps/day p=0.05, p<0.05 for secondary measures), but group differences faded at 16 weeks. There were no differences in quality of life and mental health measures during the study.LimitationsSmall sample size, limited duration of study, assessment of intermediate outcomes (steps/day).ConclusionsA clinic-integrated referral to small-group exercise sessions is feasible, safe, and moderately effective in improving physical activity in an underserved population with high comorbidities.