*Purpose: Frailty and lower extremity (LE) impairment are risk factors for numerous adverse outcomes in kidney transplant (KT) candidates, including decreased rates of transplantation, increased healthcare utilization, and death. Despite multiple studies highlighting the potential benefit of prehabilitation prior to KT, effective treatment interventions are lacking. Our objective was to examine the preliminary efficacy of an outpatient, pulmonary rehabilitation-based exercise intervention on frailty, LE impairment, and quality of life in a cohort of KT candidates and patients with advanced kidney disease.

*Methods: We conducted a prospective, pilot study between 7/2018 and 10/2019 involving adults with ≥ stage 4 chronic kidney disease who were 1) frail or pre-frail by Fried phenotype (wasting, fatigue, low physical activity, slow walk time, and low grip strength) and/or 2) had LE impairment (Short Physical Performance Battery score ≤ 10). Quality of life was measured using the Kidney Disease Quality of Life (KDQOL) survey. The intervention consisted of two ≤ 1-hour supervised exercise sessions per week for 8 weeks in our pulmonary rehabilitation unit. Pre- and post-intervention comparisons were made using Wilcoxon signed-rank test for continuous variables and McNemar’s test for categorical variables.

*Results: We enrolled 27 participants of whom 77.8% completed ≥ 50% and 70.4% completed all of the exercise sessions. Median participant age was 62 years and 85.7% had been evaluated for KT. Following the intervention, 75 % of participants who were frail at baseline improved their frailty score (n=6/8). Multiple frailty parameters improved significantly, including fatigue, low physical activity, walking time, and grip strength (Table). The proportion of participants with LE impairment also significantly improved (90.5% to 61.9%, p=0.03). Exercise time per session improved by 9 minutes (p=0.02). Participants reported satisfaction with the intervention and no study-related adverse events occurred.

*Conclusions: Frailty and LE impairment are modifiable risk factors for adverse KT outcomes. Preliminary data from this pilot study suggest that an exercise intervention involving pulmonary rehabilitation is acceptable, feasible, and safe and is associated with improved frailty parameters, LE function, and exercise time. Further studies are needed to determine whether this protocolized prehabilitation strategy improves KT outcomes.

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