The Impact of 4-weeks of Supervised Exercise on Frailty and Lower Extremity (LE) Function in Patients with Advanced Chronic Kidney Disease (CKD)
Mayo Clinic, Rochester, MN
Meeting: 2021 American Transplant Congress
Abstract number: 69
Keywords: Kidney, Kidney transplantation, Outcome, Quality of life
Topic: Clinical Science » Kidney » Kidney: Cardiovascular and Metabolic Complications
Session Information
Session Name: Kidney: Cardiovascular and Metabolic Complications
Session Type: Rapid Fire Oral Abstract
Date: Saturday, June 5, 2021
Session Time: 6:00pm-7:00pm
Presentation Time: 6:10pm-6:15pm
Location: Virtual
*Purpose: Although frailty is a modifiable risk factor for morbidity and mortality among kidney transplant (KT) candidates, the optimal duration of effective prehabilitation interventions is unknown. We have previously shown that 8-weeks of supervised exercise is associated with improved frailty parameters, quality of life (QOL), and LE function in patients with advanced CKD, including KT candidates. The objective of this study was to examine whether only 4-weeks of supervised exercise is also associated with improved frailty parameters, QOL, and LE function.
*Methods: We conducted a prospective, pilot study between 7/2018 and 5/2020 involving adults with ≥ stage 4 CKD who were 1) frail or pre-frail by Fried phenotype and/or 2) had a Short Physical Performance Battery (SPPB) score ≤ 10. Quality of life was measured using the Kidney Disease Quality of Life (KDQOL) survey. The intervention consisted of 4-weeks of twice weekly supervised exercise sessions (8 sessions) 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 35 participants of whom 27 (77%) completed the intervention. We excluded two participants whose intervention was interrupted by the COVID-19 pandemic. Of the remaining 25 participants, median age was 62 (range 40-87) years, 56% were male, 64% were on dialysis, and 84% had been evaluated for KT. Following the intervention, 67% of participants who were frail at baseline improved their frailty score (n=6/9). No improvement in grip strength was observed. However, multiple other parameters improved significantly, including fatigue, walking time, balance scores, and chair stand scores.
| Outcome | Baseline | After 4-weeks | Median difference | p-value |
| Wasting | 32.0% (n=8/25) | 24.0% (n=6/25) | 0.32 | |
| Fatigue (per KDQOL) | 42.5 [0 to 75.0] | 50.0 [20.0 to 70.0] | 5.0 [-15.0 to 50.0] | 0.02 |
| Low physical activity | 36.0% (n=9/25) | 16.0% (n=4/25) | 0.06 | |
| Walking time (s) | 5.1 [3.4 to 8.5] | 4.1 [2.5-5.5] | -1.1 [-3.9 to 0.7] | <0.0001 |
| Grip strength (kg) | 24.5 [9.8 to 80.6] | 23.1 [11.6 to 89.8] | 0.7 [-7.6 to 10.5] | 0.59 |
| Balance score | 3 [1 to 4] | 4 [1 to 4] | 0 [-1 to 2] | 0.05 |
| Chair stand score | 1 [0 to 4] | 2 [0 to 4] | 0 [-2 to 2] | 0.04 |
*Conclusions: Our pilot study suggests that 4-weeks of supervised exercise is associated with improved fatigue, walking time, balance scores, and chair stand scores among patients with advanced CKD. Longer interventions, however, may be required to modify grip strength. This study provides important preliminary data for future studies aimed at designing effective prehabilitation strategies prior to KT.
To cite this abstract in AMA style:
Lorenz E, Hickson L, Weatherly R, Thompson K, Hogan M, Kennedy C. The Impact of 4-weeks of Supervised Exercise on Frailty and Lower Extremity (LE) Function in Patients with Advanced Chronic Kidney Disease (CKD) [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-4-weeks-of-supervised-exercise-on-frailty-and-lower-extremity-le-function-in-patients-with-advanced-chronic-kidney-disease-ckd/. Accessed November 24, 2024.« Back to 2021 American Transplant Congress