This condition, known as disuse muscle atrophy, poses a substantial challenge to the
health and well-being of individuals, particular those hospitalized. To tackle this
problem , the project focuses on a specific group of individuals particularly vulnerable
to this issues: Veterans with chronic kidney disease (CKD). This disease affects a
substantial population of over 500,000 Veterans, leading to a progressive decline in
mobility, unfavorable changes in lean body mass, and heightened hospitalization rates. To
comprehensively address this concern, the project indents to develop and implement
assessment and intervention strategies tailored to the target cohort's needs. By
concentrating on Veterans with CKD, the project seeks to generate approaches that can be
widely applied to address muscle atrophy among individuals with similar conditions. To
achieve this, the project twill commence by establishing a baseline cohort of Veterans
with Stage 3 and 4 CKD at two distinct Veterans Affairs sites located in Denver and
Baltimore. Upon enrollment, the Veterans muscles health will be assessed, encompassing
various dimensions such as strength, lean muscle mass, muscle composition, mobility, and
intrinsic capacity. This comprehensive evaluation will provide a snapshot of their
pre-hospitalization muscle health. Subsequently, the enrolled Veterans will be closely
monitored for at least two years. The project's approach involves conducting regular
assessments of their muscle health every six months. Additionally, the participating
Veterans will provide information about their strength and functional status every
quarter, facilitated through a smartphone application. A particular noteworthy aspect of
the project is its inclusion of a pragmatic rehabilitation intervention trail. Veterans
who experience hospitalization during the study will have the opportunity to participate
in this trial. They will be assigned to either a supervised flywheel strengthening
exercise group or receive usual care over 16 weeks. This intervention trial aims to
assess the effective ness of targeted exercise in mitigating the effects of disuse muscle
atrophy post-hospitalization. The overarching design of the project encompasses three
main objectives:
Aim 1: Identify effective muscle assessment sites for disuse muscle atrophy. Aim 2:
Assess if standardized intrinsic capacity and physical resilience assessments predict
hospital outcomes. The investigators anticipate that physical resilience scores will
improve hospitalization and strength outcomes predictions.
Aim 3: Evaluate a supervised flywheel exercise program against usual care. Both groups
are expected to improve, with the supervised group have better results.