Individuals with kidney failure receiving maintenance hemodialysis (HD) have very low
physical activity levels and poor physical function, and this contributes to a poor
quality of life and premature mortality. To help address this problem, many researchers
and clinicians have implemented simplistic physical activity programs that include
mandated exercise prescriptions such as cycling during dialysis, light resistance
training, or at-home walking programs. But the benefits from these studies are often
disappointing, as they are characterized by poor adherence, high dropout rates, and
modest effects on physical function, body composition, cardiovascular disease risk, and
other outcomes related to QOL. To address this, the investigators have designed a novel
physical activity intervention (Move More) that is designed to overcome many of the
barriers to increasing physical activity in this population.
The goal of the program is to accumulate an increasing number of points derived from
metabolic equivalent (MET) each week the participant is in the program, indicating that
their physical activity levels are increasing throughout. The rationale for this approach
is that participants are able to choose activities that are important to them, as opposed
to prescribed mandated exercises they may not value or benefit from. In brief, it
involves working one-on-one with patients to develop an activity prescription that aims
to get participants to "move more", by any means necessary.
This includes developing strategies to incorporate more "lifestyle" physical activity
into patients' lives (e.g., grocery shopping, yardwork, walking a dog, etc.), as well as
structured exercises, including body weight exercises, flexibility training, aerobic
exercise and/or recreational activities. Importantly, the activities that are prescribed
are the types that they are willing and able to do. This contrasts with what is normally
done, which is to assign specific types of exercise that they may not be motivated or
willing to do. The investigstors recently conducted a pilot and feasibility study using
this novel intervention approach in dialysis clinics in East-Central Illinois. Our
preliminary results indicate that the approach is feasible to implement, and the
participants were able to increase their physical activity levels to a much greater
extent than is normally seen when using mandated exercise prescriptions. Qualitative data
from this trial also indicated that the patients exposed to our "Move More" intervention
enjoyed the program and would be willing to maintain their increased physical activity
levels after the trial was over.
In this study, participants will be assessed for eligibility and following baseline
testing they will be randomly assigned to one of two groups. Patients will complete a
medical history form that will help assess participation eligibility. In addition, a
physician clearance form must be signed by the patient's nephrologist to participate in
the study. Once declared eligible for the study and cleared by their physician, patients
will undergo baseline testing.
The first group (Move More) will participate solely in our personalized physical activity
prescription (Move More) program. The physical activity prescription will be
individualized based on the participants' needs assessment (consultation) at baseline.
Exercise progression will also be made on an individual basis and be determined through a
point system (METs). Points are derived from metabolic equivalent (MET) scores and can be
accumulated by performing any activity (e.g., "lifestyle" activities, aerobic, and/or
resistance exercises) the participants complete.
Accumulated points are based on MET values from the Physical Activity compendium. Points
are derived from metabolic equivalent (MET) scores and can be accumulated by performing
any activity (e.g., "lifestyle" activities, aerobic, and/or resistance exercises) the
participants complete. The participants will accumulate points based on MET values from
the Physical Activity compendium, which the investigators will provide. For completing 10
minutes of any activity, the participants will "earn" the number of points corresponding
to that activity's published MET values. Points will be based on the actual minutes of
each activity performed. For example, the published MET value for brisk walking is 3.5
METS. Based on this, the participants will receive 3.5 points for every 10 minutes of
brisk walking. The overall goal is to accumulate more points each week for the duration
of the intervention.
If randomized into the control group participants will undergo a variety of exercises
including intradialytic cycling and resistance ("strength training") exercise. The Move
More and Cycle programs will be conducted for 6 months and participants will be engaged
to participate 3x/week, during participants' regularly scheduled hemodialysis treatments.
Our primary hypothesis is that patients randomized to the Move-more intervention will
increase their physical activity levels more than those in the intradialytic exercise
group. Physical activity levels will be assessed using weekly training logs and physical
activity questionnaires at baseline and final testing (at 6 months).
At the beginning and end of the study (0 and 6 months), participants will undergo a few
tests to measure their physical function, including their walking speed, their ability to
rise from a chair, ("sit to stand test"), and a balance test, these tests are part of the
Short Physical Performance Battery. The investigators will also provide them with a
series of short questionnaires to measure their self-reported physical activity levels
(LoPAQ), depression (PROMIS Depression Short Form 8a), and fatigue (SONG-HG survey). The
purpose of these tests is to determine if the participants in the "Move-More" group show
greater improvements in these measurements than those in the intradialytic exercise
group.
