Abstract: TH-PO622
A Multicenter Exercise Intervention for Persons Transitioning to Dialysis Using the "Exercise Is Medicine" Framework
Session Information
- Health Maintenance, Nutrition, Metabolism - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- Ziolkowski, Susan, Stanford University School of Medicine, Palo Alto, California, United States
- Bootwala, Ahad Amin, Emory University, Skokie, Illinois, United States
- Jagannathan, Ram, Emory School of Medicine, Atlanta, Georgia, United States
- Anand, Shuchi, Stanford University, Stanford, California, United States
- Lobelo, Felipe, Emory University School of Public Health, Atlanta, Georgia, United States
Background
Physical activity is associated with improvement of cardiovascular health, physical function, transplant outcomes and survival in persons with CKD. Yet at the time of dialysis initiation, 44% of individuals cannot walk one block and 56% cannot climb 12 stairs.
Methods
We are conducting a pilot and feasibility randomized controlled trial (NCT03311763) using the American College of Sports Medicine ‘Exercise is Medicine’ framework in patients with eGFR < 45 ml/min/1.73m2 not on dialysis, in racially and ethnically diverse regions (San Jose, CA and Atlanta, GA). Group 1 receives a wearable activity tracker and exercise counseling; Group 2 additionally receives 8 weeks of twice-weekly group exercise sessions from a fitness professional trained in CKD related concerns (high/ low blood pressure and glucose, dialysis access precautions). Physical activity questionnaires (i.e. SF-12, IPAQ) and measurements [6-minute walk test (6MWT), handgrip strength, anthropometrics] are obtained at baseline, 8 and 16 weeks. Fitness trackers record daily step totals.
Results
51 patients were recruited (23 San Jose, 28 Atlanta). 82% of participants were non-white, 55% have diabetes and mean baseline eGFR was 30.9 ± 9.7. 6MWT means were 399 ± 118m (Group 1) and 433 ± 118m (Group 2), compared with 571 ± 90m previously reported in pooled analyses of healthy individuals. 7 individuals were hospitalized and 3 transitioned to dialysis during the study. Complete data will be available Fall 2019.
Conclusion
We successfully integrated recruitment, physical activity assessment and group exercise into diverse clinical settings servicing minority patients with advanced CKD. At baseline patients have poor capacity and experience a high burden of hospitalizations.
Participant Characteristics at Baseline
| Group 1 (n= 27) | Group 2 (n=24) | |
| Age | 61 (37-74) | 58 (32-72) |
| Female | 52 | 54 |
| Hispanic Ethnicity | 15 | 13 |
| Race Black Caucasian Other | 48 15 37 | 50 21 29 |
| Diabetes | 52 | 58 |
| eGFR (ml/min/1.73m2) | 30 (7-46) | 33 (15-46) |
| BMI (kg/m2) | 31 (16-54) | 32 (17-45) |
| 6MWT (m) | 383 (193-574) | 451 (193-719) |
| Handgrip strength (kg) | 24 (9-54) | 25 (11-55) |
Data presented as Median (range) and %
Funding
- NIDDK Support