Targeting Sedentary Behavior in CKD: A Pilot and Feasibility Randomized Controlled Trial

Abstract

Background and objectives: We tested the feasibility of reducing sedentary behavior common in CKD.

Design, setting, participants, & measurements: We carried out a Sit Less, Interact, Move More intervention in a 24-week parallel-group, randomized controlled trial in patients with stages 2-5 CKD. In the intervention group (n=54), accelerometry performed at baseline and repeated every 4 weeks was used to develop and monitor adherence to individualized plans targeting sedentary and stepping durations. The control group (n=52) was provided national physical activity recommendations; accelerometry was performed at baseline and every 8 weeks. Between-groups changes from baseline to the average follow-up values at weeks 8, 16, and 24 of the sedentary and stepping durations were the coprimary end points.

Results: The mean age was 69±13 years. Fourteen percent were on dialysis or received a kidney transplant. Eight percent of the control group and 17% of the intervention group were lost to follow-up. Sedentary and stepping durations did not change in the control group. Within the intervention group, the maximum decrease in sedentary duration (-43; 95% confidence interval, -69 to -17 min/d) and increase in stepping duration (16; 95% confidence interval, 7 to 24 min/d) and the number of steps per day (1265; 95% confidence interval, 518 to 2012) were seen at week 20. These attenuated at week 24. In mixed effects models, overall treatment effects between groups on sedentary (-17; 95% confidence interval, -43 to 8 min/d) and stepping (6; 95% confidence interval, -3 to 15 min/d) durations and the number of steps per day, a secondary end point (652; 95% confidence interval, -146 to 1449), were not significantly different. The intervention significantly reduced secondary end points of body mass index (-1.1; 95% confidence interval, -1.9 to -0.3 kg/m2) and body fat percentage (-2.1%; 95% confidence interval, -4.4% to -0.2%).

Conclusions: It is feasible to reduce sedentary duration and increase stepping duration in patients with CKD, but these were not sustained.

Clinical trial registry name and registration number: National Health and Nutrition Examination Survey (NHANES), NCT02970123.

Keywords: behavioral intervention; chronic kidney disease; sedentary behavior.

Copyright © 2021 by the American Society of Nephrology.

Figures

Graphical abstract

Figure 1.

CONSORT flow diagram of study participants. BMI, body mass index; SLIMM, Sit Less, Interact, Move More; CONSORT, CONsolidated Standards Of Reporting Trials.

Figure 2.

Changes in primary and secondary outcomes on the basis of accelerometry over the course of the study according to treatment assignment. Least square means estimates of primary and secondary end points on the basis of accelerometry in standard of care (SOC; n=52) and SLIMM (n=54) groups in mixed effects models are presented.

Figure 3.

Changes in primary and secondary outcomes on the basis of accelerometry over the course of the study according to treatment assignment and SLIMM intervention adherence. Least square means estimates of primary and secondary end points on the basis of accelerometry in SOC participants (n=52), SLIMM participants who met SLIMM goal (n=20), and SLIMM participants who did not meet SLIMM goal (n=34) by week 20 in mixed effects models are presented.

Figure 4.

Changes in body measures over the course of the study according to treatment assignment. Least square means estimates of waist circumference, BMI, and body fat percentage in SOC (n=52) and SLIMM (n=54) groups in mixed effects models are presented.