Protocolized exercise improves frailty parameters and lower extremity impairment: A promising prehabilitation strategy for kidney transplant candidates

Abstract

Background: Frailty and decreased functional status are risk factors for adverse kidney transplant (KT) outcomes. Our objective was to examine the efficacy of an exercise intervention on frailty and decreased functional status in a cohort of patients with advanced chronic kidney disease (CKD).

Methods: We conducted a prospective study involving 21 adults with ≥stage 4 CKD who were (a) frail or pre-frail by Fried phenotype and/or (b) had lower extremity impairment [short physical performance battery score ≤10]. The intervention consisted of two supervised outpatient exercise sessions per week for 8 weeks.

Results: Among our cohort, median participant age was 62 years (interquartile range, 53-67) and 85.7% had been evaluated for KT. Following the study, participants reported satisfaction with the intervention and multiple frailty parameters improved significantly, including fatigue, physical activity, walking time, and grip strength. Lower extremity impairment also improved (90.5%-61.9%, P = .03). No study-related adverse events occurred.

Conclusions: Preliminary data from this study suggest that a supervised, outpatient exercise intervention is safe, acceptable, feasible, and associated with improved frailty parameters, and lower extremity function, in patients with advanced CKD. Further studies are needed to confirm these findings and determine whether this prehabilitation strategy improves KT outcomes.

Trial registration: ClinicalTrials.gov NCT03535584.

Keywords: chronic; frailty; renal insufficiency; transplants.

Conflict of interest statement

DISCLOSURE

The authors declare no conflicts of interest.

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

Figure 1.

Enrollment and follow-up of study participants.

Figure 2.

Prevalence of frailty and SPPB scores ≤ 10 at baseline (n=21). SPPB = Short Physical Performance Battery.

Figure 3.

Proportion of frailty and SPPB scores ≤ 10 at baseline compared to post-intervention (n=21, McNemar’s test). SPPB = Short Physical Performance Battery.

Figure 4.

Box plot of interquartile range, range, and median change in time spent exercising following the intervention (n=21, Wilcoxon signed-rank).