Virtually Supervised Exercise for Kidney Transplant Candidates

Kidney transplantation (KT) is the best treatment for kidney failure; however, due to the shortage of organs, most KT candidates must wait years—sometimes over a decade--to receive a transplant. Kidney failure causes muscle wasting. So while waiting and persevering with dialysis treatments, KT candidates lose muscle and thus physical function. By the time they undergo transplantation, 47% of KT candidates have trouble walking, balancing, and/or getting out of a chair. These losses lead to poor post-transplant outcomes, longer wait times, or even waitlist removal. Such outcomes are devastating for both patients and transplant centers, and sadly are not rare. Furthermore, such events excessively impact persons of Black, Hispanic, or Asian heritage, who are more likely to develop kidney failure. We know what reverses these losses—exercise. Ideally, transplant centers would proactively prescribe a pre-transplant exercise program. But uptake of exercise interventions into KT candidate care remains minimal. This is because we continue to have a knowledge gap about what is the most effective way to deliver an exercise intervention to KT candidates. Patients have stated they prefer a home-based exercise intervention, as this format overcomes the barrier of the dialysis schedule. Yet prior home-based interventions have been limited by low adherence, reducing impact of the intervention. Supervision by an instructor can increase adherence by adding the element of accountability. But most home-based interventions have been unsupervised due to cost. With the adoption of virtually delivered health care, a new option has emerged: virtually supervised home-based exercise interventions. Using a virtual meeting platform, persons can exercise while being supervised by an instructor online. For KT candidates, who cope with the intense time and travel requirements of dialysis, virtually supervised exercise may be the best option to efficiently and effectively improve their physical function. Our goal is an effective and scalable exercise intervention that can be used by transplant centers to prevent the loss of physical function in KT candidates. We have developed an innovative clinic for KT candidates who are within two years of likely transplant, ideal for instilling health behavior change. Leveraging this clinic, we will conduct a 24-week randomized controlled trial in 80 KT candidates to evaluate the impact of a virtually supervised home-based exercise intervention using a delayed intervention design. Participants will initially receive virtually supervised exercise or health education for 12 weeks, which will be the primary endpoint. At the end of the initial 12-week period, we will evaluate the impact of the intervention on physical function (Aim 1), depressive symptoms, and fatigue (Aim 2). Both arms will then receive the exercise intervention in the second 12 weeks to assess adherence and acceptability (Aim 3). Our end product will be an intervention that can be used widely to improve the physical function of KT candidates, sustaining their hope and wish for a future free of kidney failure.