Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial

Area of Science:

• Nephrology
• Exercise Physiology
• Public Health

Background:

• Physical activity is crucial for managing chronic conditions, including advanced chronic kidney disease (CKD).
• Persons with advanced CKD often face barriers to maintaining physical activity.
• Novel interventions are needed to promote exercise in this population.

Purpose of the Study:

• To evaluate the effectiveness of two interventions aimed at improving physical activity in individuals with advanced CKD not yet on dialysis.
• To compare a mobile health (mHealth) intervention with an Exercise is Medicine (EIM) framework incorporating group exercise sessions.

Main Methods:

• A randomized controlled trial with a parallel-group design was conducted in high-volume kidney clinics.
• Participants (n=56) with estimated glomerular filtration rates < 45 mL/min/1.73 m² were assigned to either mHealth (wearable trackers and counseling) or EIM (mHealth plus directed exercise sessions).
• Assessments were performed at baseline, 8 weeks, and 16 weeks, with analyses using multilevel mixed models.

Main Results:

• In as-treated analyses, the EIM group showed improvements in daily step count and activity minutes at 8 weeks, while the mHealth group experienced declines.
• These group differences diminished by 16 weeks.
• No significant differences were observed in quality-of-life or mental health measures between groups.

Conclusions:

• A clinic-integrated referral to small-group exercise sessions (EIM) is a feasible and safe approach.
• This intervention demonstrated moderate effectiveness in enhancing physical activity among an underserved CKD population.
• Limitations include small sample size and study duration.