Development and evaluation of a home-based exercise intervention for frail kidney transplant recipients using the...

International studies have reported that frailty prevalence among kidney transplant recipients ranges from 13.3% to 33.3%, while investigations in China indicated that preoperative frailty may affect up to 41% of recipients. The aim of this study was to develop a home-based exercise intervention program for frail kidney transplant recipients based on the "Attitude-Definition-Open mind-Planning-Try it out" (ADOPT) model and to evaluate its effectiveness in clinical practice.

By using a convenience sampling method, 120 frail kidney transplant recipients were recruited from an organ transplantation center at a grade A tertiary hospital in Shanxi Province between January 2022 and April 2024. Inclusion criteria: (1) meeting the diagnostic criteria for frailty based on the Fried phenotype; (2) age ≥18 years and ≤65 years; (3) undergoing kidney transplantation for the first time; (4) possessing normal listening, speaking, reading, and writing abilities; and (5) providing voluntary consent to participate in the study. Participants were randomly assigned to either a control group, which received standard postoperative care and routine outpatient follow-up, or an intervention group, which received the same standard care supplemented with a home-based exercise program structured according to the ADOPT model. The Attitude-Definition-Open mind-Planning-Try it out (ADOPT) model serves as a structured and dynamic nursing intervention framework, encompassing five key phases: Attitude (A), Definition (D), Open mind (O), Planning (P), and Try it out (T). Participants in the control group engaged in a self-directed, non-standardized home-based exercise regimen. On the day of discharge, researchers provided general discharge instructions and required participants to scan a QR code to join the department's follow-up WeChat group. Educational materials on exercise, medication, and diet were shared weekly in this group. Participants could also consult the research team regarding problems encountered during home exercise; the team provided guidance as needed, but without applying the structured ADOPT framework. Outcomes were measured at baseline and at 4-, 12-, 24-, and 48-weeks post-intervention. Evaluation metrics included the Fried Frailty Phenotype, grip strength, gait speed, Short Physical Performance Battery, Hospital Anxiety and Depression Scale, quality of life scores, and serum creatinine levels.

A total of 108 participants completed the study, with 55 in the intervention group and 53 in the control group. When compared to the control group, the intervention group demonstrated statistically significant improvements in Fried frailty scores, grip strength, gait speed, Short Physical Performance Battery scores, and overall quality of life (P < .05). Significant reductions in anxiety and depression scores were also observed (P < .01). No significant changes were found in serum creatinine levels in either group (P > .05).

The ADOPT model-based home exercise intervention program was found to be safe, scientifically grounded, and feasible for frail kidney transplant recipients. Preliminary findings support its potential to enhance post-operative physical functioning, daily living activities, and overall recovery quality in the early post-transplant period.