Home-Based Precision Multicomponent Exercise and Daily Steps in Non-Dialysis-Dependent Stages 3-5 Chronic Kidney...

Chronic kidney disease (CKD) is associated with reduced physical activity, impaired functional capacity, and diminished health-related quality of life (HRQoL). Evidence supports exercise benefits, but scalable delivery models embedded in nephrology care remain limited. We conducted a prospective, parallel-group, randomized clinical trial comparing a 24-week, home-based, multicomponent exercise program delivered by a physician-nurse team with standard care in adult patients with nondialysis-dependent CKD Stages 3-5. The intervention emphasized progressive walking, resistance training using elastic bands and bodyweight, and balance/mobility drills, with nurse-led check-ins (weekly through 12 weeks, then biweekly to 24 weeks). The primary outcome was daily steps assessed by accelerometry, and the secondary outcomes included handgrip strength, gait speed, five-times sit-to-stand, and six-minute walk distance (6MWD), plus HRQoL. Prespecified mediator analyses evaluated whether 24-week changes in functional metrics mediated the effect of group assignment on HRQoL change. Analyses followed intention-to-treat with mixed-effects models adjusted for demographic and clinical covariates. Among the 140 randomized participants, 117 (intervention 56; control 61) contributed to intention-to-treat analyses. Compared with usual care, the 24 week home-based, multicomponent exercise program produced greater increases in daily steps at 12 weeks (adjusted mean difference [aMD] 331.45 steps/day; 95% confidence interval: 205.34-457.56; P < .001) and 24 weeks (aMD 793.78; 95% confidence interval: 668. 77-918.79; P < .001). Physical function improved at 12 and 24 weeks, respectively: handgrip strength (aMD 1.93 kg and 1.36 kg; both P < .001), gait speed (0.09 m/s and 0.24 m/s; both P < .001), sit to stand (-1.92 s and -2.49 s; both P < .001), and 6MWD (22.12 m and 68.85 m; both P < .001). HRQoL improved, with mediation analyses indicating that gains in 6MWD accounted for approximately 21.0% of the effect on score. No life threatening adverse events occurred; reported events were mild and self limiting. Home-based, multicomponent exercise program integrated into routine nephrology workflows and delivered by a physician-nurse team improved physical activity, physical function, and HRQoL in patients with nondialysis-dependent CKD Stages 3-5.