Face-to-Face Mentoring, Remotely Supervised Home Exercise Prehabilitation to Improve Physical Function in Patients Awaiting Kidney Transplantation: A Randomized Clinical Trial

Frontiers in Psychology. 2022;13:831445
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Abstract

Objective: This study aims to explore the feasibility, safety, and effectiveness of home exercise prehabilitation on a new social platform for remote guidance to optimize the physical function of patients with end-stage renal disease awaiting kidney transplantation and provide scientific guidance on home prehabilitation exercises for patients awaiting kidney transplantation. Methods: The subjects of this randomized clinical trial were randomly divided into the test and control groups. The control group maintained their exercise habits, while the trial group was given a 12-week personalized home prehabilitation exercise prescription (aerobic exercise + functional resistance exercise + flexibility exercise) on a new social platform with remote guidance. The participants' physical and cardiorespiratory fitness, quality of life, and psychological functioning were assessed before and after the intervention. The 6-min walk test (6MWT) walking distance and its percentage of attainment, the handgrip, the 5 repetition-sit-to-stand test, and the 4-m gait speed were used as primary outcome indicators, while the Short Form Health Survey SF-36 (health survey summary table) and the Hospital Anxiety and Depression scale were used as the secondary outcome indicators. Results: After 12 weeks of intervention, the changes in the 6MWT measured distance (+ 44.9 +/- 40.2, P = 0.001) and the percentage of 6MWT measured distance achieved (+ 6.8 +/- 5.7, P = 0.001), the handgrip (+ 2.7 +/- 4.3, P = 0.028), the 5-sit-to-stand test (-1.1 +/- 1.4, P = 0.005), and the 4-m walking speed (-0.3 +/- 0.4, P < 0.001) of the test group (n = 21) improved significantly. In the control group (n = 16), the changes in the 6MWT measured distance (-13.1 +/- 57.2), the 6MWT measured distance attainment percentage (-2.1 +/- 9.1), the handgrip (-0.1 +/- 2.5), the 5-sit-to-stand test value (0.6 +/- 2.2), and the 4-m walking speed (0.2 +/- 0.5) showed no significant difference. No significant improvement in anxiety, depression, and SF-36 was noted in both the test and control groups. Conclusion: The remote coaching of home exercise pre-habilitation on a new social platform significantly improves the physical and cardiopulmonary fitness of patients with end-stage renal disease awaiting kidney transplantation. This treatment is safe and feasible in this population.

CET Conclusion

Reviewer: Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
The small randomised controlled trial explored the feasibility and safety of a home prehabilitation exercise programme for patients with end-stage renal disease who are estimated to be within 12 weeks of receiving their first kidney transplant. A sample size calculation was based on improvement in the 6-minute walk test (6MWT) and indicated that a minimum of 40 patients were needed. Fifty-five patients were randomised but no details were given regarding the randomisation process and whether allocation was concealed. The prehabilitation intervention was a 12-week programme consisting of aerobic exercise, functional resistance training and stretching exercises. Eighteen out of 55 patients dropped out (7 and 11 patients from the prehabilitation and control groups, respectively) because of loss of interest, time conflicts or loss of contact, leaving 37 patients in the analysis. The primary outcomes 6MWT, handgrip, 5-repetition sit-to-stand test and 4-m gait speed all improved significantly from baseline to post-intervention in the prehabilitation group. However, the between-group analyses showed no significant differences for any of these outcomes post-intervention. The authors suggest that future studies need to evaluate the effectiveness of each exercise type further in a larger trial.

Methodological quality

Jadad score : 2
Allocation concealment : NO
Data analysis : PER PROTOCOL

Study details

Aims : This study aimed to investigate the feasibility, safety, and effectiveness of face-to-face mentoring, remotely supervised home exercise prehabilitation to optimize the physical functions of end-stage renal disease (ESRD) patients, and provide a guideline basis for home prehabilitation exercises for patients awaiting renal transplantation.
Interventions : Participants were randomised to 12 weeks of home exercise prehabilitation or to 12 weeks without home exercise prehabilitation.
Participants : 55 patients awaiting kidney transplantation.
Outcomes : The primary endpoints were 6-min walk test (6MWT) walking distance, 6MWT measured distance compliance percentage, grip strength, 5 repetition-sit-to-stand test (5R-STS), and 4-m gait speed. Secondary endpoints were hospital anxiety, depression, and quality of life.
Follow up : 12 weeks

Metadata

Funding : Non-industry funding
Publication type : Randomised Controlled Trial
Trial registration : ChiCTR2000037846
Organ : Kidney
Language : English
Author email : 15115296105@163.com
MeSH terms : kidney transplantation