Exercise for Kidney Failure

Overseen By Deborah Zimmerman, MD, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ottawa Hospital Research Institute

Disqualifiers: Unstable angina, Uncontrolled hypertension, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

90 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if adding a specific exercise routine to regular care can improve the well-being of individuals on long-term dialysis. Participants will use Nordic Walking poles and receive online resources for home exercises, a pedometer to track their steps, and monthly encouragement from dialysis staff. The study seeks adults with end-stage kidney disease who have been on peritoneal dialysis or hemodialysis for over six months and can safely engage in exercise. As an unphased trial, this study offers a unique opportunity to contribute to research that could enhance the quality of life for dialysis patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on exercise for patients on dialysis, so it's best to discuss your medications with the trial team or your doctor.

What prior data suggests that this exercise intervention is safe for patients with kidney failure?

Research has shown that exercise is safe for people with chronic kidney disease (CKD), including those on dialysis. One study found that a 4-week supervised exercise program was not only safe but also had a high completion rate among CKD patients. Another report indicated that exercising during dialysis sessions did not cause any problems.

Exercise also improved physical abilities like walking and standing up from a chair, which are important for daily activities. Experts suggest that dialysis patients aim for 150 minutes of moderate exercise each week to enhance overall health and quality of life.

Overall, exercise is well-tolerated and has demonstrated positive effects in people with kidney issues without causing harm. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the exercise prescription for kidney failure because it represents a proactive, non-pharmaceutical approach to managing the condition. Unlike standard treatments that focus on medical interventions and medications, this method emphasizes regular physical activity tailored to the individual's needs, which could enhance overall health and potentially improve kidney function. Additionally, it aims to empower patients by integrating more physical activity into their daily lives, which is a shift from the usual care that primarily involves verbal encouragement without a structured plan. This approach could lead to improved quality of life and possibly slower progression of kidney disease, offering a promising complement to existing treatments.

What evidence suggests that this exercise intervention is effective for kidney failure?

Research shows that exercise can help people with kidney failure. Studies have found that regular physical activity significantly lowers blood pressure in individuals over 50 with kidney problems. Other research highlights that exercise improves physical abilities, such as rising from a chair and walking longer distances. In this trial, participants in the Exercise Intervention arm will receive an exercise prescription alongside standard care. A 12-month exercise program has also led to better physical function compared to usual care. Additionally, maintaining a long-term exercise routine may slow the decline in kidney function over time. These findings suggest that exercise could benefit those on dialysis. ^{1 5 6 7 8}

Who Is on the Research Team?

Deborah Zimmerman, MD, MSc

Principal Investigator

Ottawa Hospital Research Institute

Are You a Good Fit for This Trial?

This trial is for adults with end stage kidney disease who have been on dialysis for over six months, can walk, understand English or French, and are willing to use Nordic Walking poles. It's not suitable for those with conditions like unstable angina or uncontrolled high blood pressure, a daily step count over 8000 steps, an upcoming kidney transplant from a living donor, potential renal recovery, reliance on other mobility aids they feel unsafe replacing with walking poles, or participation in another conflicting trial.

Inclusion Criteria

I can understand English or French.

Abuse to use Nordic Walking poles

I have severe kidney disease and can walk.

Exclusion Criteria

I am scheduled for a kidney transplant from a living donor.

I feel unsafe using Nordic walking poles instead of my usual mobility aid.

My kidney function is expected to improve.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive the exercise intervention for 12 months, including Nordic Walking poles, online resources, pedometer use, and monthly encouragement

12 months

Monthly visits (in-person or virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Exercise Prescription

Trial Overview The study tests if exercise helps people receiving chronic dialysis. Participants will be randomly assigned to either receive standard care or add an exercise program using Nordic Walking poles and online resources for one year. Their progress will be tracked with pedometers and encouraged by staff monthly.

How Is the Trial Designed?

Group I: Exercise Intervention Experimental Treatment 1 Intervention

Participants in this arm will receive standard of care along with the exercise prescription intervention

Group II: Standard of Care Active Control 1 Intervention

This group will receive standard of care treatment including regular verbal encouragement to exercise (monthly) by dialysis unit staff.

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Published Research Related to This Trial

Recent evidence supports the use of exercise-based rehabilitation for individuals with chronic kidney disease (CKD), highlighting its potential to improve health-related quality of life and overall outcomes.

There is a growing commitment within the kidney research community to implement practical exercise interventions, including options for prehabilitation and post-transplant rehabilitation, as well as tailored programs for those undergoing hemodialysis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise as a therapeutic intervention in chronic kidney disease: are we nearly there yet? Castle, EM., Billany, RE., Lightfoot, CJ., et al.[2023]

Patients with kidney failure undergoing dialysis have significantly low exercise capacity, which affects their ability to perform daily activities and work, but this can be improved through interventions like kidney transplants and exercise training.

Epoetin therapy can help correct anemia in these patients, leading to increased exercise tolerance; however, the improvement in exercise capacity is modest compared to the increase in hematocrit levels, suggesting that additional exercise training and motivation are essential for maximizing physical function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The importance of exercise training in rehabilitation of patients with end-stage renal disease. Painter, P.[2005]

Kidney transplant recipients generally engage in lower levels of physical activity compared to the general population, which can lead to reduced quality of life and increased mortality risk.

Exercise training interventions are safe for kidney transplant recipients and have been shown to improve both quality of life and exercise capacity, indicating a potential benefit that warrants further research into long-term cardiovascular outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Activity in Kidney Transplant Recipients: A Review. Takahashi, A., Hu, SL., Bostom, A.[2019]

A 12-month supervised exercise program for older adults with advanced chronic kidney disease (CKD) was found to be safe and well-tolerated, with no significant increase in adverse events reported.

Participants in the exercise group showed significant improvements in physical functioning, including a greater distance walked in the 6-minute walk test and better performance on the Timed Up and Go Test, indicating that exercise can enhance physical capabilities in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Long-term Exercise Training on Physical Performance and Cardiorespiratory Function in Adults With CKD: A Randomized Controlled Trial. Weiner, DE., Liu, CK., Miao, S., et al.[2023]

This nonrandomized trial aims to improve the physical function and quality of life in patients with end-stage kidney disease (ESKD) through various low-intensity exercise programs, highlighting the importance of patient choice in their exercise regimen.

The study will assess the feasibility, safety, and adherence to these exercise interventions over three months, with outcomes including aerobic capacity, quality of life, and long-term clinical results, providing valuable insights into effective strategies for increasing physical activity in ESKD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Personalized Patient-Centered Intervention to Empower through Physical Activity the Patient in the Dialysis Center: Study Protocol for a Pragmatic Nonrandomized Clinical Trial. Manfredini, F., Lamberti, N., Battaglia, Y., et al.[2021]

Patients with chronic kidney disease (CKD) who are on dialysis typically have low exercise capacity and physical functioning, but regular exercise training can significantly improve these aspects.

Despite the clear benefits of exercise for CKD patients, the nephrology community has not yet integrated exercise recommendations into standard care practices, highlighting a need for better implementation of exercise counseling in treatment plans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing exercise: what do we know? Where do we go? Painter, P.[2022]

Exercise is increasingly recognized as an effective treatment and preventive measure for various medical conditions, including chronic kidney disease, which affects about 10% of the population.

The review highlights that exercise can improve cardiovascular health, reduce inflammation, and enhance physical functioning in kidney disease patients, suggesting it should be integrated into clinical management strategies for all stages of the condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Exercise as medicine" in chronic kidney disease. Wilkinson, TJ., Shur, NF., Smith, AC.[2022]

A 10-week supervised resistance exercise program significantly improved health-related quality of life and physical performance in 16 kidney transplant recipients, with notable enhancements in specific quality of life domains and physical tests like the 6-minute walk distance and handgrip strength.

The exercise intervention was safe, with no reported adverse events or injuries, indicating that resistance training can be a beneficial and safe rehabilitation strategy for kidney transplant patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a resistance training program in kidney transplant recipients: A randomized controlled trial. Hernández Sánchez, S., Carrero, JJ., Morales, JS., et al.[2021]

In a study of 130 patients with chronic kidney disease, those on renal substitution therapy for less than 6 months engaged in more physical activity compared to those diagnosed longer, suggesting early intervention may encourage activity levels.

Higher levels of moderate and vigorous physical activity were linked to better physical functioning and general health perceptions, particularly in women and patients diagnosed between 7 to 18 months, indicating that physical activity can enhance quality of life in chronic kidney disease patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Association of physical activity with quality of life in patients with chronic kidney disease]. Pinillos-Patiño, Y., Herazo-Beltrán, Y., Gil Cataño, J., et al.[2021]

A 6-month personalized walking exercise program for patients with kidney failure significantly reduced the long-term risk of hospitalization or death by 29% during a follow-up of up to 36 months, based on data from 227 participants.

Patients who adhered to the exercise program (attending more than 60% of sessions) experienced an even greater benefit, with a 45% lower risk of hospitalization or death compared to the control group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-Term Effect of Physical Exercise on the Risk for Hospitalization and Death in Dialysis Patients: A Post-Trial Long-Term Observational Study. Mallamaci, F., D'Arrigo, G., Tripepi, G., et al.[2023]

Exercise interventions, particularly moderate-intensity activities like walking, are effective in improving fitness and health outcomes for patients with chronic kidney disease (CKD), as recommended by updated KDIGO guidelines.

Incorporating exercise into CKD care can reduce mortality and morbidity associated with a sedentary lifestyle, and even more vigorous exercise can be safely prescribed to patients with various comorbidities for greater health benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of exercise training in the management of chronic kidney disease. Howden, EJ., Coombes, JS., Isbel, NM.[2015]

A study of 133 kidney transplant recipients revealed that they spent an average of 9.4 hours per day being sedentary and only engaged in about 20.7 minutes of moderate-to-vigorous physical activity, indicating a need for increased physical activity among this population.

Factors such as age, body mass index, education, and income were found to influence levels of physical activity and sedentary time, suggesting that targeted interventions could help improve activity levels and reduce sedentary behavior in kidney transplant recipients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevalence and Correlates of Accelerometer-Based Physical Activity and Sedentary Time Among Kidney Transplant Recipients. Vallance, JK., Johnson, ST., Thompson, S., et al.[2022]

Patients with chronic kidney disease (CKD) and those on dialysis are often sedentary, with many not engaging in any physical activity, which is linked to higher risks of health complications and mortality.

The review highlights the importance of physical exercise in improving clinical outcomes for CKD and dialysis patients, emphasizing the need for specific exercise recommendations to combat the negative effects of a sedentary lifestyle.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial. Mallamaci, F., Pisano, A., Tripepi, G.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5337868/

Physical Exercise and Patients with Chronic Renal Failure The results of subgroup analyses show that, in the age >50, physical activity can significantly reduce blood pressure in patients with renal failure.

2. bmcnephrol.biomedcentral.com bmcnephrol.biomedcentral.com/articles/10.1186/s12882-021-02618-1

Clinical practice guideline exercise and lifestyle in chronic ... We recommend that haemodialysis patients should aim for 150 min of moderate intensity activity a week (or 75 min of vigorous activity) or a ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10552838/

Exercise as a therapeutic intervention in chronic kidney ... The intervention led to clear improvements in physical function (the sit-to-stand-60, the timed up and go, and the six-minute walk test) ...

4. evidence.nejm.org evidence.nejm.org/doi/full/10.1056/EVIDoa2300057

Exercise during Hemodialysis in Patients with Chronic Kidney ... Twelve months of intradialytic exercise in patients with kidney failure significantly improved the STS60 compared with usual care.

5. sciencedirect.com sciencedirect.com/science/article/pii/S246802492401862X

Review of Exercise Interventions to Improve Clinical ... This analysis found that a 2-year exercise intervention led to approximately 0.5 ml/min per 1.73 m2 per year slower decline in eGFR compared to health education ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10616430/

Examining the safety and effectiveness of a 4-week ... The 4 weeks of supervised exercise was safe, was associated with an excellent completion rate and improved frailty parameters in CKD patients with CKD.

7. kireports.org kireports.org/article/S2468-0249(24)01862-X/fulltext

Review of Exercise Interventions to Improve Clinical ... The potential benefits of exercise training in CKD range from slowing disease progression to improving comorbidities and quality of life.

8. sciencedirect.com sciencedirect.com/science/article/pii/S2013251421001255

Impact and safety outcomes of an intradialytic physical ... In 100% of the cases, it was shown that carrying out a physical exercise regimen during dialysis was safe since there were no complications, neither during nor ...