Aerobic or Resistance Training and Pulse Wave Velocity in Kidney Transplant Recipients: A 12-Week Pilot Randomized Controlled Trial (the Exercise in Renal Transplant [ExeRT] Trial).

BACKGROUND: Cardiovascular disease remains the leading cause of death in kidney transplant recipients. This pilot study examined the potential effect of aerobic training or resistance training on vascular health and indexes of cardiovascular risk in kidney transplant recipients. STUDY DESIGN: Single-blind, randomized, controlled, parallel trial. SETTING & PARTICIPANTS: 60 participants (mean age, 54 years; 34 men) were randomly assigned to aerobic training (n=20), resistance training (n=20), or usual care (n=20). Participants were included if they had a kidney transplant within 12 months prior to baseline assessment. Patients were excluded if they had unstable medical conditions or had recently started regular exercise. INTERVENTION: Aerobic training and resistance training were delivered 3 days per week for a 12-week period. The usual-care group received standard care. OUTCOMES & MEASUREMENTS: Pulse wave velocity, peak oxygen uptake (Vo2peak), sit-to-stand 60, isometric quadriceps force, and inflammatory biomarkers were assessed at 0 and 12 weeks. RESULTS: The anticipated 60 participants were recruited within 12 months. 46 participants completed the study (aerobic training, n=13; resistance training, n=13; and usual care, n=20), resulting in a 23% attrition rate. Analyses of covariance, adjusted for baseline values, age, and dialysis vintage pretransplantation, revealed significant mean differences between aerobic training and usual care in pulse wave velocity of -2.2±0.4 (95% CI, -3.1 to -1.3) m/s (P<0.001) and between resistance training and usual care of -2.6±0.4 (95% CI, -3.4 to -1.7) m/s (P<0.001) at 12 weeks. Secondary analyses indicated significant improvements in Vo2peak in the aerobic training group and in Vo2peak, sit-to-stand 60, and isometric muscle force in the resistance training group compared with usual care at 12 weeks. There were no reported adverse events, cardiovascular events, or hospitalizations as a result of the intervention. LIMITATIONS: Pilot study, small sample size, no measure of endothelial function. CONCLUSIONS: Both aerobic training and resistance training interventions appear to be feasible and clinically beneficial in this patient population.

Captivating a captive audience: a quality improvement project increasing participation in intradialytic exercise across five renal dialysis units.

BACKGROUND: Benefits of exercise on dialysis (EOD) are well established, however, uptake in our local satellite haemodialysis units is low. The implications of the status quo are risks to treatment efficiency, equity and patient centredness in managing personal health risks. The current study aimed to identify and address barriers to exercise participation while on dialysis by substantiating local EOD risks, assigning context, implementing changes and evaluating their impact. Our primary objective was to increase the uptake of EOD across our five dialysis units. METHODS: Semi-structured interview and questionnaire data from patients and nursing staff were used to inform a root-cause analysis of barriers to exercise participation while on dialysis. Intervention was subsequently designed and implemented by a senior physiotherapist. It consisted of patient and nursing staff education, equipment modification and introduction of patient motivation schemes. RESULTS: Staff knowledge, patient motivation and equipment problems were the main barriers to EOD. A significant increase in the uptake of EOD from 23.3% pre-intervention to 74.3% post-intervention was achieved [χ2 (1, N = 174) = 44.18, P < 0.001]. CONCLUSIONS: Barriers to EOD are challenging, but there is evidence that patients wish to participate and would benefit from doing so. The input of a physiotherapist in the dialysis units had a significant positive effect on the uptake of EOD. National guidelines should encourage dialysis units to include professional exercise provision in future service planning.