Characteristics, Attitudes and Preferences of an End-Stage Kidney Disease Population at the Beginning of an Exercise Program: A Pragmatic Multicenter Trial

TL;DR

This study explores how end-stage kidney disease patients respond to different exercise options offered by a facilitator, finding that older and less active patients prefer supervised low-intensity programs.

Contribution

The study introduces a pragmatic approach to exercise facilitation for ESKD patients, highlighting preferences based on age and physical capacity.

Findings

Older patients with lower exercise capacity preferred supervised low-intensity training.

Most non-participants cited lack of interest or existing activity as reasons.

Patient choice was influenced by age and 6-minute walking test results.

Abstract

Background/Objectives: This multicenter nonrandomized pragmatic trial (NCT04282616), offering different options for active support by an exercise facilitator (EF) in the dialysis unit, aims to explore the attitudes and preferences of end-stage kidney disease (ESKD) patients in relation to their characteristics, capabilities and barriers. Methods: In six European dialysis units, an EF was set to offer to each ESKD patient able to walk four simple low-cost three-month interventions: (i) advised physical activity increase (U-PA-I); (ii) structured home-based walking exercise (S-HB-LI); (iii) in-hospital (pre/postdialysis) supervised walking and resistance low-intensity training (S-SU-LI); and (iv) performance assessment only (PPA). After collecting attitudes and perceptions of patients, the EF was available for counseling about the choice. Outcome measures were the percentage of engaged patients among the total population, the percentage of active interventions versus PPA and their distribution among the available options, as well as the factors related to patients’ choices (anthropometry, clinical, exercise capacity, and others). Results: Of the 297 eligible patients, 221 met the inclusion criteria, 176 (59%) of whom chose to participate (males, n = 113; aged 68 ± 10 years). The patients’ choices were as follows: S-SU-LI, (n = 80), S-HB-LI (n = 66), PPA (n = 25) and U-PA-I (n = 5). Patients in the LI group were significantly older (p < 0.001) and had a lower exercise capacity, as measured by the 6 min walking distance (p < 0.001). No significant differences in sex, distance from the dialysis center, dialysis duration, or recruiting site were recorded. The main reasons for nonparticipation were not being interested (67%) or already active (22%). Conclusions: In this exploratory research, patients exhibited positive attitudes toward exercise training and abandoning a sedentary lifestyle when counseled by an EF and when offered the possibility to choose. As the patient profile becomes more comorbid and frail, supervised and/or lower-intensity programs are preferred.

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