The Effect of a Prehabilitation Exercise Program on Physical Functioning for Patients Undergoing Kidney Transplantation

Condition(s) studied

Investigational drug(s) / intervention(s)

Exercise and Prehabilitation: All participants who are allocated to the exercise group will be asked to complete 4-5 days per week of mixed modality exercise incorporating aerobic, resistance, and flexibility training. The aerobic component can include any modality the patient is capable of doing, including walking, swimming or biking. By the end of the prehabilitation period the target will be 30 minutes of aerobic exercise three times a week at an intensity of 3-5 RPE. The resistance component will include 5-6 exercises using body weight and resistance bands. The target will be 12 repetitions and 3 sets, two times a week. The flexibility component will include 5 exercises that can be completed at the end of each session. Participants will self-report their participation in the prehabilitation program based on an electronic survey.

Study summary

Pre-operative physical functioning has been acknowledged as a factor influencing post-operative complication risk, recovery progression and mortality risk. Current guidelines have yet to focus on the pre-operative period as a potential target to improve levels of physical functioning before renal transplantation. This project proposes the introduction of an exercise intervention pre-operatively to mitigate functional decline pre-operatively and improve post-operative outcomes following renal transplantation.

We hypothesize that a home-based exercise prehabilitation program prior to kidney transplantation will result in improved functional outcomes including the 6-minute walk test, 60-second timed sit to stand, Fried Frailty Score, quality of life and fatigue. Further we hypothesize that prehabilitation will result in improved outcomes regarding post-operative recovery, complication rate, length of stay and mortality.

Objectives

A) Identify whether a prehabilitation program can mitigate functional decline pre-operatively regarding walking speed, strength, endurance, quality of life and fatigue

B) To determine whether a tailored home-based exercise program prior to kidney transplantation is feasible with regards to adherence in patients with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD).

C) To determine if a prehabilitation program results in improved clinical outcomes within one week following Kidney Transplantation (KT) as well as at 30 and 90 days including but not limited to time to first ambulation, time to first bowel movement, postoperative complications (Clavien-Dindo classification), mortality and length of stay.

D) Quantify the differences described above, if any exist.

Eligibility

Primary outcome measure(s)

• Change in 6-minute walk test (6-MWT). — Change from baseline to 1 week prior to renal transplantation. Again, change from 1 month post transplant to 6 month post transplant.
  Change from baseline in metres (m).
• Change in 30-second timed sit to stand. — Change from baseline to 1 week prior to renal transplantation. Again, change from 1 month post transplant to 6 month post transplant.
  Change from baseline in number of repetitions completed in 30 seconds.
• Change in Fried Frailty Score. — Change from baseline to 1 week prior to renal transplantation. Again, change from 1 month post transplant to 6 month post transplant.
  Change from baseline, score based on a 4-point scale.
• Change in fatigue level. — Change from baseline to 1 week prior to renal transplantation. Again, change from 1 month post transplant to 6 month post transplant.
  Change from baseline, score based on a 13 point scale.
• Change in quality of life (QOL). — Change from baseline to 1 week prior to renal transplantation. Again, change from 1 month post transplant to 6 month post transplant.
  Change from baseline, score based on a 25 question survey.
• Time to first ambulation following kidney transplantation. — One week following kidney transplant.
  Assessed in days.
• Time to first bowel movement following kidney transplantation. — One week following kidney transplant.
  Assessed in days.
• Change in number of participants with post operative complications. — Change from 1 week following kidney transplant to 30 and 90 days post operatively.
  Number of participants with post operative complications as assessed by Clavien-Dindo classification.
• Length of hospital stay following kidney transplantation. — One week following kidney transplant.
  Assessed in days.

Trial sites (1)

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