The Effect of Intradialytic Resistance Exercises Using Resistance Bands With Exercise Physiologist Consultation on the Physical Function of People Undergoing Hemodialysis: a Proof of Concept Study
Phase: NA
Conditions: End Stage Renal Failure on Dialysis, Frail Elderly Syndrome
Sponsor: Satellite Healthcare

 
IDEX Protocol - Confidential                                                                            Page 1 of 20 
 
 
 
Protocol Title: 
 
The effect of intradialytic resistance exercises using 
resistance bands with exercise physiologist consultation on 
the physical function of people undergoing hemodialysis: a 
proof of concept study 
 
Principal Investigator: 
  
 
C. Dyer Diskin, M.D. 
300 Santana Row, Suite 300, San Jose, CA 95128 
 
 
 
Additional 
Investigators: 
  
 
Paul Bennett PhD, Wael Hussein M.D 
 
Satellite Healthcare 
Study Number: 
 
SH066IDEX 
 
Funding Sponsor:  
 
Satellite Healthcare  
300 Santana Row, Suite 300, San Jose, CA 95128 
Ph: 650.404.3640 F: 650.625.6040 
 
 
Initial Version: 
Amended Version: 
Approved Version: 
 
 
2nd October 2018 
19th November 2018 
10th December 2018 
  
 
 
 
 
 

 
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1. 
Background and Significance  
Patients with end-stage renal disease (ESRD) receiving in-center hemodialysis 
(HD) suffer from high rates of frailty, physical inactivity and mortality.  While the 
prevalence of frailty in older adults (>65 years of age) in the community dwelling 
population has been measured around 7%,1 in those undergoing in center 
hemodialysis the prevalence has been found to be as high as 73%.2  Even the rate 
of frailty in the younger (<65) HD population has been measured as high as 36%.3 
In a study that defined frailty using the Fried Frailty Index (FFI) for the 
hemodialysis population, frailty was associated with a 40.2% 3 year mortality 
compared to the rate of 16.2% in the same non-frail ESRD population.3  Overall, 
this correlated with 2.7 times greater risk of death (95% CI 1.02-7.07, p=0.046) 
independent of age, sex, comorbidity and disability. Another study examined the 
various components of frailty (weight loss, exhaustion, low physical activity, 
weak grip strength and slow gait speed) finding that over a 3.8-year time period, 
one component of frailty was associated with a hazard ratio of 2.73. This hazard 
ratio increased to 10 for patients with all 5 components.4 Exercise has been 
promoted as a way to combat or slow the progression of frailty across many 
disciples and age groups.  However, exercise in the ESRD patient population 
remains challenging. 
 
Intradialytic exercise has been a subject of several investigative studies for the 
past several decades.  A Cochrane systematic review in 2011 found there to be 
significant benefit in patient’s aerobic capacity, resting blood pressure, and 
health-related quality of life from exercising three times per week for greater than 
30 minutes per HD session.5  There have been several examples in the literature 
of exercise studies and subsequent meta-analysis that have shown improvement in 
many of the physical fitness tests used to measure frailty such as the 6 minute 
walk test (6MWT), Timed Get up and Go Test (TUG), Maximum Walking Speed 
Test, Sit to Stand Test (STS) and overall metabolic equivalents achieved.6,7,8,9  
These exercise routines usually involve either aerobic exercise, resistance exercise 
or a combination of the two for at least 30 minutes during the 1st two hours of 

 
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each HD session.  The use of resistance exercises via elastic bands alone has been 
shown to improve the patient’s 30 second STS test and 8-foot TUG test.10   
 
Despite the known benefits of exercise, there are no formal intradialytic exercise 
protocols in the United States.  The main barriers in the US are thought to be 
interference with the workflow of an outpatient dialysis center as well as high 
rates of patient non-adherence and drop out. A German single-center long term 
study employing exercise professionals measured 1 and 5-year adherence at 78% 
and 43% respectively.11 Unfortunately the data on adherence and efficacy in the 
United States is lacking. This remains a challenge across the world as 
nephrologists and dialysis center staff are thought to lack the personnel and 
resources needed to advise dialysis patients on individualized exercise regimens.12 
 
A test of the feasibility and efficacy of an intradialytic exercise (IDEx) strategy 
will be the primary intent of this project. This IDEx study will consist of an 
exercise physiologist consultation with HD patients once a week during their 3 
times weekly in-center HD sessions over a 3-month period.  At these 
consultations, exercise physiologists will perform physical assessments and 
develop individualized resistance exercise plans using elastic bands. The exercise 
physiologist will continue to visit with the patient once weekly after the initial 
consultation over the 3-month period. The effects of the resistance exercise 
regimens on physical function will be measured.  
 
2. 
Study Aims 
The primary objective of this study will be to test the feasibility and efficacy of a 
3 month exercise physiologist consultation program. Specifically, our aims will be 
to: 
a. Test the feasibility of a 3-month exercise physiologist led program  
b. Measure the effect of an exercise physiologist collaboration and intradialytic 
exercise on the physical function of HD patients using the 30 second STS test, 

 
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handgrip strength test [required for frailty scale], 8-foot TUG test and patient 
physical activity based off of the Low Physical Activity Questionnaire.   
 
3. 
Administrative Organization 
The study will be administered from Satellite Healthcare, Inc., 300 Santana Row, 
Suite 300, San Jose, CA, 95128. The study site will be Satellite Healthcare 
Milpitas.  1860 Milmont Dr, Milpitas, CA, 95035.   
 
4. 
Study Design 
a. Experimental design of the study  
Randomized controlled trial (RCT) proof of concept study design 
b. Study population  
Convenience sample from prevalent HD patients from Satellite Milpitas 
Hemodialysis center in Northern California. 
c. Sample size  
 
      n=50 (25 intervention - 25 control) 
d. Study Outcomes 
Feasibility outcomes 
 Adherence calculated as the total number of self-reported exercise 
sessions attempted by the patient when EP not present divided by the total 
number of hemodialysis sessions. This information will be collected from 
the patient at the weekly meeting with the EPs.  
 Adverse events defined as any injury, impairment or medical condition 
that was directly or suspected to be due to performing the prescribed 
exercise. 
Efficacy Outcomes 
 Change in physical function as measured by the 30 second sit to 
stand test (STS), handgrip strength test (HGST) and the 8 foot timed up 
and go test (TUG). Performed prior to initiation of dialysis at their mid-
week dialysis session.  
 

 
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5. 
Study Procedures 
a. Subject selection procedures 
The Principal Investigator is responsible for screening subjects for the study, 
ensuring subjects meet all inclusion criteria. 
b. Inclusion criteria  
 Age 18 years or greater 
 Ability to understand and communicate English 
 Diagnosis of ESRD and currently undergoing in-center hemodialysis 
 On HD for longer than 6 weeks 
 Approved by the Satellite Milpitas Medical Director and/or referring 
physician  
c. Exclusion criteria 
 Previous major amputations 
 Inability to independently ambulate 
 Known to be pregnant 
d. Recruitment procedures  
 The Satellite Healthcare database will be used to identify all in-center 
hemodialysis patients at the Satellite Milpitas Dialysis Center  
 This list of potential subjects will be approved by the Satellite Milpitas 
Medical Director who will screen to ensure they meet inclusion criteria.   
 The study research associate (RA) and PI (Dr. Diskin) will meet with the 
potential screened subjects in the dialysis center at the patient’s weekly 
dialysis sessions  
 The RA and PI will describe the study using a one-page information sheet 
and consent form as approved by the IRB. 
 The RA and PI will offer the patient to take the information home and 
discuss with their relatives and significant others   
 The RA and PI will then approach eligible participants again to consent to 
participate in the study.  After consent is obtained, participants will be 
randomized into two groups using sequentially numbered opaque sealed 
envelopes.  

 
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e. Study Intervention 
 12 exercise physiologist consultations over 12 weeks 
 Up to 3 exercise physiologists will implement an individualized resistance 
exercise program using elastic bands 
f. Study Measures and Activities 
 Subjects will meet with an exercise physiologist once weekly during one 
of their usual in-center HD sessions over a 3-month period.  
 At the initial visit, the following physical function tests will be performed 
on the patient by EP: STS, HGST and TUG.   
 At subsequent consultations, exercise physiologists will provide exercise 
plans and collect feedback on the exercises from the patients.  
 EPs will tailor exercise routines to the individual patients based on a 
combined aerobic and resistance exercise program.   
Aerobic Exercise 
Participants will be asked to commence at a minimum of walking 3 times 
per week commencing at 20 minutes, and increasing both intensity and 
time up to 30 minutes x 3 times per week.  
Resistance Exercise 
Participants will be instructed to initially exercise various upper, core and 
lower body muscle groups using resistance bands for 1 set of 10 
repetitions twice weekly. Intensity and repetitions of exercises will be 
adapted to participants’ abilities throughout the 12 weeks. Warm up and 
warm down exercises will be included where relevant. 
 Weekly progress notes and exercise checklists will be employed to 
monitor the types of exercises used.  (see attachments f-h) 
 The estimated duration for the appointments will be 30 minutes 
 A modified version of the Fried Frailty Index Score will be used to assess 
for the presence of frailty in both groups at the start of the study.  The 
modification will be the replacement of the Minnesota Leisure Time 
Activity Questionnaire (MLTAQ) used to measure the low physical 
activity portion of the FFI with the Low Physical Activity Questionnaire 

 
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(LoPAQ).  This was previously compared to the MLTAQ in a study of 
dialysis patients14.  
 Exercise physiologist will encourage patients to complete their 
individualized exercise routines during their dialysis sessions for which 
the EP is not present but also at home at their convenience.   
 Adverse events can be reported directly to the center manager or the PI. 
The EP will ask directly about adverse events at every meeting.    

 
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6. 
Data Analysis Plan 
Demographic data: age, gender, ethnicity, weight, BMI, end stage kidney disease 
cause, co-morbid conditions, vintage on dialysis, dialysis treatment details and 
biochemical indices will be collected. Paired t-test or Wilcoxon-sign-rank will be 
used to compare the pre and post intervention STS, Hand Grip Test, TUG and 
modified FFI results depending on the distribution of the data. Patients who drop 
out or withdraw from the study will be included in the final outcomes with 
intention-to-treat analysis.   
 
 
 
 
 
 
 
 
 
 
7. 
Timeline 
 
Timeline (months) 
1 
2 
3 
4 
5 
6 
7 
Refine protocol 
  
  
  
 
 
 
 
Staff in-services 
 
 
 
 
 
 
 
Patient recruitment 
  
  
  
 
 
 
 
Exercise physiology intervention 
  
  
  
 
 
 
 
Evaluation interviews 
 
 
 
 
 
 
 
Data cleaning  
 
 
 
 
 
 
 
Data analysis 
 
 
 
 
 
 
 
Papers/Report write up 
  
  
  
 
 
 
 

 
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IDEx Data Collection Plan 
 
Test 
Initial 
Assessment 
Week 1 
Week 2 
Week 3 
Week 4 
Week 5 
Week 6 
Week 7 
Week 8 
Week 9 
Week 10 
Week 11 
Week 12 
Demographic 
 
Name/MR No. 
 
DOB/Age 
 
Gender 
 
Racial Origin 
 
Height 
 
Smoker 
 
Dialysis 
Vintage 
(months) 
 
Renal Disease 
 
 
 
x 
 
 
 
 
 
 
 
 
 
 
 
 
Comorbidities 
 
Lung 
 
PVD 
 
Cerebral 
 
Diabetes 
 
Hypertension 
 
Heart Failure 
 
x 
 
 
 
 
 
 
 
 
 
 
 
 
Dialysis Info 
 
Weight (dry) 
 
BMI 
 
KtV  
 
Hb, PO4, K 
 
Blood 
Pressure 
 
x 
 
 
 
 
 
 
 
 
 
 
 
 
 
Physical Function 
Tests 
 
Sit to Stand  
 
x 
 
 
 
 
 
 
 
 
 
 
 
 
x 
 
Timed up and 
go 
x 
x 
 
Hand Grip 
x 
x 
Modified Fried 
Frailty Index 
x 
 
EP Meeting Record 
x 
x 
x 
x 
x 
x 
x 
x 
x 
x 
x 
x 
x 

 
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References 
 
1. Fried LP, Tangen CM, Walston J et al. Frailty in older adults: Evidence for a 
phenotype. J Gerontol A Biol Sci Med Sci 2001;56A:M146–M156. 
2. Yeran Bao, MD; Lorien Dalrymple, MD, MPH; Glenn M. Chertow, MD, MPH; 
George A. Kaysen, MD, PhD; Kirsten L. Johansen, MD. Frailty, Dialysis Initiation, 
and Mortality in End-Stage Renal Disease. Arch Intern Med. 2012 Jul 
23;172(14):1071-7 
3. McAdams-DeMarco MA, Law A, Salter ML, Boyarsky B, Gimenez L, Jaar BG, 
Walston JD, Segev DL. Frailty as a novel predictor of mortality and hospitalization in 
individuals of all ages undergoing hemodialysis. J Am Geriatr Soc. 2013 
Jun;61(6):896-901 
4. Johansen KL, Delgado C, Kaysen GA, Chertow GM, Chiang J, Dalrymple LS, Segal 
MR, Grimes BA. Frailty among patients receiving hemodialysis: evolution of 
components and associations with mortality. J Gerontol A Biol Sci Med Sci. 2018 
Sep 5. 
5. Heiwe, S & Jacabson, S: Exercise training for adults with chronic kidney disease. 
Cochrane Database Of Systematic Reviews: Art. No.: CD003236, 2011. 
6. Ji‑Hyung Cho.,Ji‑Yeon Lee, Sukyung Lee, Hyuntae Park, Seung‑Wook Choi, Jun 
Chul Kim. Effect of intradialytic exercise on daily physical activity and sleep quality 
in maintenance hemodialysis patients. International Urology and Nephrology (2018) 
50:745–754.  
7. Guio BM, Gomes CP, Costa FBD, Oliveira ADS, Duarte MT, Leite M Júnior. 
Beneficial effects of intradialytic cardiopulmonary rehabilitation. J Bras Nefrol. 2017 
Jul-Sep;39(3):275-282 
8. Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, 
Churchward DR, Highton P, Smith AC, Singh SJ, Bridle C, Burton JO. Effects of 
intradialytic cycling exercise on exercise capacity, quality of life, physical function 
and cardiovascular measures in adult haemodialysis patients: a systematic review and 
meta-analysis. Nephrol Dial Transplant. 2018 Mar 28 
9. Gomes Neto M, de Lacerda FFR, Lopes AA, Martinez BP, Saquetto MB.Intradialytic 
exercise training modalities on physical functioning and health-related quality of life 
in patients undergoing maintenance hemodialysis:  systematic review and meta-
analysis. Clin Rehabil. 2018 Sep;32(9):1189-1202.  
10. Bennett P, Fraser S, Barnard R, Haines T, Ockerby C, Street M, Wang W, Daly R. 
Effects of an intradialytic resistance training programme on physical function: a 
prospective stepped-wedge randomized controlled trial. Nephrol Dial Transplant 
(2015) O:1-8 
11. Anding K, Bär T, Trojniak-Hennig J, Kuchinke S, Krause R, Rost JM, Halle M. A 
structured exercise programme during haemodialysis for patients with chronic kidney 
disease: clinical benefit and long-term adherence. BMJ Open. 2015 Aug 
27;5(8):e008709. 
12. Bennett, PN. Peter, J. Wang, W. & Street, MA. (2016) Nurse perceptions of enablers 
and barriers to exercise on dialysis. Nephrology Nursing Journal 43(4). 331-337 
13. Bennett, PN., Daly, R., Frazer, S, Haines, T. Ockerby, C. Kent, B., (2013) The 
impact of an exercise physiologist coordinated resistance exercise program on the 
physical function of people receiving hemodialysis: A stepped wedge randomized 
control study. BMC Nephrology 14:204  
14. Johansen KL, Painter P, Delgado C, Doyle J. Characterization of Physical Activity 
and sitting time among patients on Hemodialysis using a new physical activity 
instrument. Journal of Renal Nutrition 25:1, 2015 25-30 

 
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8. 
Attachments 
 
a. 30 Second Sit to Stand 
b. Handgrip Strength Test  
c. 8 Foot Timed Up and Go 
d. Modified Fried Frailty Index 
e. Low Physical Activity Questionnaire 
f. EP Weekly Progress Note  
g. EP Exercise Plan 
h. EP Weekly Checklist  
i. Pre and Post Intervention Assessment 
 
 
 

 
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a.   30 Second Sit to Stand 
 
Method 
Use a straight back chair with a solid seat that is 16” high.  Ask participant to sit 
on the chair with arms folded across their chest.   
 
Instructions  
“Stand up and sit down as quickly as possible, keeping your arms folded across 
your chest.  Do this for 30 seconds.”   
 
Measurement 
The person testing counts the times the client comes to a full standing position in 
30 seconds. 
 
Reference: (Jones, Rikli, & Beam, 1999) 

 
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b. Handgrip Strength Test 
 
Materials Needed: 
 Handgrip strength Dynamometer 
 Paper, pen/pencil (to record scores) 
 
Instructions: 
1. Illustrate the use of the instrument to the patient prior to testing 
2. The patient should be in a standing position, arms to their side, not 
touching their body.  Elbow slightly bent. 
3. Ask the patient to squeeze the dynamometer with as much force as 
possible, being careful to squeeze only once for each measurement. 
4. Three trials should be made with a pause of about 10-20 seconds 
between each trial to avoid muscle fatigue 
5. Record the result of each trial to the nearest kilogram.  If the difference 
of the score is > 3 kgs, then repeat the test once more after a rest 
period. Use the average of 3 measurements. 
6. For dialysis patients the non-fistula dialysis arm will be used.  If both 
arms have a fistula, then the arm with the inactive fistula will be used.  
If no fistula is present, then the non-dominant arm will be used.   
 
 
Reference: (Handgrip Strength Protocol. Tufts University Nutrition 
Collaborative, 2003) 
 
 
 

 
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c. 8 Foot Timed Up and Go 
 
Equipment/set-up 
Place a chair (approximately 17 inches in height) against a wall or firm object for 
safety to prevent it from sliding backwards. Place a cone on the floor exactly 8 ft 
away (distance measured is from the front edge of the chair to the back edge of 
the cone). Ensure a minimum of 4 ft of clearance beyond the cone to allow for 
turning room. A stopwatch is also required. 
 
Starting Position  
Patient is seated in the chair with hands on thighs and feet flat on the floor. 
 
Protocol  
Patient is instructed that on the signal “go,” they are to rise from the chair 
(pushing off of thighs or chair is permitted), walk “as quickly as possible” around 
the cone and return to a seated position in the chair. The participant is told that 
they will be timed and should therefore walk as quickly as possible but not to run. 
Following a demonstration, the patient is allowed one practice trial followed by 
two test trials. 
 
Scoring 
The clinician begins the timer when the “go” signal is given (even if the patient 
has not begun to move) and stops the time at the exact instant that the 
participant’s buttocks contacts the chair following the walk segment. Note the 
scores of both test trials to the 1/10th second yet the faster of the two times is 
recorded on the assessment form for evaluation purposes. Results obtained with 
this test may be compared to age-related normative values.  
 
Adaptation  
Use of an assistive device is permitted if required (remember to mark what type of 
device the patient used on the evaluation form) yet does not allow for comparison 
with age related, normative values from the Senior Fitness Test. Be sure to retest 
the patient using the same device on following visits. Additional trials can be 
administered without a device or a different type of device if appropriate. 
 
Score > 8.5 seconds is associated with high fall-risk in community-dwelling older 
adults.  
 
Reference: (Rose, Jones, & Lucchese, 2002) 
 
 
 
 
 
 

 
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d. Modified Fried Frailty Index (Frailty = > 3 of the below criteria) 
 
 
Fried Frailty Index V2.0 
Category 
Criteria 
Weight Loss 
 
If yes, give one point towards frailty.  
 
Self-reported weight loss > 10 lbs/year based 
off dry weight. (Yes or No) 
Physical endurance/energy 
 
If No to #1 OR if every day/every week given 
as #2 give one point towards frailty.  
1. Do you feel full of energy? (Yes or 
No?) 
2. During the last month, how often have 
you rested in bed during the day? 
(every day, every week, not at all) 
Low Physical Activity 
 
If no as an answer for very energetic physical 
activity OR moderately energetic physical 
activity give one point towards frailty.  
 
Frequency of mildly energetic, moderately 
energetic and very energetic physical activity 
using LoPAQ (see attachment e) 
Weakness 
 
If grip strength is below the 20% cutoff for 
gender and BMI listed, then give one point 
towards frailty.   
Hand grip strength in kg, dominant hand, 
average of 3 measurements 
 
Frailty: cutoff point 
Grip strength lowest 20% 
 
Men 
BMI < 24: < 29 kg 
BMI 24-26: < 30 kg 
BMI 26-28: < 30 kg 
BMI > 28: < 32 kg 
 
Women 
BMI < 23: < 17 kg 
BMI 23-26: < 17.3 kg 
BMI 26-29: < 18 kg 
BMI > 29: < 21 kg 
Slow Walking Speed  
 
If TUG test takes >19 seconds then give one 
point towards frailty.   
 
 
Timed Up and Go > 19 seconds  
If total points towards frailty is > 3 then patient meets criteria for frailty by Fried Frailty Index 
 
 
Reference: (Fried et al. Frailty in older adults: evidence for a phenotype. Journal of 
Gerontology. 2001;56:M146-156); 
 

 
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e. Low Physical Activity Questionnaire 
 
 
 
(Johanson et al, Characterization of Physical Activity and sitting time among patients on 
Hemodialysis using a new physical activity instrument. Journal of Renal Nutrition 25:1, 2015 25-
30) 
 
 
 
 

 
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f. EP Weekly Progress Note 
 
How did the exercises go in the last week? At how many of your other sessions last 
week did you attempt to complete your exercises?  How many of your aerobic exercises 
did you complete last week? 
 
 
 
Have there been any noticeable changes that you have observed from our last meeting? 
 
 
Is there anything that you are able to do now that you could not do before (endurance, 
strength, or flexibility)? 
 
 
Have you experienced any symptoms or side effects from your exercise? If yes, what 
were they? (e.g., pain during any of the exercises? Any dizziness or light-headedness 
during or post-exercise?) 
 
 
How can we modify the exercises from our last meeting? 
 
Frequency 
 
 
Intensity 
 
Type 
 
 
Time 
 
 
 
 
 
What new exercises should we add or change for this upcoming week? (Document 
additional exercises for the new week and changes in prescription) 
 
 
What are your exercise goals for the next week?  
 
 

 
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g. EP Exercise Plan  
 
WARM UP 
ACTIVITY 
SETS REPS TIME 
DIST 
INTENSITY** 
NOTES 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Aerobic Exercises 
Number of Attempts 
Average Time 
Average Distance 
 
 
 
 
 
 
 
 
 
CORE BODY – STRENGTH TRAINING 
EXERCISES 
SETS REPS WEIGHT/BANDS 
REST TIME 
NOTES 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
UPPER BODY – STRENGTH TRAINING 
EXERCISES 
SETS REPS WEIGHT/BANDS 
REST TIME 
NOTES 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LOWER BODY – STRENGTH TRAINING 
EXERCISES 
SETS REPS WEIGHT/BANDS 
REST TIME 
NOTES 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
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h. EP Weekly Checklist  
IDEX VISIT CHECKLIST 
1. Initial Intake visit 
☐ Complete the PRE-Study Assessment form for both control and intervention 
patients. 
☐ Provide intervention patient with an initial Exercise Plan form. 
☐ Make a copy of the Exercise Plan form. Provide one to the patient and place one 
in the Patient Information binder. 
☐ Scan the PRE-Assessment forms for all patients and email to Dyer Diskin at 
diskinc@satellitehealth.com 
2. Weekly visit #1-11 
☐ Complete the Progress Note form. 
☐ If any alterations are made to the exercise plan, complete a new Exercise Plan 
form. 
☐ Make a copy of the updated Exercise Plan form. Provide one to the patient and 
place one in the Patient Information binder. 
3. Weekly visit #12 
☐ Complete the POST-Study Assessment form for both control and intervention 
patients. 
☐ Complete the Progress Note form. 
☐ Scan the POST-Study Assessment form for all patients and email to Dyer Diskin 
at diskinc@satellitehealth.com 
4.  Reminders 
☐ Report any adverse events (side effects from exercise) to the Center Manager 
and email Dyer Diskin at diskinc@satellitehealth.com 
☐ At any point, a patient may choose to leave the study. If this happens, notify the 
Center Manager Alan Rex Gil Cepe and email to Dyer Diskin at 
diskinc@satellitehealth.com 

 
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Pre and Post Intervention Assessment 
Hand Grip Strength Measurements: Using the Handgrip strength dynamometer take 
the best of three measurements for the non-fistula arm.  If both arms have fistulas, 
use the arm that is not currently being accessed.  If no fistula is present, use the non-
dominant arm. Chart whether the left or right arm is used for the test.  For the post-
assessment make sure it is the same hand used in the pre-assessment. Pause 10-20 
seconds between each test.   
Handgrip Strength 
Test 1: 
Test 2: 
Test 3: 
Average:  
Hand Used: 
Timed Up and GO (TUG): Record time in seconds for the patient to walk 8 feet in a 
straight line and return to a seated position.  Patient is allowed one practice run.  
Two are counted.  Note the average of the two.  Chart if an assistance device such as 
a walker or cane is needed and note the type of assistance device.   
Timed Up and Go (TUG) (seconds) 
Trial #1: 
Trial #2:  
Average:  
Assistance Device: 
Sit-to-Stand: Have the patient sit with arms crossed over the chest stand up and sit 
down as quickly as possible.  Record the number of times they can go from sitting to 
standing in 30 seconds.   
Sit-to-Stand (Repetitions/ Time) 
# of repetitions: 
Repetitions/Time:  
Low Physical Activity Questionnaire: Administer the questionnaire on the following 
page as instructed.  Scan and email back results of this and the above physical 
function tests to diskinc@satellitehealth.com.   [see attachment e]