Exercise is Medicine for Patients With CKD
Condition: Chronic Kidney Disease stage4; Chronic Kidney Disease Stage V; Physical Activity
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Interventional

Summary: 
      The investigators plan to integrate and tailor the existing Exercise is Medicine framework,
      an evidence-based multi-level intervention program developed by the American Society of
      Sports Medicine, for the care of patients with advanced chronic kidney disease. In this pilot
      randomized control trial, investigators will compare the effects and feasibility of two
      intervention arms designed to start and maintain physical activity in this high-risk
      population (Group 1: physical activity assessment, brief counseling session + physical
      activity wearable versus Group 2: Group 1 intervention components + referral to a free,
      community-based, EIM practitioner led group exercise program).
    

Detailed description: 
      Persons on dialysis are physically inactive, with most reporting activity levels below the
      fifth percentile of healthy age-matched groups. Physical inactivity in turn increases the
      risk for functional decline and mortality in this vulnerable population. The investigators
      propose a pragmatic clinical trial for an exercise intervention among persons transitioning
      to dialysis. The investigators will use an existing framework - Exercise is Medicine (EIM) -
      developed by the American College of Sports Medicine. The investigators will randomize 98
      persons from two regions-Atlanta and Bay Area-in two intervention arms with incremental
      levels of clinical-community integration: physical activity assessment during Nephrology
      clinical visit, brief counseling at pre-dialysis education and physical activity wearable
      (group 1) versus group 1 intervention components plus a referral to a free, EIM
      practitioner-led group exercise program over 16 weeks (group 2; 8 week core intervention; 8
      week follow up). The investigators will assess efficacy by comparing between group
      differences in minutes/week of (measured) moderate intensity physical activity. To evaluate
      implementation, investigators will use questionnaires and exit interviews for assessing
      barriers to referral, participation and retention along the path of the intervention;
      investigators will use cost-utility analyses to assess scalability. Further the investigators
      will have a plan for dissemination of the intervention by partnering with insurance providers
      and both for-profit and non-profit dialysis organizations. The overall goal is to inform the
      development of a practical, cost-conscious intervention that addresses barriers to physical
      activity commonly faced by persons on dialysis, and can be delivered as a "package" to
      interested practices.
    

Intervention name(s): EIM Fitness Practitioners; Counseling and wearable device
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Exercise is Medicine Practitioners will facilitate peer groups that attend twice-weekly exercise classes for 8 weeks, with clinical monitoring and advise regarding increasing physical activity.; Brief exercise counseling session and provision of a wearable fitness tracking device to promote physical activity.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: implementation