The impact of a six-month home-based resistance exercise program in adults with type 2 diabetes and chronic kidney disease on muscle function, frailty status, health related quality of life and health literacy
Creators: Kamprath, Chelsea
Publisher: name: University of Alberta Library
Year: 2022

<p>Background &amp; Aims: Chronic kidney disease (CKD) coinciding with the presence of diabetes mellitus, known as diabetic kidney disease (DKD), is found in up to 50% of adults with type 2 diabetes (T2D). People suffering from DKD often have a high co-morbid burden that is associated with an increased prevalence of frailty and reduced muscle function, reduced health related quality of life (HRQOL) and increased healthcare utilization. The prevalence of this co-morbid burden and reduced muscle function in DKD highlights the need for effective strategies that can help to prevent or reverse the progression of these patients into a state of physical dysfunction. This thesis examined the primary outcomes specifically related to functional outcomes (short physical performance battery assessment [SPPB] and hand-grip) and frailty status (Edmonton Frailty Scale) and secondary outcomes of HRQOL (Short Form Health Survey [SF-36]) and health literacy (Functional, Communicative and Critical Health Literacy Scale) in an ongoing study called the FANTASTIC STUDY (The Development of an Innovative Home-based Strategy for Frailty Prevention in Adults with Diabetes and Chronic Kidney Disease). The hypothesis for this thesis is that participation in the 6-month resistance exercise program will result in improvements in functional outcomes, frailty status, HRQOL, and health literacy. Also examined was if participants with a higher level of baseline health literacy (HL) would have the greatest improvements in functional outcomes, frailty status and HRQOL.<br>
Methods: An open-labelled, double block randomized controlled trial was conducted in adults aged 50 – 80 years with concurrent T2D and CKD (stages I-IV) who were screened at baseline for frailty using the Clinical Frailty Score. Participants were excluded if they did resistance-type exercise &gt;1 times per week, were on dialysis, had functional/cognitive impairments, had recent bone fractures or a history of skeletal muscle disorders. All participants attended baseline and   6-month visits at the Clinical Research Unit, with monthly home/virtual visits.  Participants were randomized into intervention (resistance exercise + nutrition literacy) or standard of care (physical activity and nutrition education based on current Canadian guidelines). <br>
Results: After 6 months, frail intervention participants showed significant percentage change in functional outcomes of balance (40%), sit-to-stand (38.5%), total SPPB scores (23%) and hand-grip (32%). Frail intervention participants also saw improvements in frailty status, as measured by the Edmonton Frailty Scale (-41%) and HRQOL domains of bodily pain (30.6%) and physical component scores (16%). Non-frail intervention participants saw significant percentage change in sit-to-stand (33%) and total SPPB scores (11%).  Higher HL was associated with improvements in sit-to-stand and total SPPB scores for both frail and non-frail intervention participants (p&lt;0.01).<br>
Conclusions: Performing resistance exercise with resistance bands for 6 months improved functional outcomes, frailty status and HRQOL in older adults with T2D and CKD (stage I-IV). These findings are important as reduced functional performance and HRQOL is associated with negative outcomes such as fall risk and hospitalization. Studies that explore the role of HL may be valuable when developing RE interventions in older adults. Future studies examining frailty status as a direct outcome following RE only interventions are warranted.</p>