Increasing Activity Post-Kidney Transplant With SystemCHANGE

Not Applicable

Completed

Conditions: Cardiovascular Diseases
Kidney Transplant; Complications
Physical Activity
Cardiorenal; Change

Interventions: Behavioral: Fitbit (Control)
Behavioral: SystemCHANGE and Fitbit (Intervention)

Registration Number: NCT03191630

Lead Sponsor: Ohio State University

Brief Summary: Inactivity is a common problem among older kidney transplant recipients (KTRs) and is associated with their high incidence of obesity and cardiovascular problems which are the leading cause of death for KTRs. However, the combination of SystemCHANGE activity trackers holds promise for increasing physical activity of KTR patients post-surgery.

This pilot study will incorporate Fitbit health trackers with an intervention of questions about influences to physical activity in a population of kidney transplant recipients who are at particularly high risk of cardiovascular disease and death.

Detailed Description: This is a randomized study with intervention and control arms of sixty kidney transplant recipients age 60 and older. Demographic information will be collected during the screening phone call and will include: gender, race, marital status, income, education, transplant date, prescribed medications, type of diet, smoking status, and co-morbidities. All study data will be entered directly into electronic research forms using REDCap.

Overview of Intervention and Control Groups:

Intervention and control groups will be enrolled in the study in the same manner, receive the same instruction on use of the Fitbit and have the same number of study contacts. Group sessions will be held at the OSU Transplant Clinic with 10-12 participants for 6 months and a 6-month maintenance phase without contact from study personnel until month 12.

Intervention Group Active Phase, Group Session 1 (1 hour, 20 minutes): Research staff will demonstrate proper Fitbit activity tracker use, set up the smartphone application, and assist entry of daily step goals into the smartphone application. Fitbits will be set up with Gmail accounts with unique unidentifiable codes. Participants will be taught how to sync to their smartphone and retrieve data from their Fitbit. One week following this session, participants will be called to troubleshoot problems and be encourage to increase their step goal 5% each month (total phone time 15 minutes).

Intervention/Control Group Timeline:

Intervention Active Phase, Group Session 2 (1 hour): Fitbit activity tracker reports will be reviewed by research staff with participants. SystemCHANGE concepts will be discussed such as "opportunities for improvement" and "possibilities for doing better."

A SystemCHANGE powerpoint will outline components and participants will be placed in groups of 5 where researchers will guide participants through the 4 steps of SystemCHANGE.

Participants will be asked to identify important people that influence their physical activity, which habits or activity occur daily, weekly, or monthly, and how these habits and people impact physical activity. Participants will also include things that influence their participation in physical activity (e.g., availability of facilities as a walking path getting home from work late, or sleeping late on a weekend). Social activities and any rituals associated with physical activity such as gardening, housecleaning, shopping, and hobbies will also be noted. Research staff will place the routines (daily, weekly, monthly) into a graphic format that helps participants understand how routines are related to each other and can work for, or against, changing physical activity behavior. These cycles will be discussed to help understanding of how a routine involving family demands, for example, may influence participation in physical activity. Goals for increasing steps will be made, (generally, a 5% increase) and use of their activity tracker reports for monitoring progress toward improvement will be discussed and demonstrated. In this session and throughout, participants will be encouraged to look beyond personal motivation and explore their life routines and the people who shape those routines.

Intervention Active Phase, Group Sessions 3-7 (1 hour/session): Prior to each session, the participants' activity tracker reports will be given to them and reviewed during the group session. Participants will be asked what they are learning about their physical activity and what changes they want to make. Participants will be asked to describe their improvements and be encouraged to continue using the activity tracker for the next 6 months during the maintenance phase.

Intervention Maintenance (6 months): At the final monthly session, participants will be instructed to continue until month 12.

Control Group Session 1 for the control group will be identical to the Intervention with the only exception being that participants in the control group will NOT be asked to increase their step goal 5% each month based on the step-data received from baseline to week 1.

Session 2 will be used to troubleshoot and discuss any problems with the Fitbit activity trackers. In later sessions, educational information about healthy living as a transplant recipient will be presented, including topics such as diet, taking medication, risk for skin cancer, gastrointestinal side effects, dental care, and new onset post-transplant diabetes. The meeting time will be equivalent to those of the intervention group

The maintenance phase will last 6 months. At month 7, just as the intervention group, participants will be reminded to continue their use of the Fitbit activity tracker and that the research team will not be in contact with them for 6 months. There will be a final meeting at month 12.

Study staff will provide assistance as needed by reading questions to participants. Outcome data from both study groups will be collected at the appropriate sessions.

Retention: Text messages will be sent to participants during months when they are not attending a face-to-face session to provide encouragement and reinforcement for their participation in the study. In addition, phone calls will be made by research staff during each month to each participant to provide updates on their progress in the study as well as encouragement and support. Participants who complete the study will be allowed to keep their activity tracker.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 60

Inclusion Criteria

Kidney transplant recipient at The Ohio State University Wexner Medical Center, Kidney Transplant Program
Age 60 or older
Received clearance from healthcare provider to participate
Ability to speak, read, and hear English
Possession or ready-access to a smart phone capable of accessing mobile activity tracker data
Lacks cognitive impairment (verified by mini cognition test)
Able to walk without an assist device (cane or walker)
Not currently hospitalized
Greater than 3 months post- transplant

Exclusion Criteria

Currently on dialysis
Currently participating in a weight loss program
Currently participating in a structured exercise program
Currently wearing/using an activity tracker
Planning to relocate out of the Columbus area in the next 6 months or less

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control	Fitbit (Control)	This arm includes participants randomized to the control group who will use activity trackers (Fitbits) only, and not receive the SystemCHANGE intervention.
Intervention	SystemCHANGE and Fitbit (Intervention)	This are includes participants randomize to the intervention group who will receive the combination of the SystemCHANGE TM and activity tracker intervention

Primary Outcome Measures

Name	Time	Method
Steps Taken Per Day by Using an Activity Tracker	(T2) 3months, (T3) 6months, & (T4)12 months	Steps were averaged per day.

Secondary Outcome Measures

Name	Time	Method
Body Mass Index (BMI)kg/m2	(T2) 3months, (T3) 6months, & (T4)12 months	Body mass index (BMI; kg/m2) will be calculated as \[mass (lb)/ height (in)2 x 703
Quality of Life: Physical (Functional) and Mental (Well-being) Health"	(T2) 3months, (T3) 6months, & (T4)12 months	Physical and mental component scores, ranging from 0 (lowest level of health) to 100 (highest level of health), are derived from the individual items and was used as study outcomes.
Six Minute Walk Test	(T2) 3months, (T3) 6months, & (T4)12 months	A section of 98 feet was marked off on a hard flat surface using two orange cones. Participants were asked to walk at a comfortable pace for 6-minutes between the cones while being timed, and the distance walked was recorded in feet.
Radial Pulse (Beats Per Minute)	(T2) 3months, (T3) 6months, & (T4)12 months	The research staff will obtain a radial pulse (heart rate) over a 60-second count while the participant remains seated. The research staff collecting the radial pulse reading will be a registered nurse and blinded to the study groups.
Health Outcome: Waist Circumference (cm)	(T2) 3months, (T3) 6months, & (T4)12 months	Waist circumference (WC) will be obtained by measuring the individual's circumference halfway between the illac crest and the lower anterior ribs with the person standing upright during expiration.
Resting Blood Pressure	(T2) 3months, (T3) 6months, & (T4)12 months	Resting blood pressure will be measured on each participant in a seated position using a Withings blood pressure cuff by the research staff. The research staff collecting the resting blood pressure reading will be a registered nurse. The research staff collecting the readings will be blinded to the study groups.
Weight (Pounds)	(T2) 3months, (T3) 6months, & (T4)12 months	Weight was measured without shoes and in light clothing using a digital scale.