Physical Activity in Haemodialysis Patients: a Feasibility Study
- Conditions
- End Stage Renal Failure on Dialysis
- Interventions
- Other: Chair based exercises in the dialysis environment
- Registration Number
- NCT04103177
- Lead Sponsor
- Oxford Brookes University
- Brief Summary
There is a well established link between physical inactivity and increased mortality in the general population and across many of the more common disease areas including chronic kidney disease (CKD). Patients with CKD have very high levels of morbidity and mortality and are known to have low fitness levels. Randomised controlled trials of exercise have demonstrated the benefits of physical activity for CKD patients. Despite this, physical activity levels remain low and translating these research findings into clinical practice is challenging.
This feasibility study aims to assess the feasibility and acceptability of an instructor led structured exercise programme which includes an educational component to engage and increase physical activity levels in haemodialysis patients attending the Oxford University Hospitals Trust haemodialysis unit. Consented participants will fill in a self reported physical activity questionnaire (Human Activity Profile), partake in functional mobility assessments including (Timed-Up and Go) and a chair based exercise programme. At the end of the study, participants, and nursing staff will undertake a semi-structured interview aimed at understanding acceptability of the intervention. The results of this feasibility study will then be used to inform whether a larger trial in haemodialysis patients is feasible. All questionnaires, physical activity interventions and interviews will be undertaken during routine visits to the haemodialysis unit.
- Detailed Description
There is a well established link between physical inactivity and increased mortality in the general population and patients with chronic kidney disease (CKD) have low fitness levels when compared to their healthy counterparts (50% of expected norm when commencing dialysis therapy). Trials have shown that physical activity confers many physical and mental health benefits in this patient population, with improvements in fitness, walking capacity, health of the heart and quality of life; indeed, national guidelines now consider physical activity to be a cornerstone of disease management (Cochrane Collaboration 2006; Workgroup KD 2005). CKD patients have lower levels of physical activity than age-matched controls; this is particularly marked for older patients and those on dialysis. The Department of Health recommends ≥150 mins/ week of moderate intensity PA (accumulated in bouts of at least 10 minutes) for the general population (DoH UK Physical Activity Guidelines 2011). Many studies have sought to characterise the most effective forms of exercise for CKD patients. Recent attention has focussed on intradialytic cycling, with studies showing benefits not only for fitness and endurance but also muscle strength, power, and physical function. However, translating research guided physical activity programmes into routine clinical practice is challenging, requiring consideration of patients' physical and psychological barriers to exercise.
Assessing the impact of any activity programme requires comparison of health and exercise behaviours pre and post intervention. Several self-report physical activity questionnaires are available but the Human Activity Profile has been validated in CKD patients (Johansen et al. 2001). However, information obtained from patient self-reporting is subjective and prone to bias. Objective measurement devices such as accelerometers are more accurate.
Feasibility of an effective intervention to increase physical activity requires understanding of perceptions of exercise in the population of interest. In this way, the intervention can be specifically targeted to take account of perceived benefits and barriers towards physical activity and thereby increase compliance. This study will provide: 1)feasibility and acceptability of an instructor led chair based exercise programme and educational package (booklet); 2) both self-report and objective measurements of physical activity levels in a sample of haemodialysis patients. This key information will later be used to assess whether a informed large scale PA intervention study in haemodialysis patients is feasible.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 16
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• Participant is willing and able to give informed consent for participation in the trial.
- Male or Female, aged 18 years or above.
- Undergoing regular haemodialysis (2 or 3 times per week) in the Oxford Main and Tarver Dialysis Units
- Is able and willing to comply with all trial requirements.
- Willing to allow his or her General Practitioner and consultant, if appropriate, to be notified of participation in the trial.
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Unable to give consent
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Poor dialysis compliance
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Female participant who is pregnant, lactating or planning pregnancy during the course of the trial.
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Participant with life expectancy of less than 1 month and/or receiving palliative care.
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Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the trial, or may influence the result of the trial, or the participant's ability to participate in the trial.
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Planning to leave Oxford Dialysis units within the study trial
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Absolute contra-indications to PA including:
- Recent significant change in resting ECG suggesting significant ischaemia, recent Myocardial Infarction within 2 days or acute cardiac event
- Unstable angina
- Uncontrolled cardiac arrhythmia causing symptoms or haemodynamic compromise
- Symptomatic severe aortic stenosis
- Uncontrolled symptomatic heart failure
- Acute pulmonary embolus or infarction
- Acute myocarditis or pericarditis
- Third degree heart block
- Suspected or know dissecting aortic aneurysm
- Acute systemic infection, accompanied by fever, body aches or swollen lymph glands
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Intervention group Chair based exercises in the dialysis environment 20 participants to receive physical activity educational booklet with instructions on chair based exercises, Instructor-led training on how to perform the chair based exercises, two times a week, over a 6 week period, and motivational interviewing and prompts.
- Primary Outcome Measures
Name Time Method Semi structured interviews and questionnaires targeted to determine participant acceptability of PA intervention and the people delivering it Interviews should last no longer than an hour and will be conducted at month 3 post baseline Interviews with patients and staff
- Secondary Outcome Measures
Name Time Method Change is being assessed 3 metre Timed Up and Go Change from baseline functional mobility at 6 months Functional activity, 1 minute to complete
Change is being assessed Hand grip strength Change from baseline arm strength at 6 months Functional strength, 2 minutes to complete.
Change is being assessed Wrist worn accelerometery data Change from baseline of activity at 6 months Accelerometers to be worn for one week at 3 time points to assess daily activity
Client Service Receipt Inventory Questionnaire Change from baseline Participants will be given as short tick-box questionnaire to collect information regarding other hospitals facilities they have visited including General Practitioner visits over the last 6 months. This will exclude routine visits to haemodialysis.
Hospital departments and services used in last 6 months- No=0 Yes=1 Use of community care services in last 6 months- No=0 Yes=1 Diagnostic tests in last 6 months- No=0 Yes=1 Use of mobility aids in last 6 months- No=0 Yes=1 Adaptations at home in last 6 months-No=0 Yes=1 Changes in informal care in last 6 months months- No=0 Yes=1 Journeys to receive care in last 6 months No=0 Yes=1 Current occupation range of 1-7Change is being assessed Human Activity profile questionnaire Change from baseline of physical activity at 6 months This tick box questionnaire consists of 94 questions and seeks to determine the activities participants currently do. 15 minutes to complete
Change is being assessed EQ-5D-3L questionnaire Change from baseline quality of life at 6 months This is a self-completing short questionnaire comprising questions on the following 5 areas: mobility, self-care and daily activities. This should take no longer to complete.
Change is being assessed 10 metre walk test Change from baseline functional mobility at 6 months Functional activity, 5 minutes to complete
Change is being assessed IPOS Renal questionnaire Change from baseline quality of life at 6 months This is self-completing questionnaire comprising of 11 questions assessing renal symptoms with other items for additional concerns. 10 minutes to complete
Falls and Fractures questionnaire Change from baseline We wish to know if participants have had any falls or fractures in the last 6 months and assess baseline mobility level.
Questions are based on Yes or No
Referred medical falls clinic☐ Referred therapy falls clinic☐ Referred non-FLS primary care No. of falls, slips, trips in last 12 months= Indoor Gait: range from 1-2 Outdoor Gait: range from 1-2 Any Indoor falls- yes or no
Broken bones in adult hood= Yes/No
Trial Locations
- Locations (1)
Oxford University Hospitals NHS FT
🇬🇧Oxford, Oxfordshire, United Kingdom