Evaluation of a pragmatic exercise rehabilitation programme in chronic kidney disease.
BACKGROUND
Physical activity has the potential to positively impact upon aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients independent of the stage of the disease process. Physical activity is recommended in a number of national CKD guidelines, but its incorporation into routine care has been slow. The translation of research-led physical activity programmes into an established procedure appears to be a particular obstacle. This study included 263 patients, consecutively referred over a 4-year period, to a pragmatic 12-week renal rehabilitation (RR) programme delivered within a National Health Service (NHS).


METHODS
One hundred and thirty-one patients were assessed and started the RR programme. Anxiety and depression were measured using the hospital anxiety and depression (HAD) scale. The self-reported level of fitness was measured with the Duke's activity status index (DASI), and exercise capacity was assessed with the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 s (STS60), timed up and go (TUAG) and stair-climb descent (SCD) tests. All measures were assessed at baseline and at 12 weeks. Attendance and completion of the RR programme were recorded for all patients.


RESULTS
There were significant improvements in exercise capacity and functional ability ranging from 21 to 44%, and significant improvements in anxiety (15%) and depression (29%) in the 77 patients who completed the RR programme. The self-reported level of fitness was found to be significantly associated with completion (P = 0.01), with older participants showing a trend towards being more likely to complete (P= 0.07). Fifty-four patients, out of the 131 patients who commenced the RR programme, failed to complete 12 or more of the 24 scheduled sessions. Patients requiring haemodialysis (HD) treatment constituted the largest number of dropouts/non-completers (49%) in the study.


CONCLUSIONS
This study demonstrates that a pragmatically constructed, NHS-delivered exercise-based RR can substantially improve both physical function and mental well-being for the wide range of CKD patients who regularly participated (55%). Compliance/adherence data indicate that this type of rehabilitation programme is particularly well received by pre-dialysis (PD) CKD and post-transplantation patients.
King's College Hospital, London, UK. sharlene.greenwood@nhs.net
Sharlene A
SA
Greenwood
Herolin
H
Lindup
Kevin
K
Taylor
Pelagia
P
Koufaki
Robert
R
Rush
Iain C
IC
Macdougall
Thomas H
TH
Mercer
D001007:Anxiety; D015331:Cohort Studies; D003863:Depression; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010349:Patient Compliance; D011379:Prognosis; D015397:Program Evaluation; D011788:Quality of Life; D012046:Rehabilitation / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000523:psychology / Q000534:rehabilitation*