title: A prospective 2-site parallel intervention trial of a research-based film to increase exercise amongst older hemodialysis patients.
abstract: Evidence suggests that exercise training for hemodialysis patients positively improves morbidity and mortality outcomes, yet exercise programs remain rare and are not systematically incorporated into care. We developed a research-based film, Fit for Dialysis, designed to introduce, motivate, and sustain exercise for wellness amongst older hemodialysis patients, and exercise counseling and support by nephrologists, nurses, and family caregivers. The objective of this clinical trial is to determine whether and in what ways Fit for Dialysis improves outcomes and influences knowledge/attitudes regarding the importance of exercise for wellness in the context of end-stage renal disease.
  
  
  
  This 2-site parallel intervention trial will recruit 60 older hemodialysis patients from two urban hospitals. The trial will compare the film + a 16-week exercise program in one hospital, with a 16-week exercise-only program in another hospital. Physical fitness and activity measures will be performed at baseline, 8 and 16 weeks, and 12 weeks after the end of the program. These include the 2-min Walk Test, Grip Strength, Duke Activity Status Index, and the Timed Up-and-Go Test, as well as wearing a pedometer for one week. Throughout the 16-week exercise program, and at 12 weeks after, we will record patients' exercise using the Godin Leisure-time Exercise Questionnaire. Patients will also keep a diary of the exercise that they do at home on non-dialysis days. Qualitative interviews, conducted at baseline, 8, and 16 weeks, will explore the impact of Fit for Dialysis on the knowledge/attitudes of patients, family caregivers, and nephrology staff regarding exercise for wellness, and in what ways the film is effective in educating, motivating, or sustaining patient exercise during dialysis, at home, and in the community.
  
  
  
  This research will determine for whom Fit for Dialysis is effective, why, and under what conditions. If Fit for Dialysis is proven beneficial to patients, nephrology staff and family caregivers, research-based film as a model to support exercise promotion and adherence could be used to support the National Kidney Foundation's guideline recommendation (NKF-KDOQI) that exercise be incorporated into the care and treatment of dialysis patients.
  
  
  
  NCT02754271 (ClinicalTrials.gov), retroactively registered on April 21, 2016.
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada. pia.kontos@uhn.ca.|Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada. pia.kontos@uhn.ca.
authors.forename: Pia
authors.initials: P
authors.lastname: Kontos
authors.affiliation: Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, ON, M5S 1A8, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.|Institute of Medical Sciences, University of Toronto, 1 King's College Cir., Toronto, ON, M5S 1A8, Canada.|Department of Medicine, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.
authors.forename: Karen-Lee
authors.initials: KL
authors.lastname: Miller
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.|Department of Physical Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.
authors.forename: Romeo
authors.initials: R
authors.lastname: Colobong
authors.affiliation: School of Rehabilitation Therapy, Queen's University, 31 George St., Kingston, ON, K7L 3N6, Canada.
authors.forename: Trisha
authors.initials: T
authors.lastname: Parsons
authors.affiliation: Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, ON, M5S 1A8, Canada.|Division of Nephrology, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.
authors.forename: Sarbjit Vanita
authors.initials: SV
authors.lastname: Jassal
authors.affiliation: St. Michael's Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, ON, M5T 1P8, Canada.
authors.forename: Alison
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.|Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst St., Toronto, ON, M6A 2E1, Canada.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Binns
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, 550 University Ave., Toronto, ON, M5G 2A2, Canada.|Department of Medicine, University of Toronto, 1 King's College Cir., Toronto, ON, M5S 1A8, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.|Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst St., Toronto, ON, M6A 2E1, Canada.|Department of Medicine, Baycrest Health Sciences, 3560 Bathurst St., Toronto, ON, M6A 2E1, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
mesh_terms: D000368:Aged; D002170:Canada; D017028:Caregivers; D003376:Counseling; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006801:Humans; D007676:Kidney Failure, Chronic / Q000534:rehabilitation* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009040:Motion Pictures; D009042:Motivation; D000072104:Nephrologists; D009726:Nurses; D010353:Patient Education as Topic / Q000379:methods*; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D057170:Translational Research, Biomedical; D000070857:Walk Test
keywords: Education; End-stage renal disease (ESRD); Exercise; Hemodialysis; Knowledge translation; Mixed methods