Virtually Supervised Exercise for Kidney Transplant Candidates

肾移植(KT)是治疗肾衰竭的最佳方法，但由于缺乏 对于器官移植，大多数KT候选人必须等待数年--有时超过十年--才能接受移植。肾 失败会导致肌肉萎缩。因此，在等待和坚持透析治疗的同时，KT候选人 失去肌肉，从而失去身体功能。到他们接受移植时，47%的KT候选人 走路、保持平衡和/或从椅子上站起来都有困难。这些损失导致了移植后的不良反应。 结果、更长的等待时间，甚至是等待名单的删除。这样的结果对两位患者都是毁灭性的。 和移植中心，可悲的是，这并不罕见。此外，这类事件过度影响了 黑人、西班牙裔或亚洲血统，他们更有可能发生肾衰竭。我们知道什么会逆转 这些损失--锻炼。理想情况下，移植中心会主动开出移植前的处方。 程序。但是，运动干预在KT候选护理中的接受度仍然很低。这是因为我们 在什么是提供运动干预最有效的方法上继续存在知识差距 给KT候选人。患者表示，他们更喜欢以家庭为基础的运动干预，因为这种形式 克服了透析时间表的障碍。然而，以前的基于家庭的干预措施受到以下限制 低依从性，减少干预的影响。讲师的监督可以提高遵从性 通过增加问责的元素。但大多数基于家庭的干预措施都没有得到应有的监督 要付出代价。随着虚拟提供的医疗保健的采用，出现了一个新的选择：虚拟监督 基于家庭的运动干预。使用虚拟会议平台，人们可以一边锻炼一边锻炼 由在线讲师监督。对于KT考生来说，他们需要应付紧张的时间和旅行 根据透析的要求，虚拟监督的锻炼可能是高效和有效的最佳选择 改善他们的身体机能。我们的目标是一种有效的、可扩展的运动干预 由移植中心使用，以防止KT候选人的身体功能丧失。我们有 为可能进行移植的两年内的KT候选人开发了创新的诊所，非常适合 灌输健康行为改变。利用这个诊所，我们将进行为期24周的随机对照 对80名KT候选人进行试验，以评估虚拟监督的居家锻炼干预的影响 采用延迟干预设计。参与者最初将接受虚拟监督的锻炼或健康 12周的教育，这将是主要终点。在最初的12周期间结束时，我们将 评估干预对身体功能(目标1)、抑郁症状和疲劳的影响 (目标2)。然后，在第二个12周内，两组成员都将接受锻炼干预，以评估依从性 和可接受性(目标3)。我们的最终产品将是一种可广泛使用的干预措施，以改善 KT候选人的身体功能，维持他们对未来无肾功能衰竭的希望和愿望。

Kidney transplantation (KT) is the best treatment for kidney failure; however, due to the shortage of organs, most KT candidates must wait years—sometimes over a decade--to receive a transplant. Kidney failure causes muscle wasting. So while waiting and persevering with dialysis treatments, KT candidates lose muscle and thus physical function. By the time they undergo transplantation, 47% of KT candidates have trouble walking, balancing, and/or getting out of a chair. These losses lead to poor post-transplant outcomes, longer wait times, or even waitlist removal. Such outcomes are devastating for both patients and transplant centers, and sadly are not rare. Furthermore, such events excessively impact persons of Black, Hispanic, or Asian heritage, who are more likely to develop kidney failure. We know what reverses these losses—exercise. Ideally, transplant centers would proactively prescribe a pre-transplant exercise program. But uptake of exercise interventions into KT candidate care remains minimal. This is because we continue to have a knowledge gap about what is the most effective way to deliver an exercise intervention to KT candidates. Patients have stated they prefer a home-based exercise intervention, as this format overcomes the barrier of the dialysis schedule. Yet prior home-based interventions have been limited by low adherence, reducing impact of the intervention. Supervision by an instructor can increase adherence by adding the element of accountability. But most home-based interventions have been unsupervised due to cost. With the adoption of virtually delivered health care, a new option has emerged: virtually supervised home-based exercise interventions. Using a virtual meeting platform, persons can exercise while being supervised by an instructor online. For KT candidates, who cope with the intense time and travel requirements of dialysis, virtually supervised exercise may be the best option to efficiently and effectively improve their physical function. Our goal is an effective and scalable exercise intervention that can be used by transplant centers to prevent the loss of physical function in KT candidates. We have developed an innovative clinic for KT candidates who are within two years of likely transplant, ideal for instilling health behavior change. Leveraging this clinic, we will conduct a 24-week randomized controlled trial in 80 KT candidates to evaluate the impact of a virtually supervised home-based exercise intervention using a delayed intervention design. Participants will initially receive virtually supervised exercise or health education for 12 weeks, which will be the primary endpoint. At the end of the initial 12-week period, we will evaluate the impact of the intervention on physical function (Aim 1), depressive symptoms, and fatigue (Aim 2). Both arms will then receive the exercise intervention in the second 12 weeks to assess adherence and acceptability (Aim 3). Our end product will be an intervention that can be used widely to improve the physical function of KT candidates, sustaining their hope and wish for a future free of kidney failure.