Virtually Supervised Exercise for Kidney Transplant Candidates

肾移植（KT）是肾衰竭的最佳治疗方法;然而，由于缺乏足够的药物， 器官，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， 失去肌肉和身体功能。当他们接受移植时，47%的KT候选人 行走、平衡和/或从椅子上站起来有困难。这些损失导致移植后不良 结果，更长的等待时间，甚至是删除等待列表。这样的结果对两个病人来说都是毁灭性的 和移植中心，很遗憾这并不罕见此外，这些事件对残疾人的影响也很大， 黑人、西班牙裔或亚裔更容易患肾衰竭。我们知道什么能逆转 这些损失-运动。理想情况下，移植中心会主动规定移植前的锻炼 程序.但是，对KT候选人护理的运动干预仍然很少。这是因为我们 关于什么是最有效的运动干预方法， 卡帕头候选人患者表示他们更喜欢在家进行运动干预，因为这种形式 克服了透析时间表的障碍。然而，以前的家庭干预措施受到以下因素的限制： 低依从性，降低干预的影响。指导员的监督可以提高依从性 通过增加责任的元素。但大多数基于家庭的干预措施都是无人监督的， 成本。随着虚拟医疗的采用，出现了一种新的选择：虚拟监督 以家庭为基础的锻炼干预。使用虚拟会议平台，人们可以在 由在线导师监督。对于KT候选人，谁应付紧张的时间和旅行 透析的要求，虚拟监督运动可能是最好的选择，以有效地和有效地 改善他们的身体功能。我们的目标是一个有效的和可扩展的运动干预， 移植中心用来防止KT候选人身体功能的丧失。我们有 为可能在两年内进行移植的KT候选人开发了一个创新诊所， 灌输健康行为改变。利用这个诊所，我们将进行一项为期24周的随机对照研究， 在80名KT候选人中进行试验，以评估虚拟监督的家庭运动干预的影响 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 为期12周的教育，这将是主要终点。在最初的12周结束时，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 (Aim 2）。然后，在第二个12周内，两组都将接受运动干预，以评估依从性 可接受性（目标3）。我们的最终产品将是一种干预措施，可以广泛用于改善 KT候选人的身体功能，维持他们对未来没有肾衰竭的希望和愿望。

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.