Abstract
Frailty is associated with adverse health outcomes in people with chronic kidney disease (CKD). Evidence supporting targeted interventions is needed. This pilot randomised controlled trial (RCT) aimed to inform the design of a definitive RCT evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD. Participants were recruited from nephrology outpatient clinics to this two-arm parallel group mixed-methods pilot RCT. Inclusion criteria were: ≥65 years old; CKD G3b-5; and Clinical Frailty Scale score ≥4. Participants categorised as pre-frail or frail using the Frailty Phenotype were randomised to a 12-week progressive multi-component home-based exercise programme or usual care. Primary outcome measures included eligibility, recruitment, adherence, outcome measure completion and participant attrition rate. Semi-structured interviews were conducted with participants to explore trial and intervention acceptability. Six hundred and sixty-five patients had an eligibility assessment with 217 (33%; 95% CI 29, 36) eligible. Thirty-five (16%; 95% CI 12, 22) participants were recruited. Six were categorised as robust and withdrawn prior to randomisation. Fifteen participants were randomised to exercise and 14 to usual care. Eleven (73%; 95% CI 45, 91) participants completed ≥2 exercise sessions/week. Retained participants completed all outcome measures (n = 21; 100%; 95% CI 81, 100). Eight (28%; 95% CI 13, 47) participants were withdrawn. Fifteen participated in interviews. Decision to participate/withdraw was influenced by perceived risk of exercise worsening symptoms. Participant perceived benefits included improved fitness, balance, strength, well-being, energy levels and confidence. This pilot RCT demonstrates that progression to definitive RCT is possible provided recruitment and retention challenges are addressed. It has also provided preliminary evidence that home-based exercise may be beneficial for people living with frailty and CKD. ISRCTN87708989; https://clinicaltrials.gov/.
Highlights
Frailty is a state of increased vulnerability to a disproportionate decline in health status when exposed to an insult, such as infection or trauma [1]
It has provided preliminary evidence that home-based exercise may be beneficial for people living with frailty and chronic kidney disease (CKD)
Six hundred and sixty-five patients had an eligibility assessment with 217 (33%; 95% confidence intervals (CI) 29, 36) eligible for enrolment
Summary
Frailty is a state of increased vulnerability to a disproportionate decline in health status when exposed to an insult, such as infection or trauma [1]. Frailty and its precursor pre-frailty are associated with adverse health outcomes [4]. Within CKD populations, frailty is associated with worse health-related quality (HRQOL) [5], falls [6], hospitalisation [7] and mortality [8]. Evidence supporting targeted interventions for people living with pre-frailty/frailty is still needed [10]. Frailty is associated with adverse health outcomes in people with chronic kidney disease (CKD). This pilot randomised controlled trial (RCT) aimed to inform the design of a definitive RCT evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD
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