Virtually Supervised Exercise for Kidney Transplant Candidates

肾移植候选者的虚拟监督锻炼

基本信息

批准号：
10504925
负责人：
Christine K Liu
金额：
$ 64.13万
依托单位：
PALO ALTO VETERANS INSTIT FOR RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10504925
关键词：
Accountability Adherence Adoption Asian Beck depression inventory Black Populations Black race Caring Climacteric Clinic Deterioration Dialysis procedure Education Elements Equilibrium Event Excision Exercise Fatigue Future Goals Health behavior change Health education Healthcare Hispanic Home Individual Intervention Interview Kidney Diseases Kidney Failure Kidney Transplantation Knowledge Lead Locales Measures Methods Motivation Muscle Muscular Atrophy Nephrology Operative Surgical Procedures Organ Outcome Participant Patients Persons Phase Physical Function Procedures Randomized Controlled Clinical Trials Randomized Controlled Trials Readiness Schedule Science Severities Suggestion Supervision Testing Time Transplantation Travel United States Vision Wait Time Waiting Lists Walking acute care arm base cost depressive symptoms exercise intervention exercise program improved improved functioning innovation instructor knowledge translation meetings novel patient oriented post-transplant prevent primary endpoint reduce symptoms therapy design transplant centers uptake virtual virtual delivery virtual healthcare

项目摘要

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.

肾移植（KT）是治疗肾衰竭的最佳方法，但由于缺乏大多数 KT 候选者必须等待数年（有时甚至超过十年）才能接受肾脏移植。失败会导致肌肉萎缩，所以在等待和坚持透析治疗的同时，KT 候选人 47% 的 KT 候选者在接受移植时会失去肌肉，从而失去身体功能。行走、平衡和/或从椅子上站起来有困难，这些损失会导致移植后的情况不佳。更长的等待时间，甚至被删除候补名单，这些结果对两名患者来说都是毁灭性的。和移植中心，可悲的是，此类事件对患者的影响过大。黑人、西班牙裔或亚洲血统的人更容易患肾衰竭，我们知道什么可以逆转。理想情况下，移植中心会主动安排移植前锻炼。但 KT 候选人护理中对运动干预的采用仍然很少，这是因为我们。对于什么是最有效的运动干预方法仍然存在知识差距患者表示他们更喜欢家庭运动干预，因为这种形式。克服了透析计划的障碍，但之前的家庭干预措施受到了限制。依从性低，减少干预的影响可以提高依从性。但大多数家庭干预措施都没有受到监督。随着虚拟医疗保健的采用，出现了一种新的选择：虚拟监督。使用虚拟会议平台，人们可以在家锻炼。适合需要应对紧张时间和旅行的 KT 考生。透析的要求，虚拟监督锻炼可能是高效且有效的最佳选择我们的目标是有效且可扩展的运动干预。移植中心用于防止 KT 候选者身体功能丧失。为可能进行移植的两年内的 KT 候选者开发了一个创新诊所，非常适合利用这个诊所，我们将进行为期 24 周的随机对照试验。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使用延迟干预设计，参与者最初将接受虚拟监督的锻炼或健康。 12 周的教育，这将是最初 12 周期结束时的主要终点。评估干预措施对身体功能（目标 1）、抑郁症状和疲劳的影响（目标 2）双臂将在接下来的 12 周内接受运动干预以评估依从性。和可接受性（目标 3）。 KT 候选人的身体机能，维持他们对未来没有肾衰竭的希望和愿望。