Author(s): CARUSO, L., PIVA, G., STORARI, A., CREPALDI, A., BATTAGLIA, Y., LOPEZ-SOTO, P.J., ALEJANDRO, M.M., MANFREDINI, F., LAMBERTI, N., Institution: UNIVERSITY OF FERRARA, Country: ITALY, Abstract-ID: 1256

INTRODUCTION:
Despite the recommendations of the international guidelines, the adherence to physical exercise programs by patients with end-stage kidney disease (ESKD) is very low, with only 20 to 40% of patients physically active. In this pragmatic nonrandomized trial (ClinicalTrials.gov NCT04282616) we set up an exercise facilitator in a dialysis unit, to facilitate the introduction of patients to exercise.
METHODS:
A total of 262 patients were contacted for eligibility at the University Hospital of Ferrara (Italy) and Cordoba (Spain) dialysis facilities. After excluding patients with absolute contraindication to exercise (e.g. amputation, unstable angina, etc.), the exercise physiologist proposed advised participation in one of the four different 3-month options related to physical function: 1) a supervised program (SUP) before each dialysis session (30-minute of aerobic walking combined to strengthening and flexibility exercises); 2) a structured home-based low-intensity interval walking program lasting 16 minutes daily (SHB); 3) training advice to increase physical activity according to the available guidelines (AD); or 4) a periodic assessment overtime of their exercise capacity (CO).
RESULTS:
A total of 76 patients were ineligible for inability to ambulate even assisted (52%) or to communicate in Italian language (24%). Within the 186 eligible patients, 45 (24%) declined to participate due to: low interest in physical activity (n=30, 67%); satisfaction with the current level of functional ability (n=10, 22%); lack of time (n=5, 11%). The remaining 141 people decided to participate, leading to an adherence of 76% of the eligible patients or 54% of the entire dialysis population.
The most chosen training programs were SUP (n=57, 40%) and SHB (n=61, 43%), while 19 (13%) patients chose to perform periodic assessments (CO), and 4 people (4%) asked for advice on physical activity (AD).
Concerning the choice of the different exercise options, significant differences were observed for age (SUP: 73±11 years; SHB: 65±13; CO: 61±11; AD: 56±10; p<0.001), dialysis vintage (SUP: 6±3 years; SHB: 4±2; CO: 3±3; AD: 2±2; p<0.001), Charlson comorbidity index (SUP: 8±3; SHB: 7±3; CO: 5±2; AD: 4±2; p<0.001) and mobility as assessed by the 6-minute walking distance (SUP: 243±112 meters; SHB: 311±125; CO: 378±106; AD: 235±122; p<0.001). A significantly lower quality of life was also reported for SUP and SHB patients compared to the other two groups.
No differences were noted for sex, distance from the dialysis center, or means of transportation.
CONCLUSION:
the presence of an exercise specialist inside the dialysis center was crucial for improving and facilitating adherence to physical activity in ESKD patients. The preliminary results indicated that tailored supervised training sessions are preferred by the most frail participants, and home-based programs remained a valuable option for this population.