Group-Based Exercise in CKD Stage 3b to 4: A Randomized Clinical Trial

Abstract Rationale & objective We aimed to test interventions to improve physical activity in persons with advanced chronic kidney disease not yet on dialysis. Study Design Randomized controlled trial with parallel group design Setting & Participants We embedded a pragmatic referral to exercise programming in high-volume kidney clinics servicing diverse populations in San Jose, California and Atlanta, Georgia. We recruited 56 participants with eGFR Interventions We randomized participants to a mobile health (mHealth) group—wearable activity trackers and fitness professional counseling, or an EIM group—mHealth components plus twice weekly small-group, directed exercise sessions customized to persons with kidney disease. We performed assessments at baseline, at eight weeks at the end of active intervention, and at 16 weeks after passive follow-up, and used multilevel mixed models to assess between group differences. Outcomes Activity tracker total daily step count Results Of 56 participants, 86% belonged to a racial/ethnic minority group; randomized groups were well-balanced on baseline step count. In intention-to-treat analyses, the EIM and mHealth groups both experienced declines in daily step counts, but there was an attenuated reduction in light intensity physical activity (0.2 [5.8] vs. -8.5 [5.4] min/day, p=0.08) in the EIM compared to the mHealth group at eight weeks. In as-treated analyses, total daily step count, distance covered, and light and moderate-vigorous activity minutes/day improved in the EIM group and declined in the mHealth group at eight weeks (+335 [506] vs -884 [340] steps/day p=0.05, p Limitations Small sample size, limited duration of study, assessment of intermediate outcomes (steps/day). Conclusions A clinic-integrated referral to small-group exercise sessions is feasible, safe, and moderately effective in improving physical activity in an underserved population with high comorbidities.