THE EFFECTIVENESS OF TWELVE WEEK STRUCTURED HOME EXERCISE PROTOCOL ON FUNCTIONAL CAPACITY, STRENGTH AND PULMONARY FUNCTION AMONG KIDNEY TRANSPLANT RECIPIENTS

H. Shah¹, N. Shah²

¹Institute of Kidney Disease and Research Centre - Institute of Transplantation Sciences, Physiotherapy, Ahmedabad, India, ²SBB College of Physiotherapy, VS Hospital Campus, Physiotherapy, Ahmedabad, India

Background: Kidney transplantation is one of the most challenging areas of modern medicine; evolving steadily across India. Parallelly there is rise in subjects seeking post kidney transplantation care. Due to complex pathophysiology, prolong use of corticosteroids, fear of grafted organ rejection and lack of proper exercise awareness; these population suffers from low level of physical functioning and cardio-metabolic risk after transplant. Participation in physical exercises seems very helpful, safe and have been shown to be related to better clinical outcomes.

Purpose: The reported clinical trials of exercise training in Indian kidney recipients are very few and mostly during in-hospital phase. Considering very important role of regular exercises in late post transplantation phase and to overcome transportation problems, infection risks, inconvenience of attending regular classes; a unique expert consensus derived, validated structured unsupervised home exercise program was evaluated for its effectiveness.

Methods: In this single centre, single blinded controlled clinical trial; 12 week lasted structured home exercise protocol was evaluated by randomly distributing the 102 kidney transplant recipients(KTR) in intervention(n=55) and control(n=57) group who matched inclusion and exclusion criteria. The Intervention group(IG) received the unique self-monitoring exercise educational material in local language with illustration of flexibility, aerobic, resisted and pranayam exercises. They were follow up regularly by phone calls and told to maintain exercise logbook. Where as control group(CG) received exercise counselling without exercise prescription. Both group were assessed at base line and at the end of 12 week for six minute walk distance(6MWD), dominant hand grip strength(DHGS), one minute sit to stand(1MSTS), five times sit to stand(5XSTS) and force-based spirometric lung function.

Results: Both the groups were homogeneous for various parameters at baseline. After 12 weeks, 6MWD improved by 13.6meter (Δ mean; p=0.096) in CG where as 79.6meter (Δ mean; p<0.001) in IG. DHGS reduced by 0.26kg (Δ mean; p>0.05) in CG where as improved by 0.9kg (Δ mean; p<0.001) in IG. 1MSTS improved by 1.53repetitions (Δ mean; p>0.05) in CG where as improved by 5.43 repetitions (Δ mean; p<0.001) in IG. 5XSTS reduce by 0.2seconds (Δ mean; p=0.08) in CG where as reduce by 3.2seconds (Δ mean; p<0.05) in IG, FEV1 % reduced by 0.65% in CG (Δ mean; p=0.19) whereas increased by 2.01% in IG(Δ mean; p<0.01),FVC %increased in IG by 1.58%( Δ mean; p<0.01) but did not changed in CG(Δ mean; p=1). No change was seen for FEV1/FVC% (CG;Δ mean; p=0.06 and IG, Δ mean;p=0.19). Between group difference for all above parameters were statistically significant after 12 weeks. Magnitude of effect(Cohen’s d) was large for 6MWD and STS performance after intervention. Total adherence to the structured home exercise program was 69.4%.

Conclusions: Twelve week structured unsupervised home exercise protocol resulted in significant improvement in assessed parameters in the intervention group than in control group in KTR.

Implications: Present study results can be considered in future efforts to prescribe effective, personalised home exercise programs for Indian adults with kidney transplantation who cannot able to attend rehabilitation centres in their late post transplantation period.

Funding acknowledgements: No funding was received for this research work.

Keywords:
Kidney transplantation
Structured unsupervised home exercises program

Topics:
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Institute of kidney disease and research centre, Institute of transplantation sciences

Committee: IKDRC-ITS

Ethics number: IKDRC-ITS/09/2018