Research Award Recipients

Sustainable Exercise Habits and Vascular Health in Hemodialysis Patients

Co-Applicant(s): Mohsen Agharazii, Paul Poirier

Lay Abstract

Background: Patients with chronic kidney disease (CKD) suffer from a high burden of cardiovascular disease (CVD) and recurrent hospitalizations, which lead to disabilities and a significant loss of quality of life. Physical exercise, with its profound effect on musculoskeletal and cardiovascular systems, could potentially slow down or interrupt this vicious cycle. Despite current general recommendations to engage in physical activities, CKD patients are largely inactive. In dialysis care units, the implementation and integration of a rehabilitation program remains scarce due to numerous barriers related to infrastructure, a lack of exercise knowledge and resources, and patient's difficulties in coping with their diseases. While many physical exercise modalities have shown beneficial effects in CKD, supervised and home-based training have important drawbacks namely subsequent detraining cessation after intervention, suboptimal exercise intensities and progression for benefits, along with a reduced rate of adherence due to waning motivation. In CKD, two of the major gaps in the increasing amount of literature on exercise are identifying effective strategies to maintain long-term adherence to an active lifestyle and related vascular adaptations that could be associated with beneficial cardiovascular outcomes.

Purpose: This study will lay the foundations for the development of an exercise rehabilitation program that will empower the dialysis population while optimizing exercise specialist resources, with the goal of successfully improving the maintenance of an optimal active lifestyle and its associated cardiovascular benefits.

Method: For this project, we will involve 80 hemodialysis adults divided into two groups.

One group will receive an exercise behavioral education content once every week for 12 weeks aiming to promote exercise knowledge and support adherence to the recommended weekly physical activity level (150 minutes per week).

The other group will receive the same exercise education content, along with supervised exercise training once a week during hemodialysis. At the end of the intervention, we will be able to determine if changes in physical activity were sufficient to lead to cardiovascular benefits. The study will continue up to 6 months after the end of the intervention to determine the proportion of patients who maintain an adequate daily physical activity level, and if it is associated with fewer adverse health events. Anticipated outcomes: We anticipate that our integrated exercise education program and supervised training will be effective in promoting long-term engagement in physical activity. This, in turn, is expected to lead to improved markers of cardiovascular health and a reduced incidence of adverse events, including cardiovascular events, falls, and hospitalizations.

Patient engagement: This program has been developed in collaboration with a patient partner to ensure that it takes into account and communicates aspects that are important to patients in this research project.

Relevance to Patients/Community: This project is essential for the systematic and effective implementation of an optimal exercise and education rehabilitation program for patients with kidney disease. This approach has the potential to be scalable and extend beyond the specialized centers, thereby improving the health of CKD patients on a larger scale. Furthermore, it will yield valuable vascular insights that can help refine exercise prescriptions tailored to specific prevention needs, such as blood pressure management and blood circulation to extremities.