ABSTRACT
Background: Sarcopenia is a prevalent complication in chronic kidney disease (CKD) and a central component of the frailty phenotype associated with adverse clinical outcomes. In the era of COVID, there is a critical need for practical, safe, interactive, and personalized home-based exercise targeting improvements in physical function in vulnerable patients living with CKD. Method(s): The ESTEEM-VIDA CKD pilot randomized clinical trial tests the efficacy of a home-based, video-supervised, and personalized exercise program on cardiorespiratory fitness (CRF) and physical performance in patients with moderatesevere CKD. Exercise (EX, n=12) consisted of 30-40min exercise sessions, thrice a week for 12 weeks: high-intensity interval training, strength training, and moderate intensity walking. One week of video-supervised exercise alternates with one week of self-directed exercise. Each one-week video-supervised session was conducted by exercise trainers using a videoconference tool, while self-directed exercise weeks used pre-recorded exercise videos. Controls (CTL, n=5) received diet and exercise counseling at baseline. Pre- and post-intervention CRF (VO2peak) and total work were measured using a graded cycle ergometer test and physical performance was assessed by the 6-minutes walking distance (6MWT) test. The effect of exercise on change in CRF and 6MWT using linear mixed effects models was tested. Result(s): Mean age was 62 +/-10y with 47% females and 53% with diabetes. Mean eGFR was 34.4+/-11.8 ml/min per 1.73m2. Mean total work and 6MWT at baseline were 31.7 +/-17kJ and 494 +/-51m, respectively. EX was associated with a 6.9kJ increase in total work (95% CI 2, 12;p=0.008) compared to CTL independent of change in VO2peak, suggesting improved muscular efficiency following training. EX was associated with a 43m increase in 6MWT (95% CI 11, 75;p=0.008) compared to CTL. VO2peak did not differ between groups (p=0.99). Conclusion(s): Preliminary findings suggest a home-based, video supervised, personalized exercise program is feasible and efficacious in improving muscular and physical performance in CKD. It provides a tool for studying metabolic and molecular health and may shed new light on the pathophysiology of sarcopenia in CKD.