ABSTRACT
Background: Physical inactivity of HD patients was aggravated during the COVID-19 pandemic due to the imposed lockdown and suspension of ongoing intradialytic exercise program (IDE). To address this, we have developed an online exercise program (OLEP). The aim of this study was to analyze its implementation over a 12-weeks period. Method(s): Implementation study based on retrospective analysis using the REAIM framework (reach, effectiveness, adoption, implementation, maintenance). OLEP was proposed to 24 HD units previously offering IDE and included live online exercise sessions (3 times/week) led by 2 exercise physiologists via Zoom. For each RE-AIM dimension specific implementation outcomes were adapted to OLEP. Effectiveness measures included safety (adverse events during exercise sessions) and in-clinic physical function tests (sit-to-stand 5 and 30, 8-foot up and go (8UG), handgrip strength and single leg stance) performed at baseline and 12 weeks in a group of OLEP participants and a group of patients who refused to participate. Result(s): OLEP was adopted by 16 units (66.7%). Among 2063 patients of these units, 313 (15.2%) were eligible. Of those, 84 accepted to participate in OLEP (4.1% reach of all patients). Compared to refusals, OLEP participants had higher female proportion (p=0.009), higher education level (p<0.001), lower lean tissue index and handgrip strength (both p<0.001), and completed less steps/day (p=0.008). Maintenance in OLEP over the 12 weeks was 59.5%, i.e., 40.5% drop-out - of which 65% were voluntary. Implementation fidelity (patient's adherence to exercise sessions) was 73.1+/-18.8%, and implementation dose was 2.2+/-0.6 exercise sessions/week. Effectiveness: OLEP participants improved performance in all physical function measures (p<0.05), except in 8UG (p=0.677), whilst refusals did not (p>0.05);no severe adverse events were reported. Conclusion(s): Our data suggests that an OLEP is realistic, safe and may improve physical function. Therefore, its applicability may subsist beyond the pandemic and be used to complement IDE. However, strategies to increase proficiency to use mobile health technology may be needed to reach more patients.