SP424Exercise Therapy in the Early Stage After Kidney Transplantation Is Effective for Improving Physical Performance: A Prospective Cohort Study with Historical Control

Abstract

INTRODUCTION: Chronic kidney disease is an independent risk factor for frailty, which is primarily characterized by poor physical performance and inactivity. In kidney transplant (KT) patients, frailty is a predictor of adverse outcomes. The longterm goal of KT is healthy return to normal activity; thus, improvement of physical performance after KT is important. However, outcomes of exercise therapy in patients with KT, particularly the efficacy of early exercise therapy after KT, have not been evaluated. In this pilot study we investigated the effect of early exercise intervention on physical performance, physical activity, and kidney function in KT patients. METHODS: This study included both a prospective and a historical cohort. In the prospective cohort 10 KT patients underwent early exercise intervention after KT (exercise group) and their outcomes were compared to those of a historical cohort of 14 KT patients who did not undergo intervention (control group). Measurements were performed on all patients before KT and at the 2 months follow-up, as described below. The exercise group underwent supervised aerobic training and unsupervised walking training conducted from 6 days to 2 months after KT. Physical performance was assessed by the 6-minute walking distance (6-MWD) [m] and isometric leg strength (LS) [% body weight (BW)]. Physical activity was measured using wearable accelerometers for a week and evaluated as the daily number of steps and moderate-tovigorous activity time per day. Kidney function was measured using the estimated glomerular filtration rate (eGFR). RESULTS: The 6-MWDimproved in the exercise group (mean distance [95% CI]: baseline, 567 [537, 598] m; follow-up, 613 [570, 656] m) but not in the control group (baseline, 549 [471, 627] m; follow-up, 548 [458, 639] m; p = 0.021 between groups). Similarly, LS improved in the exercise group (mean%BW[95% CI]: baseline, 58 [50, 66] %BW; follow-up, 64 [55, 74] %BW) but not in the control group (baseline, 61 [52, 70] %BW; follow-up, 59 [50, 68] %BW; p = 0.026 between groups). However, no improvement of physical activity was found in either the exercise or control groups at 2 months after KT. Dialysis was withdrawn in all patients and the recovery curves of eGFR after KT showed no significant difference between groups (Figure 1). CONCLUSIONS: Exercise therapy in the early stage after KT is effective for improving physical performance and did not adversely affect kidney function. (Table Presented).