The effect of a pre-transplant diet and exercise intervention on post-transplant metabolic profile in living kidney donor transplant recipients: the SIMPLICITY trial

3 month intervention of dietary advice and exercise programme. Both components commence 3 months prior to transplantation and cease at the end of transplantation. Dietary advice and behaviour modification will be prescribed by a qualified dietitian on an individual basis according to initial and subsequent assessments of disease profile, stage of kidney disease, body composition and medications. Dietary education will be based on meeting the Evidenced Based Guidelines for the Nutritional Management of Chronic Kidney Disease (2006). The general objective behind each dietary prescription will be to increase muscle, reduce excess adipose tissue and stabilise biochemistry. Advice will be given to the intervention group on a monthly basis for the first 3 months. Dietary compliance will be measured by using a three day food dairy (using household measures) and during face-to-face visits with the dietitian. Two weekdays and one weekend day will be assessed at baseline, 1 week pre transplant and at 3 months post transplant. Additional records such as food diaries and logs may be used if clinically indicated. Weight lifting (Progressive resistance training) exercises will be prescribed at baseline for each individual by the exercise trainer in accordance with baseline testing results and health status. Each exercise session will include the following: * Chest press * Bent over single arm row * Upright row * Biceps curl * Triceps kickback * Leg extension * Hip abduction * Hamstring curls * Abdominal lifts Substitution of exercises will be done on an individual basis in accordance with injuries or conditions. The trainer will ensure at baseline that the study participants can successfully perform each exercise without supervision. Exercises will be performed at home with weights supplied by the hospital. Duration/Intensity of Exercises. Participants will perform 3 sets of 8 repetitions for each exercise listed above. During the first and second weeks, participants will achieve 50-60% (Borg Scale 10-13) of 1 repetition maximum. Participants will be advised to increase their training workload regularly, based on successful achievement of 3 sets of 12 repetitions at 2 consecutive sessions. An increase of approximately 5% training load would be recommended. Each session should last for 60 minutes and be undertaken on 3 occasions per week from 3 months pre transplantation. At each exercise session participants will complete their perceived exertion on the Borg Scale and record training volumes, loads and adverse events in the training logs. Participants will exercise independently throughout the study without supervision. Trainers will contact each participant on a weekly-fortnightly basis to offer motivation and assess their ongoing exercise program taking into consideration their returned exercise logs, health status and any reported adverse events. At month 1 and 2 the intervention group will have a supervised exercise session with the trainer. These visits shall ensure compliance with the prescribed exercise regimen and exercise technique. Any modifications to the exercise regimen may be done at these visits such as increasing the load lifted. The trainer will ensure that the Borg Intensity Scale logs are being completed correctly. Additional supervised visits may be conducted at the trainer’s discretion, if the participant requires further training on the exercises. At baseline, pre-transplantation and 3 months post transplant, participants will complete some basic fitness tests. A 3 repetition maximum strength test (93% of maximum lifting capacity) of their upper and lower body will be done to assess strength. The control group will also perform these fitness tests.