The Effect of a Prehabilitation Exercise Program on Peritoneal Dialysis Outcomes: A Feasibility Study

Participants in the Intervention Group will complete an exercise-based intervention. The program will be guided by consumers and currently published guidelines for people receiving peritoneal dialysis and chronic kidney disease. It will contain core abdominal, lower body and upper body strengthening exercises and, cardiovascular conditioning through a modality of the participants choice (walking, cycling etc.) to be prescribed by the exercise physiologist. Exercise physiologists are university qualified allied health professionals equipped with the knowledge, skills and competencies to design, deliver and evaluate safe and effective exercise interventions for people with chronic medical conditions. The intervention will involve two key components. 1) Pre-Catheter Insertion 1 x 1 hour face to face or Zoom meeting with the study exercise physiologist upon recruitment to the intervention arm and, prior to the peritoneal dialysis catheter insertion. The exercise physiologist will be informed by the medical history of the participant and prescribe a tailored home-based exercise program in addition to education on exercise-related considerations (e.g. exercise preferences, previous injuries, blood pressure, blood glucose levels (if diabetic) etc.) specific to their medical history. This program will involve resistance bands and a gym ball, to be provided to each participant. The exercise physiologist will follow-up with the participant two weeks after this consult to ensure the participant is exercising safely and correctly and, to enquire about adverse events. 2) Post- Catheter Insertion At four weeks following catheter insertion, the exercise physiologist will meet with the participant at their regular post catheter insertion appointment. Following this, 1 x 15-minute telehealth weekly call (via phone/Teams/Zoom) will be performed for 8-weeks from the exercise physiologist in the post-catheter insertion phase to provide advice, counselling (program progression / regression) and enquire about adverse events. The exercise physiologist will pay particular consideration to the catheter and prescribe a program that focuses on a gradual and safe return to pre-catheter exercises. Note that these calls will only be completed whilst the participant is completing the intervention (i.e. not in the 4 week period post-peritoneal dialysis catheter insertion). The exercise program in both phases will be guided by published guidelines for people receiving peritoneal dialysis and general guidelines published for people living with chronic kidney disease, [Bennett, P. N., Bohm, C., Harasemiw, O., Brown, L., Gabrys, I., Jegatheesan, D., ... & Thompson, S. (2022). Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations. Peritoneal Dialysis International, 42(1), 8-24.] [Smart, N. A., Williams, A. D., Levinger, I., Selig, S., Howden, E., Coombes, J. S., & Fassett, R. G. (2013). Exercise & Sports Science Australia (ESSA) position statement on exercise and chronic kidney disease. Journal of Science and Medicine in Sport, 16(5), 406-411.] These guidelines recommend people receiving peritoneal dialysis complete approximately 150mins of moderate physical activity per week. However, the exercise physiologist will apply clinical expertise to prescribe participants a graded program aimed at progressing towards these goals that will be guided by the participants current activity levels and medical history. This is to ensure safety and that the program is achievable. Intervention Duration The intervention will be delivered in two phases; 1) pre-catheter insertion phase prior to insertion of the peritoneal dialysis catheter (this will vary from 30-90 days pre-catheter insertion) and 2) 8-week post-catheter insertion phase following the peritoneal dialysis catheter insertion. The commencement of the second 8-week phase will not begin within 4-weeks post-peritoneal dialysis catheter insertion when physical lifting and strenuous exercise restrictions are already in place by treating clinicians. Adherence in both phases will be monitored weekly via a survey that is sent via SMS asking participants to self-report how many sessions they completed over the previous 7-days.