Development and feasibility testing of a Self-directed intervention to increase Physical Activity in chRonic Kidney disease (SPARK)

People living with chronic kidney disease not requiring renal replacement therapy are often not active enough to gain the health benefits that physical activity can provide. This thesis described the iterative development and feasibility testing of a theory-driven intervention (SPARK) to address this issue This thesis comprises four studies utilising mixed-methodologies; a systematic review investigating the association of physical function and physical activity with all-cause mortality and adverse clinical outcomes; secondary analysis of a cross-sectional study exploring physical activity behaviour and patients’ attitudes to being active; the development of a theory-based intervention using an iterative approach based on expert and patient involvement and feasibility testing of the SPARK intervention. Key findings: - higher mortality rates and/or prevalence of adverse clinical events were associated with lower physical activity and poorer physical function levels. - 77% of people living with chronic kidney disease not requiring renal replacement therapy are insufficiently active and walking was the preferred modality of activity. Factors considered to support physical activity behaviour included education, motivation and support. The most common physical barriers were fatigue and general malaise. Social barriers and psychological barriers were also described. - The SPARK intervention comprised an 8 week walking and strength training programme, delivered using Motivational Interviewing, supplemented with written material and supportive telephone calls during the intervention period. - Feasibility testing (n=27) was conducted in primary and secondary care and demonstrated that recruitment rates were low in primary care (5.29% consent rate), but more successful in secondary care (27% consent rate). Retention rate was 85%. Engagement data was encouraging, 24 participants (89%) returned physical activity diaries with a mean completion rate=84% days of the intervention period. This programme of work has produced an intervention that could be tested in a randomised controlled trial to investigate efficacy.</p

The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in non-dialysis chronic kidney disease: a systematic review.

Objective: People with non-dialysis dependent chronic kidney disease (CKD) and renal transplant recipients (RTR) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in non-dialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective/subjective measures of PA/physical function and the associations with adverse clinical outcomes/all-cause mortality for patients with non-dialysis chronic kidney disease stages 1 to 5 and RTR. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: 29 studies were included; 12 reporting on physical function and 17 on PA. Only 8 studies were conducted with RTR. The majority were classified as “Good” according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates and/or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over-reliance on self-report measures. Conclusions: In non-dialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function/physical activity interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function

Supplementary_material_1_-_Example_PubMed_search_strat – Supplemental material for The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review

<p>Supplemental material, Supplementary_material_1_-_Example_PubMed_search_strat for The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review by Heather J. MacKinnon, Thomas J. Wilkinson, Amy L. Clarke, Douglas W. Gould, Thomas F. O’Sullivan, Soteris Xenophontos, Emma L. Watson, Sally J. Singh and Alice C. Smith in Therapeutic Advances in Chronic Disease</p