Move More: Development, Testing, and Feasibility of a Patient-Centered Physical Activity Program with a Maintenance Phase for Patients on Hemodialysis

Background: Individuals with end-stage kidney disease (ESKD) receiving maintenance hemodialysis (HD) often experience low physical activity (PA) levels and poor physical function (PF), contributing to reduced quality of life (QOL) and increased mortality risk. Exercise programs frequently fail to significantly improve these outcomes. This study compares the efficacy of an individualized patient-centered PA program, Move More (MM), to a standard intradialytic cycling (IDC) program in improving PF and QOL among HD patients. Methods: Twenty-three HD participants were randomly assigned to MM (N=13) or IDC (N=10) for 14 weeks. Primary outcomes measured PA participation via a logbook and point system. Secondary outcomes assessed PF (STS-60, max handgrip strength, and normal 4-meter gait speed walk), patient reported outcomes (depression, fatigue, and perceived wellness), and program feasibility. Participants assigned to MM were encouraged to continue the program during a 12-week maintenance phase, with seven opting to proceed. The study evaluated participants’ behavior towards PA participation by using the Behavior Stages of Change Questionnaire. Results: Mean age was 63.1 (± 10) years; 73.9% male; and 65.2% Black with an average BMI of 36 (± 10.3). At 14 weeks, MM participants showed significant improvements in total PA minutes compared to IDC at 14 weeks (p=0.001) and marked improvements in 4-meter gait speed walk (p=0.006) and handgrip strength (p=0.014). No significant changes were found between groups in PF changes, though trends towards increased handgrip strength were observed (p=0.077). Additionally, MM participants PA levels and PF were maintained during the maintenance phase. Conclusion: The MM program increased PA levels more than the standard IDC program. However, further research with larger cohorts is necessary to ascertain if MM can lead to substantial improvements in PF. The study highlights the value of a personalized PA program to diverse physical abilities and preferences, suggesting MM’s potential for sustainable effectiveness in fostering a long-term PA engagement in HD patients.