Background
Exercise has been shown to improve symptoms, function, and mental health. Despite the fact that medical guidelines recommend regular physical activity for persons living with renal disease, many people struggle to fit this into their lifestyle. Hospital-affiliated group exercise programs for outpatients can potentially reduce fears and increase exercise self-efficacy. This study investigated the effects of a 3-month supervised Renal Nordic walking (NW) program on the fitness and quality of life of renal outpatients.

Methods
Thirty participants, aged 45-84 were randomized to NW (n=15) or non-NW (n=15) groups. The NW group was offered 2 supervised NW sessions per week; the non-NW group continued their own activities. No blinding of intervention or outcome assessment was possible. Outcome measurements at baseline and 3-month included: weight, handgrip strength (HGS), 30-sec sit-to-stand-test, 6-min-walk-test (6MWT), and Kidney Disease and Quality of Life questionnaire (KDQOL-36). Daily steps were recorded using Fitbit Flex2 tracker during the 3-month study. Using the intention-to-treat principle, changes in outcomes for each participant from baseline to 3-months were calculated and median changes between NW and non-NW group were tested with a Brown-Mood median test.

Results
Participants included renal transplant [n=10], pre-dialysis [n=14], hemodialysis [n=3], and peritoneal dialysis [n=3] patients. Two participants in the non-NW group were lost to follow-up and missing data was minimal. The NW group appeared less healthy compared to the non-NW group at baseline. However, the NW group had greater improvements in 6MWT distance (41.5m), HGS (1.1kg), and KDQOL-36 (Effect of kidney disease; p=0.021) at 3-month. 

Conclusion
A 41.5m improvement in 6MWT achieved in the NW group exceeded the Minimal Clinically Important Difference of 14.0 –30.5m. Although a larger number of participants are needed to confirm these findings more confidently, these encouraging results indicate that a group-based supervised Renal NW program may provide benefits meaningful to renal patients as part of their clinical care.  This study has led to new funding for a physiotherapist to lead the Renal NW program at St. Paul’s Hospital, Vancouver, BC.

Effects of a Renal Nordic walking program on Quality of Life and Fitness in renal patients at St. Paul’s