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Physical activity and wellbeing clinical study group

Exercise is important for people with chronic kidney disease (CKD) because when kidney function has decreased, it can affect muscles and bones.

Physical activity can potentially have a positive impact on aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients regardless of the stage of their disease process. Physical activity is recommended in a number of national CKD guidelines, but it’s incorporation into routine care has been slow.

Who we are

The physical activity and wellbeing (PAWeB) clinical study group is chaired jointly by Pelly Koufaki and Jamie Macdonald.

Our multi-professional group has members from a wide-range of disciplines across the UK. We meet bi-annually to discuss, support and facilitate research initiatives, that address physical activity behaviours and well-being of all people with chronic kidney disease (CKD). In addition to the CSG co-chairs, individual members provide contact points for other CSG themes based on their area of expertise and experience.

Jamie Macdonald

Jamie Macdonald. Senior Lecturer in Clinical Exercise Physiology, Institute for Applied Human Physiology, School of Human and Behavioural Sciences, Bangor University

Pelly Koufaki

Pelly Koufaki. Reader in Clinical Exercise Physiology and Rehabilitation, Queen Margaret University

Our mission:

Generate, support and facilitate multi-disciplinary, collaborative, translational research in physical activity and wellbeing for all people affected by kidney disease in the UK.

PAWeB CSG_strategic plan_objectives_tasks_measures

About our work

Ongoing studies:

In May 2021 our CSG organised and hosted the ‘Living well with kidney disease’ livestream event on behalf of the Royal Society of Medicine. The live stream was attended by over 90 delegates and provided a deep understanding of the physical and psychological challenges faced by people living with kidney disease.

Various CSG group members have presented at the Global Renal Exercise (GREX) Webinar Series. Most recently, Jamie Macdonald and Sharlene Greenwood discussed results from the PEDAL Trial.

Kidney Beam - This research project will assess how well the recently developed Kidney Beam online service platform improves quality of life and whether it is cost effective.

PEDAL – a randomised clinical trial (RCT) investigating the effect of intradialytic cycling on quality of life. Led by Professor Iain Macdougall and Dr Sharlene Greenwood and funded by the NIHR.  (£2.1mill). Recruited to target in renal units across 5 regions in England, Scotland and Wales. Primary manuscript published and executive report provided to the NIHR.

 

CYCLE-HD – a parallel RCT looking at the effect of intradialytic exercise on cardiovascular structure and function. Led by Professor James Burton as part of an NIHR Fellowship (£1.2mill). Recruited to target and database locked. Primary manuscript published.

Iron and Muscle –investigating whether IV iron in non-dialysis CKD patients can improve exercise capacity, muscle metabolism and physical function. Led by Drs Sharlene Greenwood, Kate Bramham and Obi Okonko (King’s) and jointly funded by Vifor Fresenius Medical Care Renal Pharma and Kidney Research UK (£1.7mill).

CULTURE-CKD –investigating cultural influences on physical activity and exercise beliefs in people with CKD. Funded by the British Renal Society and Kidney Care UK through collaboration with King’s College Hospital and Loughborough University.

ECSERT – a pilot study investigating the effects of a personalised home-based exercise intervention on cardiometabolic disease in renal transplant recipients. Led by Dr Matthew Graham-Brown and funded by Kidney Research UK.

ExeRTiOn - a pilot study assessing the acceptability of an online weight prevention programme for new kidney transplant recipients. Funded as a PhD Fellowship by Kidney Research UK to Ellen Castle.

PREHAB - a randomised pilot study assessing the impact of exercise, nutritional intervention and multidisciplinary education on outcomes in patients approaching and commencing dialysis. Led by Fiona Willingham and funded by Kidney Research UK.

QCKD: Increasing physical activity in chronic kidney disease - the patient perspective. Investigating how patients feel and think about taking up exercise and becoming more physically active, to help develop programmes to make that easier for them. Led by Alice Smith and funded by the British Renal Society.

PACE-KD: Participant Acceptability of Exercise in Kidney Disease - evaluating the feasibility (recruitment, retention and completion) of three different supervised aerobic exercise programmes in CKD patients. Led by Alice Smith and Lettie Bishop (Loughborough) and funded by Heart Research UK.

FLEX-HD: Understanding Frailty, Falls and the Role of Exercise in Haemodialysis (HD) Patients. Understanding the essential components of a falls and frailty intervention designed specifically for the HD population and how this might best be delivered. An NIHR funded PhD Fellowship led by Hannah Young.

Studies in development:

RECOVER-AKI - investigating the effect of an exercise rehabilitation programme on recovery of kidney function after an episode of acute kidney injury (AKI). Currently under review with the Wellcome Foundation and led by Daniel March.

Investigating the impact of paediatric kidney transplantation on physical activity, quality of life, cardiometabolic health and psychosocial adjustment: a longitudinal, cohort, feasibility study. Led by Pelly Koufaki in collaboration with researchers and clinicians in Glasgow, Edinburgh, Leeds and Manchester.

 

Impact:

MOVE: A web resource including guides and videos helping kidney patients to get more active. Developed by the Bangor University led by Drs Jennifer Cooney and Jamie Macdonald in collaboration with the Wales Kidney Research Unit http://move.bangor.ac.uk

Setting research priorities for patients with non-dialysis CKD in the area of renal rehabilitation, healthy lifestyle, physical activity, and diet/weight management. This followed a workshop in November 2018 and presented as a poster at UKKW 2019.

Clinical Practice Guidelines: Proposed and written by our CSG for The Renal Association, we have produced the first comprehensive national guideline on exercise and lifestyle in chronic kidney disease.

Response to COVID-19: Members of our CSG were instrumental in setting up and evaluating effectiveness of an online exercise and wellbeing service for patients with CKD unable to access physiotherapists and other allied health professionals: https://beamfeelgood.com/kidney-disease

Selected publications

  1. Greenwood SA, Koufaki P, Macdonald JH, Bulley C, Bhandari S, Burton J, et al. Randomized Trial - PrEscription of intraDialytic exercise to improve quAlity of Life (PEDAL) in patients receiving hemodialysis. Kidney Int Rep, 2021: https://doi.org/10.1016/j.ekir.2021.05.034.
  2. Greenwood SA, Castle E, Lindup H, Mayes J, Waite I, Grant D, Mangahis E, Crabb O, Shevket K, Macdougall IC, MacLaughlin HL. Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity.
  3. Gould DW, Watson EL, Wilkinson TJ, Wormleighton J, Xenophontos S, Smith AC. Ultrasound assessment of muscle mass in response to exercise training in chronic kidney disease: a comparison with MRI.
  4. Wilkinson TJ, Gould DW, Nixon DGD, Watson EL, Smith AC. Quality over quantity? Effects of skeletal muscle myosteatosis and fibrosis on physical functioning in chronic kidney disease.
  5. Kirkman DL, Scott M, Kidd J, Macdonald JH. The effects of intradialytic exercise on hemodialysis adequacy: A systematic review.
  6. Young HML, March DS, Graham-Brown MPM, Jones AW, Curtis F, Grantham CS, Churchward DR, Highton P, Smith AC, Singh SJ, Bridle C, Burton JO. Effects of intradialytic cycling exercise on exercise capacity, quality of life, physical function and cardiovascular measures in adult haemodialysis patients: a systematic review and meta-analysis.
  7. March DS, Graham-Brown MP, Young HM, Greenwood SA, Burton JO. 'There is nothing more deceptive than an obvious fact': more evidence for the prescription of exercise during haemodialysis (intradialytic exercise) is still required.
  8. O'Connor EM, Koufaki P, Mercer TH, Lindup H, Nugent E, Goldsmith D, Macdougall IC, Greenwood SA. Long-Term pulse wave velocity outcomes with aerobic and resistance training in kidney transplant recipients - A pilot Randomised controlled trial.
  9. Graham-Brown MP, March DS, Churchward DR, Stensel DJ, Singh A, Arnold R, Burton JO, McCann GP. Novel cardiac nuclear magnetic resonance method for non-invasive assessment of myocardial fibrosis in hemodialysis patients.
  10. Greenwood SA, O'Connor E, Mercer TH, Koufaki P, Tuffnell R, Rush R, Lindup H, Haggis L, Dew T, Nugent E, Abdulnassir L, Goldsmith D, Macdougall IC. Aerobic or Resistance Training and Pulse Wave Velocity in Kidney Transplant Recipients: A 12-Week Pilot Randomised Controlled Trial (The Exert Study).
  11. Koufaki P, Greenwood S, Painter P, Mercer T. The BASES expert statement on exercise therapy for people with chronic kidney disease.
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