Evidence suggests that elective cardiac patients are at risk of functional and psychological deterioration in the time preceding surgery. This poses a risk to successful post-operative rehabilitation. This prospective one-group pre-test, post-test evaluation was designed to assess a clinical Pre-operative Rehabilitation (PREHAB) home-based exercise programme, to optimise pre-operative physical function and frailty in patients awaiting elective Coronary Artery By-Pass Graft (CABG) or Valve Surgery. Consenting patients awaiting cardiac surgery, with wait time ≥ 6 weeks were referred to a Senior Physiotherapist for baseline assessment. Patients were offered PREHAB in the form of functional home-based exercise that was prescribed from baseline physical outcomes. All patients were followed up via telephone to ensure progression of exercise and any problems associated with it. This continued weekly until the patient attended Surgical Pre-assessment clinic, where all outcome measures were re-assessed. Twenty two patients, out of a total number of 36 patients seen in the surgical clinic between March 2016 and August 2016, participated in the prehab clinical evaluation. Twenty patients completed their prescribed exercises on a weekly basis prior to surgery. No adverse events or cardiac symptoms were reported as a result of the home exercise intervention. Paired t-Test analyses revealed a significant mean difference in clinical frailty score (CFS) of −0.53 ± 0.51 (95% CI [−0.774, −0.279], P = 0.0003). Significant mean difference in six-minute walk test (6MWT) distance of 42.5 ± 27.8 m (95% CI [23.840, 61.251], P = 0.0005), 6MWT walking speed of 0.5 ± 0.4kmh (95% CI, [0.2433, 0.7567], P = 0.001), and short physical performance battery (SPPB) total score of 2.2 ± 1.7, (95% CI [3.066, 1.200], P = 0.0002) were also observed. The change in 6MWT distance was shown to be significantly associated with hospital length of stay (LOS) (r = 0.7; P = 0.03). This small exploratory evaluation suggests that providing a home-based PREHAB programme for frail patients undergoing CABG or Valve surgery may be able to improve functional ability and reduce hospital length of stay for those patients undergoing cardiac surgery. A frailty score with greater sensitivity may be required to elucidate the influence frailty could have in reducing length of stay. A large randomised controlled study is required to reveal the potential beneficial effects of PREHAB in this patient population.

Physical activity has the potential to positively impact upon aerobic and functional ability, and the quality of life of all chronic kidney disease (CKD) patients independent of the stage of the disease process. Physical activity is recommended in a number of national CKD guidelines, but its incorporation into routine care has been slow. The translation of research-led physical activity programmes into an established procedure appears to be a particular obstacle. This study included 263 patients, consecutively referred over a 4-year period, to a pragmatic 12-week renal rehabilitation (RR) programme delivered within a National Health Service (NHS). One hundred and thirty-one patients were assessed and started the RR programme. Anxiety and depression were measured using the hospital anxiety and depression (HAD) scale. The self-reported level of fitness was measured with the Duke's activity status index (DASI), and exercise capacity was assessed with the incremental shuttle walk test (ISWT), sit-to-stand transfers in 60 s (STS60), timed up and go (TUAG) and stair-climb descent (SCD) tests. All measures were assessed at baseline and at 12 weeks. Attendance and completion of the RR programme were recorded for all patients. There were significant improvements in exercise capacity and functional ability ranging from 21 to 44%, and significant improvements in anxiety (15%) and depression (29%) in the 77 patients who completed the RR programme. The self-reported level of fitness was found to be significantly associated with completion (P = 0.01), with older participants showing a trend towards being more likely to complete (P= 0.07). Fifty-four patients, out of the 131 patients who commenced the RR programme, failed to complete 12 or more of the 24 scheduled sessions. Patients requiring haemodialysis (HD) treatment constituted the largest number of dropouts/non-completers (49%) in the study. This study demonstrates that a pragmatically constructed, NHS-delivered exercise-based RR can substantially improve both physical function and mental well-being for the wide range of CKD patients who regularly participated (55%). Compliance/adherence data indicate that this type of rehabilitation programme is particularly well received by pre-dialysis (PD) CKD and post-transplantation patients.

Remote digital health interventions to enhance physical activity provide a potential solution to improve the sedentary behaviour, physical inactivity, and poor health-related quality of life that are typical of chronic conditions, particularly for people with chronic kidney disease. However, there is a need for high-quality evidence to support implementation in clinical practice. The Kidney BEAM trial evaluated the clinical effect of a 12-week physical activity digital health intervention on health-related quality of life. In a single-blind, randomised controlled trial conducted at 11 centres in the UK, adult participants (aged ≥18 years) with chronic kidney disease were recruited and randomly assigned (1:1) to the Kidney BEAM physical activity digital health intervention or a waiting list control group. Randomisation was performed with a web-based system, in randomly permuted blocks of six. Outcome assessors were masked to treatment allocation. The primary outcome was the difference in the Kidney Disease Quality of Life Short Form version 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between baseline and 12 weeks. The trial was powered to detect a clinically meaningful difference of 3 arbitrary units (AU) in KDQoL-SF1.3 MCS. Outcomes were analysed by an intention-to-treat approach using an analysis of covariance model, with baseline measures and age as covariates. The trial was registered with ClinicalTrials.gov, NCT04872933. Between May 6, 2021, and Oct 30, 2022, 1102 individuals were assessed for eligibility, of whom 340 participants were enrolled and randomly assigned to the Kidney BEAM intervention group (n=173) or the waiting list control group (n=167). 268 participants completed the trial (112 in the Kidney BEAM group and 156 in the waiting list control group). All 340 randomly assigned participants were included in the intention-to treat population. At 12 weeks, there was a significant improvement in KDQoL-SF.13 MCS score in the Kidney BEAM group (from mean 44·6 AU [SD 10·8] at baseline to 47·0 AU [10·6] at 12 weeks) compared with the waiting list control group (from 46·1 AU [10·5] to 45·0 AU [10·1]; between-group difference of 3·1 AU [95% CI 1·8-4·4]; p<0·0001). The Kidney BEAM physical activity platform is an efficacious digital health intervention to improve mental health-related quality of life in patients with chronic kidney disease. These findings could facilitate the incorporation of remote digital health interventions into clinical practice and offer a potential intervention worthy of investigation in other chronic conditions. Kidney Research UK.