Activity trackers may increase physical activity of people with kidney disease

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Bennett and Leuther do not report any relevant financial information.

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Most people with advanced kidney disease are physically inactive. This inactivity is associated with increased exposure to dialysis symptoms, hospitalization, and mortality.1

In people with advanced kidney disease (AKD), 10 minutes of increased daily physical activity is associated with a 22% decrease in risk of death.2

We often encourage people with AKD to exercise to improve their fitness, increase strength, and in some cases lose excess weight. While most patients understand the value of physical activity, many do not value exercise.

Paul N. Bennett

Kerstin K. Leuther

Wearable activity trackers (WATs) such as wrist devices and integrated phone apps have the potential to sustainably increase the activity of people with AKD.

WATs provide motivation

Motivation theory tells us that a change in behavior will be more sustainable the more autonomous the motivational stimulus is.3 WATs support this autonomy by providing intrinsic rewards for the wearer. For example, the wearer is motivated to exceed the number of steps they took the day before.

This motivation can be further increased by facilitating exercise selection and through online and personal relationships with peers that develop using WATs.4th In a study of over 800 healthy adults, activity tracker wear alone increased and maintained moderate to vigorous physical activity for an extended period of 12 months.5

Portable activity trackers have rapidly gained popularity around the world. Brands like Fitbit, Jawbone, Gruve, LumoBack, BodyMedia, Polar Active, Pebble, Fitmeter, Personal Activity Monitor, Apple Watch and Withings Pulse have seen increasing usage. By 2022, it is expected that 200 million people worldwide will use such devices.2

Integrated into a mobile phone app, activity trackers enable convenient and immediate feedback on daily steps and energy consumption.

Activity tracker and AKD

Although cross-sectional studies to measure activity in patients with AKD are common (see figure), controlled studies testing the hypothesis that wearable trackers increase activity are rare. A recent study in patients on peritoneal dialysis and hemodialysis showed an increase of over 2,000 steps per day in those wearing WATs and setting goals compared to a group without an activity tracker.6th However, this change was not sustained after the study, suggesting that immediate feedback may be of limited value once the novelty wears off. Measuring our activity or lack of it by our daily step count can be of limited value in the absence of new information, mutually agreed strategies, or achievable goals.

Global anecdotal experience with WATs in dialysis patients has shown that many patients have adopted trackers but can become bored with them and some have stopped using them. Some clipped the tracker to their shoes during intradialytic cycling to count cadence. However, although activity trackers play a role in increasing activity, additional strategies are needed to bring about sustainable behavior change. Additional strategies can be:

  • give clear instructions on how to use trackers;
  • set achievable individual goals;
  • ·Individual or group peer mentoring;
  • Participating in online social community activities;
  • professional exercise support (physiotherapists, exercise physiologists, kinesiologists);
  • support a walking through America marathon or similar;
  • Documentation of the steps for each dialysis visit (similar to the documentation of weight and blood pressure);
  • Make sure the type of tracker suits the person;
  • integrate with mobile phone;
  • Make sure that shuffle and asymmetrical gaits are counted;
  • frequent downloading of data to address data, battery and storage capacity; and
  • Encourage dialysis staff to wear trackers.

Future studies

An ongoing 16-center study in Australia, entitled “Structured Exercise Program to Reduce Fatigue in Dialysis Patients: A Preference Stratified Adaptive Study (M-FIT),” will use an exercise-assisted phone app to combat fatigue and activity .7th

The use and competence of wearable and mobile technology is high among the AKD population.8th Accordingly, interventions like WATs are well accepted by people with AKD and so we can hope that people with AKD will use these types of technologies to set activity goals. Additionally, the adoption of activity tracking technology can lead to other mobile health innovations leading to greater patient engagement, increased remote monitoring, improved treatment adherence, and real-time symptom management.

The way forward

Although nephrology clinics are not training specialists, we are in the privileged position of helping patients increase their physical activity and maintain their independence. In this area of ​​responsibility, it is up to us to offer people with AKD a path to activity and movement. Promoting the use of WATs and mobile step tracking apps with individualized additional strategies can be a first step towards increasing physical activity. Systematic integration of physical activity, activity tracking, coaching and peer support in the routine care of dialysis patients can promote a more active lifestyle, which can ultimately improve the quality and quantity of life for people with AKD.

References:

1. Clarkson MJ et al. Am J Physiol Renal Physiol. 2019; doi: 10.1152 / ajprenal.00317.2018.

2. MatsuzawaR, et al. Clin J Am Soc Nephrol. 2012; doi: 10.2215 / CJN.03660412.

3. Nuss K. et al. Am J health promotion. 2020; doi: 10.1177 / 0890117120939030.

4. Karapanos E. et al. Psychological wellbeing. 2016; doi: 10.1186 / s13612-016-0042-6.

5. Finkelstein EA et al. Lancand diabetic endocrine. 2016; doi: 10.1016 / S2213-8587 (16) 30284-4.

6. SheshadriA, et al. Am J Kidney Dis. 2020; doi: 10.1053 / j.ajkd.2019.07.026.

7. Commonwealth of Australia. Future fund for medical research. Available at: www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/359-million-boost-for-rare-cancers-rare-diseases-and-unmet-medical-needs. Retrieved June 15, 2021.

8. Hussein WF et al. Clin J Am Soc Nephrol .: 2020; doi: 10.2215 / cjn.11690720.

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