Development and feasibility testing of a Self-directed intervention to increase Physical Activity in chRonic Kidney disease (SPARK)

People living with chronic kidney disease not requiring renal replacement therapy are often not active enough to gain the health benefits that physical activity can provide. This thesis described the iterative development and feasibility testing of a theory-driven intervention (SPARK) to address this issue

This thesis comprises four studies utilising mixed-methodologies; a systematic review investigating the association of physical function and physical activity with all-cause mortality and adverse clinical outcomes; secondary analysis of a cross-sectional study exploring physical activity behaviour and patients’ attitudes to being active; the development of a theory-based intervention using an iterative approach based on expert and patient involvement and feasibility testing of the SPARK intervention.

Key findings:

- higher mortality rates and/or prevalence of adverse clinical events were associated with lower physical activity and poorer physical function levels.

- 77% of people living with chronic kidney disease not requiring renal replacement therapy are insufficiently active and walking was the preferred modality of activity. Factors considered to support physical activity behaviour included education, motivation and support. The most common physical barriers were fatigue and general malaise. Social barriers and psychological barriers were also described.

- The SPARK intervention comprised an 8 week walking and strength training programme, delivered using Motivational Interviewing, supplemented with written material and supportive telephone calls during the intervention period.

- Feasibility testing (n=27) was conducted in primary and secondary care and demonstrated that recruitment rates were low in primary care (5.29% consent rate), but more successful in secondary care (27% consent rate). Retention rate was 85%. Engagement data was encouraging, 24 participants (89%) returned physical activity diaries with a mean completion rate=84% days of the intervention period.

This programme of work has produced an intervention that could be tested in a randomised controlled trial to investigate efficacy.