Understanding frailty, falls and the role of exercise in haemodialysis patients

Frailty is highly prevalent in haemodialysis (HD) patients, leading to a range of poor outcomes. Intradialytic cycling (IDC) is the predominant form of rehabilitation offered, but may not be suited to those who are frail. This thesis aimed to determine whether a randomised controlled trial (RCT) of IDC is feasible for frail HD patients and inform a tailored exercise intervention for this population.

Chapter 1 provides an overview of frailty and the potential role of exercise in an HD population.

A systematic review (Chapter 2) investigating the effectiveness of IDC on exercise capacity, quality of life and physical function found that equipoise regarding the effects of IDC exists. Trials focusing specifically upon frail HD patients were also lacking, underlining the need for a feasibility RCT.

A co-production process used to develop the progression criteria for the feasibility study is described in Chapter 3.

Chapter 4 established some recommendations for the measurement of physical activity in HD patients which are used in the feasibility trial described in Chapter 7.

The trial results (Chapter 7) indicated that, whilst a future definitive trial of IDC appears to be feasible for frail HD patients, adaptations are required to increase eligibility and outcome acceptability.

The qualitative results (Chapter 8) identified several ways that a future trial could be adapted to enhance recruitment, outcome completion and reduce withdrawals. Whilst IDC was convenient, participants preferred a programme which included exercise preparation and offered choice, supervision, companionship and individualised progression.

The original contributions within this thesis will help improve the conduct of future studies. The thesis also includes the first study to report that an RCT of IDC is feasible for frail HD patients and to outline how an exercise intervention and the design of a future definitive trial should be tailored to the needs of this group.