In the EXerCise Introduction to Enhance Performance in Dialysis (EXCITE) trial, a simple, personalized 6-month walking exercise program at home during the day off of dialysis improved the functional status and the risk for hospitalization in patients with kidney failure. In this post-trial observational study, we tested whether the same intervention was associated with a lower long-term risk of death or hospitalization (combined end point) during a follow-up extended up to 36 months.

In total, 227 patients (exercise, n=104; control, n=123) completed the 6-month trial and entered the post-trial observational study. Data were analyzed by unadjusted and adjusted Cox regression analyses and Bayesian analysis.

In the long-term observation (up to 36 months), 134 events were recorded (eight deaths not preceded by hospitalization and 126 hospitalizations, which were followed by death in 38 cases). The long-term risk for hospitalization or death was 29% lower (hazard ratio, 0.71; 95% confidence interval, 0.50 to 1.00), and in an analysis stratified by adherence to the walking exercise program during the 6-month trial, the subgroup with high adherence (>60% of prescribed sessions) had a 45% lower risk as compared with the control group (hazard ratio, 0.55; 95% confidence interval, 0.35 to 0.87). A Bayesian analysis showed that the posterior probability of a hazard ratio of 0.71 (95% confidence interval, 0.50 to 1.00) for the risk of the composite outcome observed in the post-trial observational study was 93% under the conservative prior and 97% under the optimistic prior. Sensitivity analyses restricted to the risk of hospitalization only or censoring patients at the time of transplantation fully confirmed these findings.

A simple, personalized, home-based, low-intensity exercise program was associated with a lower risk of hospitalization.

EXerCise Introduction to Enhance Performance in Dialysis (EXCITE), NCT01255969

在提高透析表现的 EXerCise 简介 (EXCITE) 试验中，在透析休息日在家进行简单、个性化的 6 个月步行锻炼计划，可以改善肾衰竭患者的功能状态并降低住院风险。在这项试验后观察性研究中，我们在长达 36 个月的随访期间测试了相同的干预措施是否与较低的长期死亡或住院风险（合并终点）相关。

总共 227 名患者（运动组，n = 104；对照组，n = 123）完成了为期 6 个月的试验并进入试验后观察研究。通过未调整和调整的 Cox 回归分析和贝叶斯分析对数据进行分析。

在长期观察（长达 36 个月）中，记录了 134 起事件（8 例死亡前未住院，126 例住院后死亡 38 例）。住院或死亡的长期风险降低了 29%（风险比为 0.71；95% 置信区间为 0.50 至 1.00），在 6 个月试验期间按坚持步行锻炼计划进行分层的分析中，该亚组与对照组相比，高依从性（> 60% 的处方疗程）的风险降低了 45%（风险比，0.55；95% 置信区间，0.35 至 0.87）。贝叶斯分析表明，试验后观察性研究中观察到的复合结果的风险比为 0.71（95% 置信区间，0.50 至 1.00）的后验概率在保守先验条件下为 93%，在保守先验条件下为 97%。乐观的先验者。仅针对住院风险或在移植时对患者进行审查的敏感性分析完全证实了这些发现。

简单、个性化、在家进行的低强度锻炼计划与较低的住院风险相关。

EXerCise 增强透析性能简介 (EXCITE)，NCT01255969