BACKGROUND End-stage renal disease (ESRD) patients receiving regular hemodialysis (HD) are a highly sedentary population with high mortality. Sufficient physical activity may reduce the risk of cardiovascular-related diseases and all-cause mortality in the HD population. OBJECTIVE This study aimed to evaluate the effectiveness of wearable devices, a health management platform, and social media for improving the physical activity of HD patients, with the goal of establishing a new intervention model. METHODS In a 24-week prospective study, a total of 31 clinically stable HD patients were enrolled. All participants were assigned home exercises based upon walking and calisthenics and patients were provided with wearable devices that collected exercise-related data. All participants maintained dietary diaries using a smartphone app. All dietary and exercise information was then uploaded to a health management platform. Suggestions about diet and exercise were provided, and a social media group was created to inspire the participants. Physical performance testing was performed at baseline and during weeks 4, 8, 12, 16 and 24, using monthly step counts, sit-to-stand tests (STS-10 and STS-60), 6-minute walking distance (6MWT) and hand grip strength (HGS). The Kidney Disease Quality of Life survey (KDQOL-36TM) questionnaire was used to assess quality of life. Nutrition status was evaluated by subjective global assessment (SGA). RESULTS A total of 25 participants completed the study; 14 were male, and the mean participant age was 51.22 years. After the intervention, the STS-10 test reduced by 4.37 seconds, the STS-60 increased 12 fold, the 6MWT increased by 55 meters, and the HGS also increased relative to the baseline. The monthly step count increased to an average of 46,437 steps. At the end of the study, the KDQOL-36TM and SGA scores were elevated. By logistical regression, the monthly step count correlated positively with 6MWT and SGA; the more steps per month achieved, the longer the distance in the 6MWT and higher SGA score were noted. CONCLUSIONS The application of wearable devices, a health management platform, and social media support not only strengthened physical activity but also improved the quality of life and nutrition in people with regular HD. These results outline a new model to promote healthy lifestyle behaviors in HD patients. CLINICALTRIAL The study protocol was approved by the Research Ethics Committee of National Taiwan University Hospital (No. 201812145RINA). The ClinicalTrials.gov number was NCT05281497.

UNSTRUCTURED Objectives: Chronic kidney disease (CKD) is a global health burden. This study aimed to evaluate the effectiveness of wearable devices and a health management platform, and to establish a self-management model in CKD patients. Methods: This was a 90-day prospective experimental study. Sixty CKD stage 1-4 patients were enrolled, including the intervention group (n=30) and the control group (n= 30). All participants were provided with wearable devices and the exercise-related data were collected using the wearable devices. Both groups recorded their dietary diary using a smart phone application. All the information was uploaded to a health management platform and suggestions about diet and exercise were only made to the intervention group. A LINE group was created to inspire participants in the intervention group. The scores of the self-efficacy and self-management questionnaires, the Kidney Disease Quality of Life score, body composition, and laboratory examinations before and after the intervention were compared. Results: A total of 49 participants completed the study (25 in the intervention group, 24 in the control group, and comprised 73.5% male, with a mean age of 51.22 years). The measured baseline characteristics of both groups were the same except the educational background. After the intervention, the scores of self-efficacy (171.28±22.92 vs. 142.21±26.36, p<0.001) and self-management (54.16±6.71 vs. 47.58±6.42, p=0.001) were significantly higher in the intervention group. The score for the Kidney Disease Quality of Life was also higher in the intervention group (293.16±34.21 vs. 276.37±32.21, p=0.021). The steps per day increased in the intervention group (9768.56 during the 1st week, increasing to 11389.12 during the 12th week). The estimated glomerular filtration rate (eGFR) of the intervention group was higher than that of the control group (72.47±24.28 vs. 59.69±22.25 mL/min/1.73m2, p = 0.025). The decline in eGFR was significantly slower in the intervention group (-0.56 vs. -4.58 mL/min/1.73m2). There were no differences in body composition between both groups at the end of study. Conclusions: The application of wearable devices and a health management platform not only strengthened self-efficacy and self-management, but improved life quality and slowed down eGFR decline in patients with CKD stage 1-4. These results provide a self-management model and promote healthy lifestyle behaviors in CKD patients.

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