Feasibility and acceptability of a telehealth-supported physical activity program for children with chronic kidney disease: a pilot mixed methods study

BACKGROUND: Children with chronic kidney disease (CKD) often experience high levels of physical inactivity, exacerbating their health challenges and diminishing their quality of life. Given the potential health risks and reported barriers to sustained engagement in physical activity interventions, our objective was to evaluate the feasibility and acceptability of an individualized telehealth-supported physical activity program for adolescents with CKD stages 2-5. METHODS: This study was a 2-arm randomized waitlist control intervention to evaluate a 12-week telehealth physical activity program in children with CKD. Eligible participants, aged 11-18 years with CKD stages 2-5, were randomized via permuted block randomization, with CKD stage and sex as stratification factors, into a waitlist control (WLC) or physical activity intervention group. The treatment group received every 2-weeks video visits and personalized physical activity plans to increase or maintain ≥150 min of moderate to vigorous physical activity/week. All participants received a remotely tracked fitness wearable. Demographic and disease-based characteristics were collected at baseline to assess group differences. End-of-treatment surveys were conducted to assess acceptability, and inductive qualitative analysis was performed on two open-ended questions for both participant and guardian. RESULTS: Of 400 patients screened for eligibility, 37 were randomized (19 to waitlist control, 18 to treatment) with a recruitment rate of 4/month and an attrition rate of 2.7%. No demographic or disease characteristic differences were observed between groups. High fitness wearable adherence was observed in 35 participants. Median telehealth visit compliance was 83%. Qualitative analysis identified 3 categories: accountability and motivation (>30% citations from participants and parents relating to instructor motivation and accountability), the interplay of physical or mental health and physical activity (44% participant physical health), and personalization of the program to limit barriers to implementation (52% participant activity type, 44% participant education). CONCLUSION: Telehealth-supported physical activity intervention is feasible in children with CKD with low attrition rates and high compliance to visits. Participants and guardians identified personalization and engagement strategies as central to their experience of the program, suggesting these may be important to intervention success.