# Identifying Goals and Barriers to Exercise for Prehabilitation in Older Adults awaiting Kidney Transplantation and their Caregivers

> **NIH NIH R03** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $161,500

## Abstract

PROJECT SUMMARY: End-stage renal disease (ESRD) is a disease of premature aging and is associated
with impairments in functional status and quality of life. The dialysis population is growing older each year, and
older patients with ESRD are at very high risk for functional impairment. Kidney transplantation (KT) is a well-
established therapy that has the potential to ameliorate the detrimental effects of ESRD on physical activity,
quality of life, and functional status. However, KT alone may not meet the full extent of this potential,
particularly for older or more impaired adults. In fact, physical activity declines immediately post-KT and fails to
return to expected levels even up to 5 years post-KT. Older patients waitlisted for KT (most of whom are on
dialysis) are therefore reliant on their pre-KT levels of exercise, which are also predictive of post-KT mortality.
 “Prehabilitation” has recently emerged as a strategy in other surgical populations to enhance recovery
and minimize functional loss, and a structured exercise program may be beneficial in the pre-KT population.
However, though exercise interventions have been successful in improving physical function and quality of life
among patients with ESRD, only a small percentage of waitlisted patients may actually be able to participate in
such interventions. Patients treated with dialysis in general have barriers such as severe fatigue, dyspnea, and
lack of time or exercise partners. Older patients have additional barriers such as further impairments in
mobility, fear of falling, and effects of polypharmacy. In addition, many older dialysis patients require caregiver
support for transport and for adherence to such interventions. Therefore older patients are likely to have unique
barriers to exercise interventions, and may also have specific goals for such an intervention. For an exercise
intervention to be successful in this setting, it is necessary to conduct formal qualitative research that includes
the voices of older adults awaiting KT as well the voices of their caregivers.
 The major goal of this study is to use qualitative research methodology to formally evaluate facilitators
of and barriers to an exercise intervention for prehabilitation in older patients awaiting KT. We will perform one-
on-one cognitive interviews of 30 older adults and 30 of their caregivers in paired dyads. We expect to elicit
unmet needs of older patients awaiting KT and goals that may not be fully addressed by the procedure. We will
then conduct semi-structured focus group interviews recruited from the cohort of patients and caregivers who
have previously been interviewed to establish a consensus on prehabilitation, including details of a possible
future intervention such as expected outcomes and specifics of coaching. Primary mentorship will be provided
by Rebecca Sudore, MD (Geriatrics, Qualitative Research). Additional mentors are Jennifer C. Lai (Frailty in
End-Organ Disease, Transplantation) and Kirst...

## Key facts

- **NIH application ID:** 10027670
- **Project number:** 1R03AG067981-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Anoop Sheshadri
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $161,500
- **Award type:** 1
- **Project period:** 2020-09-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10027670

## Citation

> US National Institutes of Health, RePORTER application 10027670, Identifying Goals and Barriers to Exercise for Prehabilitation in Older Adults awaiting Kidney Transplantation and their Caregivers (1R03AG067981-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10027670. Licensed CC0.

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