Project Summary In this R34 application, we propose to conduct an early phase clinical trial of a mind-body intervention to promote whole person health—specifically, to develop and evaluate the feasibility and acceptability of a tailored progressive muscle relaxation and walking intervention to reduce fatigue for adults with end-stage kidney disease (ESKD). Fatigue is an extremely concerning and debilitating symptom that affects the majority of adults with ESKD. Fatigue has a profound negative impact on whole person health for adults with ESKD through its influence on morbidity, quality of life, social relationships, and functional independence. There are no standard-of-care therapies available to alleviate fatigue in ESKD. There is strong evidence, from rigorous randomized controlled trials, that progressive muscle relaxation can reduce fatigue, yet this approach has been understudied in the diverse population of adults with ESKD in the U.S. Physical activity in the form of walking can also reduce fatigue, but again has been understudied as a way to reduce fatigue in adults with ESKD. There has also been minimal investigation into the feasibility and acceptability of multicomponent mind-body interventions to reduce fatigue in adults with ESKD, with an absence of any studies utilizing both progressive muscle relaxation and walking, or utilizing text messaging as a low-demand method of delivering mind-body intervention content. Our objective is to fill these research gaps by developing and evaluating such an intervention. In Aim 1, we will use content from two established evidence-based interventions—a progressive muscle relaxation intervention and a fatigue-reducing walking intervention—and work with a patient advisory board to develop a mind-body intervention tailored for adults with ESKD and fatigue. In Aim 2, we will evaluate the feasibility and acceptability of the new Fight Fatigue intervention using a two-arm design (n=40 participants, randomized to either the combined progressive muscle relaxation and walking intervention or ESKD education/attention control). The 12-week intervention will be delivered with brief in-person training followed by text messages. Findings from this study will provide the necessary data to design and test a large- scale efficacy trial to reduce fatigue for adults with ESKD and thus promote whole person health for this at-risk population.