Kidney Transplant Improvement Through New Exercise Training to Increase Capacity

Feasibility will be assessed by enrollment efficiency and participant retention. Enrollment efficiency will be calculated as the percentage of participants successfully enrolled after invitation. Thresholds of success include, ≥70% of potentially eligible agree to screening and ≥40% of eligible consent and enroll Retention will be measured as the percentage of enrollment participants who complete the 12-week study period. The threshold of successful retention is ≥70%.

Acceptability will be measured using the System Usability Scale (SUS), a validated questionnaire assessing usability and satisfaction with the study system. SUS scores will be calculated using standard scoring methods. Scores of 68 or higher will be considered indicative of acceptable usability. Quantitative findings will be supplemented with qualitative feedback from participants, including themes related to acceptability identified through end-of-study exit interviews.

Adherence will be assessed as the percentage of study days with valid step count data and, for participants in the intervention arm, the percentage of completed exercise sessions out of those recommended during the 12-week intervention period. Feasible adherence will be defined as ≥70% of study days with valid step count data and ≥70% of participants in the intervention arm completed ≥2 exercise classes per week.

Safety will be evaluated by documenting the number and type of adverse events occurring during the study period.

Change in Short Physical Performance Battery (SPPB) total score will be compared between study groups.

The SPPB total score is calculated by summing the scores from three performance-based components:

Standing balance test 4-meter gait speed test Five-times sit-to-stand test Each component is scored from 0 to 4, and the three component scores are summed to produce a total score ranging from 0 to 12, with higher scores indicating better physical function.

The aggregated total score (0-12 points) will be used as the outcome measure.

Daily physical activity will be assessed using wearable activity trackers. Between-group differences in average daily step counts will be evaluated after intervention period of 12 weeks.

Changes in SF-36 compared between study groups- 36-item measure evaluating functional status and perceptions of health status, scored from 0 to 100; higher scores associated with greater perceived HRQOL. between study groups.

Physical function will be assessed using Between-group differences in Frailty status using the Fried Frailty Phenotype

Physical function will be assessed using between-group differences in Gait speed (meters/second)

Physical function will be assessed using Between-group differences in time of Five-times sit-to-stand test (seconds)

Physical function will be assessed using Between-group differences of Handgrip strength (kilograms)

Between-group differences will be evaluated for patient-reported physical functioning using the PF-10 from the SF-36 (score range 0-100, higher scores indicate better physical functioning) and the SF-36 Physical Component Summary score (norm-based score, mean 50, higher scores indicate better physical functioning).

Changes in digital health literacy will be compared between study groups using the Electronic Health Literacy Scale (eHEALS), an 8-item questionnaire assessing perceived ability to find, understand, and use electronic health information. Items use 5-point Likert response options. Total scores range from 8 to 40, with higher scores indicating better digital health literacy

Changes in health-related quality of life will be compared between study groups using the SF-36, a 36-item measure evaluating functional status and perceptions of health. Scores range from 0 to 100, with higher scores indicating better perceived health-related quality of life.

Changes in self-efficacy will be compared between study groups using the PROMIS Self-Efficacy short form, a 4-item questionnaire assessing confidence in managing health and daily activities. Items use 5-point Likert response options. Higher scores indicate greater self-efficacy.

Changes in motivation for physical activity will be compared between study groups using the Behavioral Regulation in Exercise Questionnaire (BREQ-3), a 24-item measure assessing different types of exercise motivation. Items use 5-point Likert response options, and scores are calculated as mean subscale scores, with higher scores indicating greater endorsement of that motivational regulation type.

Changes in perceived social support will be compared between study groups using a 6-item questionnaire adapted for physical activity contexts. Items use 5-point Likert response options. Total scores range from 6 to 30, with higher scores indicating greater perceived social support.

Changes in self-reported physical activity will be compared between study groups using the Rapid Assessment of Physical Activity (RAPA), a 9-item questionnaire assessing participation in aerobic activity, strength training, and flexibility exercises. Any number less than 6 is considered suboptimal.

The proportion of participants who experience at least one of the following events within 30 days after kidney transplant: delayed graft function (needing dialysis at any time after transplant), primary non-function (non-functioning transplant), surgical complication requiring intervention, intensive care unit (ICU) transfer, discharge to an assisted care facility, any rehospitalization after discharge from transplant hospitalization, or death.

Each participant will be classified once as either:

Yes (experienced ≥1 event), or No (experienced none of the listed events). The outcome will be analyzed as a binary participant-level variable.

Group differences in number of hospitalizations while on waitlist

The proportion of participants who experience at least one of the following events within 90 days after kidney transplant: delayed graft function (defined as need for dialysis at any time after transplant), primary non-function (non-functioning transplant), surgical complication requiring intervention, intensive care unit (ICU) transfer, discharge to an assisted care facility, any rehospitalization after discharge from the transplant hospitalization, or death.

Each participant will be classified once as either:

Yes (experienced one or more of the listed events), or No (experienced none of the listed events). The outcome will be analyzed as a binary participant-level variable.

Length of stay (LOS) is defined as the number of days from the date of kidney transplant surgery to hospital discharge. LOS will be analyzed as a continuous outcome

Group differences of waitlist status from inactive to active prior to transplantation

Group differences in the cumulative number of inpatient hospital days across all hospitalizations occurring while a participant is on the kidney transplant waitlist prior to transplant.

Group differences in number of deaths while on waitlist