Patients on hemodialysis wearing Fitbits, receiving coaching show greater daily step count
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Patients on hemodialysis who wear Fitbits and receive structured feedback showed greater daily step counts than patients who didn’t receive coaching, according to data published in American Journal of Kidney Diseases.
“There is a growing experience of digital technology and intervention delivery modalities to capture and promote [physical activity (PA)] in chronic disease conditions, but little is known in patients receiving [hemodialysis (HD)] specifically,” Rakesh Malhotra, MD, MPH, nephrologist and assistant professor of medicine at University of California San Diego, and colleagues wrote. “While digital technology can accurately measure step counts in patients receiving HD, it is not known whether it can be used as a tool to promote changes in PA. Moreover, the effect of behavior feedback interventions in patients receiving HD is understudied.”
In a pilot randomized controlled trial, researchers examined 55 patients with end-stage kidney disease undergoing HD between January 2019 and April 2020, all of whom were able to walk with or without devices to help.
Patients wore a Fitbit Charge 2 wearable activity tracker on their nonvascular access arm for 7 days prior to randomization to provide baseline step counts. Then, they were assigned 1:1 to receive a structured feedback intervention or not for 12 weeks. Those who received counselling were coached on a weekly basis about their Fitbit steps.
Researchers considered step count the primary outcome of the study. Additionally, they measured the absolute change in daily step count, averaged per week from baseline to the end of the 12-week intervention period.
Using a mixed-effect linear regression analysis, researchers explored the change in daily step count from baseline to 12 weeks in both groups.
Ultimately, 46 patients completed the full 12-week intervention, with 23 in each group. The patients with structured feedback averaged a daily count of 3,704 steps at baseline and those who only used the Fitbit showed an average daily count of 3,808 steps. Following the 12-week intervention, researchers noticed no significant difference in adherence to wearing the Fitbit between groups.
At week 12, patients receiving structured feedback increased their daily count by about 920 steps, whereas those without feedback only increased about 281 steps.
“This change occurred rapidly over the first 4 weeks and appeared sustained over the 12-week study. The magnitude of differences in steps was large across arms, both in terms of their potential impact on downstream clinical changes, and statistical significance,” Malhotra and colleagues wrote. “These data demonstrate feasibility of the use of wearable activity tracker to increase PA when patients are away from the HD unit, and the feasibility of a structure feedback intervention to increase PA] in patients receiving HD.”
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