RATIONALE AND OBJECTIVE: Kidney transplantation (KT) is the preferred treatment for kidney failure but carries significant posttransplant risks, particularly for frail patients. This study evaluated the effects of an exercise-based prehabilitation program on exercise capacity, muscle function, and muscle size among KT candidates. STUDY DESIGN: Analysis of functional outcomes within the FRAILMar study, a randomized controlled trial. SETTING AND PARTICIPANTS: 121 KT candidates on the KT waiting list. INTERVENTION: The intervention group participated in a prehabilitation program comprising 24 exercise sessions (1 hour, 3 times per week for 8 weeks); the control group received standard care. Randomization was stratified by frailty status. OUTCOME: The primary outcome was exercise capacity assessed by maximal workload during a cardiopulmonary exercise test. Secondary outcomes included peripheral muscle function, respiratory muscle function, muscle size, and changes in frailty status. RESULTS: The mean age of the 121 individuals who were randomized was 63.4 years, 76% were men, and 40% were frail (Fried phenotype >= 2). Of these patients, 106 completed the prehabilitation program; among them, compared with standard care, prehabilitation significantly improved exercise capacity (+12.8 watts (95% CI 3.4 to 22.2), p = 0.008), handgrip strength (+1.8 kg (95% CI 0.7 to 2.8), p < 0.001), and rectus femoris thickness (+1.2 mm; (95% CI 0.3 to 2.0), p = 0.007). Frail patients showed significant improvements across most measures, demonstrating potential benefits for this subgroup. LIMITATIONS: This analysis was limited by a short follow-up period and the risk of type I error due to multiple comparisons, even though outcomes were prespecified. CONCLUSIONS: An 8-week exercise-based prehabilitation program may improve KT candidates' exercise capacity, muscle function, and muscle size, and these effects also were observed among frail patients. These findings may inform future research in this area and the evaluation of the value of standardized prehabilitation protocols. FUNDING: Grant from government (Instituto de Salud Carlos III). TRIAL REGISTRATION: Registered at Clinicaltrials.gov with study number NCT04701398.
With permission from the National Kidney Foundation.

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