OBJECTIVES: (1) Explore the effects of a 12-week home-based rehabilitation programme on cardiorespiratory fitness in kidney transplant recipients; (2) Compare cardiorespiratory fitness parameters in kidney transplant recipients and age-sex matched healthy volunteers to aid the justification for routine rehabilitation programmes. DESIGN: Pilot randomised controlled trial with nested case-control. SETTING: Home-based rehabilitation; hospital-based outcome assessments. PARTICIPANTS: Pilot randomised controlled trial: 50 stable kidney transplant recipients (> 1 year post-transplant) (randomised 1:1; n = 25 control and n = 25 intervention). Nested case-control: 30 kidney transplant recipients and 30 healthy volunteers. InterventionA 12-week home-based aerobic and resistance rehabilitation programme or guideline-directed care control. MAIN MEASURES: Cardiorespiratory fitness measured by cardiopulmonary exercise testing. RESULTS: Pilot randomised controlled trial: After adjusting for baseline, follow-up values were significantly greater in intervention compared to control for peak oxygen uptake (VO2peak) mL/kg/min, (+1.50, p = 0.03) and maximum workload (+8 W, p = 0.04) but not VO2peak L/min or variables at the gas exchange threshold. Higher frequency of aerobic exercise sessions was associated with greater improvements in cardiorespiratory fitness (R2 0.252, p = 0.040). Nested case-control: VO2peak was reduced in kidney transplant recipients compared to healthy volunteers (18.81 +/- 4.61 versus 24.06 +/- 5.72 mL/kg/min; p < 0.001), as was VO2 at the gas exchange threshold (11.70 +/- 2.67 versus 14.47 +/- 3.39 mL/kg/min; p < 0.001). CONCLUSION: A 12-week home-based rehabilitation programme induced a significant improvement in some cardiorespiratory fitness variables and higher frequency of aerobic exercise associated with greater improvements. Cardiorespiratory fitness is significantly impaired in kidney transplant recipients compared to age-sex-matched healthy volunteers. Together, these findings highlight the clinical importance of promoting aerobic exercise and the integration of rehabilitation programmes into routine care for this population. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04123951 (https://clinicaltrials.gov/study/NCT04123951).

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