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Chronic Kidney Disease Stage 3 and 4EXACT-CKDPADNCT06621264

Exercise Activity to Improve Mobility in Patients With CKD and PAD

A study testing EXERCISE TRAINING WITH OR WITHOUT MEDICATION in people with Chronic Kidney Disease Stage 3 and 4 and Peripheral Artery Disease (PAD), run by University Hospital of Ferrara at 3 sites in Italy.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

People affected by chronic kidney disease and concomitant diagnosed peripheral artery disease at intermediate stages, without contraindications to exercise therapy will be invited to participate in the study. Whose providing informed consent, will be randomly assigned to one of two groups: 1. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
EXERCISE TRAINING WITH OR WITHOUT MEDICATION
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
124 participants
Where
3 sitesItaly
Study dates
1 Oct 2024to 31 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • chronic kidney disease at KDOQI stages III or IV and concomitant Peripheral artery disease at stages I, II, III;
  • ability to walk independently;
  • cognitive function to give informed consent identified by a Mini Mental Status Examination score greater or equal to 20/30
  • absence of clinical conditions contraindicating exercise therapy (e.g., unstable angina, severe heart failure at NYHA class IV, anemia with lower than 10.0 g/dl).

Who cannot join

  • major amputations;
  • major surgery planned in the next 3 months;
  • known comorbid conditions that may limit survival to less than 2 years;
  • inability or unwillingness to comply with protocol requirements.

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Fabio Manfredini Prof. Fabio Manfredini, MD, PhD contact

+390532236187

fabio.manfredini@unife.it

Italy3 sites, 3 recruiting
  • University Hospital of Ferrara

    Ferrara, Italy, 44124

    Fabio Manfredini Prof. Fabio Manfredini, MD PhD, 00390532236187, fabio.manfredini@unife.it

    Fabio Manfredini, MD PhD

    Recruiting
  • Ospedale Pederzoli Peschiera del Garda

    Peschiera del Garda, Italy

    Yuri Battaglia Prof. Yuri Battaglia, MD PhD, 0039+0456449111, yuri.battaglia@univr.it

    Yuri Battaglia, MD PhD

    Recruiting
  • Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli

    Reggio Calabria, Italy

    Vincenzo Panuccio Dr. Vincenzo Panuccio, MD, 0039+0965397111, enzopanuccio@gmail.com

    Vincenzo Panuccio, MD

    Recruiting

Other trials in Italy

About this study

Official title: EXercise ACTivity to Improve Mobility, Active Behavior and Quality of Life of Chronic Kidney Disease Patients With Peripheral Artery Disease: the EXACTckd-pad Multicenter Randomized Controlled Trial

People affected by chronic kidney disease and concomitant diagnosed peripheral artery disease at intermediate stages, without contraindications to exercise therapy will be invited to participate in the study.

Whose providing informed consent, will be randomly assigned to one of two groups:

Read more
  1. Exercise program receiving two daily 10-minute interval walking sessions at a slow increasing speed.
  2. Control group: receiving usual care including optimal medical therapy and nutritional advice.

Patients of both groups will be measured at baseline, after the end of the exercise program (6-month) and at follow up (12-month). Outcome measures will include walking ability by the 6-minute walking test (primary outcome) and lower limbs perfusion, body composition, quality of life, laboratory outcomes and long-term hospitalizations.

Read the detailed description

People with chronic kidney disease (CKD) are exposed to a high risk of developing peripheral artery disease (PAD) and its related adverse health outcomes. This dangerous combination of pathological conditions increases overall cardiovascular risk, mortality and lower limbs amputations.

The scientific literature suggests a strategic co-management of CKD-PAD patients by multidisciplinary teams including specialists of different areas and expertise. Indeed, a common issue is that both these diseases are negatively associated with a sedentary behavior. Exercise therapy may enhance the physical functioning, the risk factors management, the lower limbs vascularization and reduce the cardiovascular risk that affects this population. Since the CKD-PAD population is less likely to be provided recommended optimal care, and considering that 2 out of 3 CKD patients have a completely sedentary behavior for several barriers to training participation, proper exercise programs should be developed. This multicenter randomized-controlled trial aims to test the effectiveness of a 6-month home-based structured walking program on physical functioning and laboratory and clinical outcomes. Purposely 100 CKD patients at KDOQI stages III or IV with concomitant PAD at Rutherford's stages I to III, aged > 18 years and without absolute contraindications to exercise training will be randomized to receive an exercise intervention (Ex) or usual care (Control, Co). The 6-month training intervention, previously tested in PAD and CKD patients, consist in two 10-minute daily interval walking sessions performed inside the home.

Patients will receive a detailed exercise prescription according to their baseline walking capacity, with the walking speed maintained at home through sound pacing by a digital metronome. The prescribed speed will be weekly increased from the 60 to the 100% of their baseline walking speed with a fixed working time throughout the program. Two serial visits during the program will be scheduled to reinforce adherence to exercise, maintained and verified by a digital application, and to control the blood pressure. Patients enrolled in the Co group will receive standard CKD-PAD care, including optimal medical therapy and nutritional advices.

The primary outcome of the study will be the variations of mobility as assessed by the 6-minute walking test at the end of the program. Secondary outcomes will include lower limbs perfusion and strength, body composition and bone mineral density, quality of life, laboratory outcomes including rate of progression of CKD and the long-term hospitalizations and mortality.

Outcome measures will be assessed by blinded operators at baseline, at the end of the program for exercise group (6-month) and at 12 months follow up.

Being tested
EXERCISE TRAINING WITH OR WITHOUT MEDICATION, Control (Standard treatment)
Keywords
Exercise therapy;, Mobility, Ageing, Chronic Kidney Disease, Peripheral artery disease
Medical subject headings
Renal Insufficiency, Chronic, Peripheral Arterial Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EXERCISE TRAINING WITH OR WITHOUT MEDICATIONBehavioural

    Also called exercise, rehabilitation

    Patients enrolled in this group will receive a detailed 6-month exercise prescription aimed at providing in-home low fatiguing walking training (at light-moderate intensity, or 2-3 out of 10 of the CR10 Borg\'s scale). The program consists of a two daily 10-minute interval walking sessions (1 minute walking : 1 minute resting) at a prescribed speed controlled by a digital metronome (https://www.youtube.com/watch?v=ki8YX_t-0jA). The training speed will be set up according to the patients baseline walking capacity (approximately 50% lower than the habitual gait speed) and will be weekly increased until reaching the habitual gait speed. The training time will be maintained constant throughout the entire program. Exercise prescription will be updated during two intermediate hospital visits at the 1st and 3rd months. Patients will be provided with a digital application properly developed to keep pacing and to record the correct training execution.

  • Control (Standard treatment)Other

    Also called Usual care

    Patients enrolled in the Co group will receive standard CKD-PAD care, including optimal medical therapy and nutritional advices

Study groups in NCT06621264
Study groupRoleWhat they receive
Exercise groupExperimentalPatients enrolled in this group will receive a detailed 6-month exercise prescription aimed at providing in-home low fatiguingwalking training (at light-moderate intensity, or 2-3 out of 10 of the CR10 Borg's scale). The program consists of a two daily 10-minute interval walking sessions (1 minute walking : 1 minute resting) at a prescribed speed controlled by a digital metronome (https://www.youtube.com/watch?v=ki8YX_t-0jA). The training speed will be set up according to the patients baseline walking capacity (approximately 50% lower than the habitual gait speed) and will be weekly increased until reaching the habitual gait speed. The training time will be maintained constant throughout the entire program. Exercise prescription will be updated during two intermediate hospital visits at the 1st and 3rd months. Patients will be provided with a digital application properly developed to keep pacing and to record the correct training execution.
Receives: Behavioral: EXERCISE TRAINING WITH OR WITHOUT MEDICATION
Control groupPlacebo comparatorPatients enrolled in the Co group will receive standard CKD-PAD care, including optimal medical therapy and nutritional advices
Receives: Other: Control (Standard treatment)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 6-minute walking test

    The patients will be instructed to walk back and forth on a 20-meter corridor aiming at covering as much distance as possible. The total distance covered (6MWD) will be measured in meters

    Measured: Baseline; End of program (6-month); Follow up (12-month)

Secondary outcomes (11)
  1. Lower limbs perfusion

    This measure will be performed according to the published standards with the patient laying by dividing the blood pressure at the ankle with the systolic blood pressure.

    Measured: Baseline; end of the program (6-month); Follow up (12-month).

  2. handgrip strength will be measured by a standard dynamometer

    both hands, patients will be asked to perform three repetitions. The peak and mean values are collected

    Measured: Baseline; end of the program (6-month); Follow up (12-month).

  3. Quality of life will be assessed by the short-form 36 (SF-36) questionnaire

    This is a generic questionnaire that contains 36 questions referring to 8 specific domains related to patient health over the previous 4 weeks

    Measured: Baseline; end of the program (6-month); Follow up (12-month).

  4. Bone mineral density

    bone mineral density will be measured through phalangeal quantitative ultrasound with an ultrasound signal of 1.25 MHz frequency and a methodology devoid of X-rays. The results are consistent with those obtained by standard DEXA

    Measured: Baseline; end of the program (6-month); Follow up (12-month).

  5. lower limbs strength assessed by the 5-time sit-to-stand test

    Patients will raise up from a standard height chair with their arms folded across the chest five times as quickly as possible. The total time elapsed for completing the five repetitions is recorded in seconds

    Measured: Baseline; end of the program (6-month); Follow up (12-month).

  6. Body mass index

    Body composition will be assessed with direct measures of height and weight. Body mass index will be calculated as the ratio between weight (in kg) and the squared height (in meters)

    Measured: Baseline, end of the program (6-month); follow up (12-month)

  7. Circulating indexes of kidney function

    Serum creatinine will be directly measured through standard laboratory methods. The estimated glomerular filtration rate will be calculated through the 2009 Chronic Kidney Disease Epidemiology Collaboration equation

    Measured: Baseline, end of treatment (6-month); follow up (12-month)

  8. Long-term survival rate

    All-cause mortality of the enrolled patients will be checked from the regionals datasets. In case of positive findings, the days elapsed from enrollment to the event will be recorded for additional analyses, as well as the reasons and the diagnoses.

    Measured: Baseline, end of treatment (6-month); follow up (12-month); follow up (18-month); Follow up (24-month); FOllow up (36-month)

  9. Long-term hospitalizations

    All-cause hospitalization will be checked from the regionals datasets. In case of positive findings, the days elapsed from enrollment to the event will be recorded for additional analyses, as well as the reasons and the diagnoses.

    Measured: Baseline, end of treatment (6-month); follow up (12-month); follow up (18-month); Follow up (24-month); FOllow up (36-month)

  10. Rate of admission to dialysis

    Number of patients that will be admitted to dialysis will be recorded and the time from enrollment to the dialysis admission will calculated

    Measured: Baseline, end of treatment (6-month); follow up (12-month); follow up (18-month); Follow up (24-month); FOllow up (36-month)

  11. Pain-free walking distance

    During the 6-minute walking test, the distance at the onset of symptoms referred by the patient will be collected and reported

    Measured: Baseline, end of treatment (6-month), follow up (12-month)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Oct 2024
  2. Study start1 Oct 2024
  3. Primary completion20 Nov 2025 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
124 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06621264
Sponsor's protocol ID
PNRR-MAD-2022-12376611
Acronym
EXACT-CKDPAD
Status last verified
May 2025
First submitted
26 Sep 2024
Last updated
31 May 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The database generated for the study with anonimyzed patients\' characteristics will be available on institution public repository

Publications

  • Manfredini F, Panuccio V, Battaglia Y, Storari A, Lamberti N, Piva G, Veronesi M, Tripepi R, Rinaldo N, Crepaldi A, Momente C, Piccinini A, Traina L, Fargion AT, Straudi S, Baroni A, De Giorgi A, Martinuzzi C, Monesi M, Capitanini A, Aucella F, Cupisti A, Mallamaci F, Zoccali C, Manfredini R. Exercise therapy to improve mobility, active behaviour and quality of life of chronic kidney disease patients with peripheral artery disease: study protocol for the EXACT-CKDPAD multicentre randomised controlled trial. BMJ Open Sport Exerc Med. 2025 Jul 15;11(3):e002740. doi: 10.1136/bmjsem-2025-002740. eCollection 2025.

    PubMed 40672525

Questions about this trial

What is this clinical trial studying?

A study testing EXERCISE TRAINING WITH OR WITHOUT MEDICATION in people with Chronic Kidney Disease Stage 3 and 4 and Peripheral Artery Disease (PAD), run by University Hospital of Ferrara at 3 sites in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 31 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Fabio Manfredini Prof. Fabio Manfredini, MD, PhD (+390532236187, fabio.manfredini@unife.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

6-minute walking test (time frame: Baseline; End of program (6-month); Follow up (12-month)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06621264, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 May 2025.

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