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Principal Investigator: Amy Kogon
Organization: CHILDREN'S HOSP OF PHILADELPHIA
Fiscal Year: 2024
Award: $183,815
Funding agency: National Institute of Diabetes and Digestive and Kidney Diseases
PROJECT SUMMARY
For youth with chronic kidney disease (CKD), cardiovascular disease (CVD) is a leading cause of morbidity and
early mortality. Youth with CKD are less physically active than their healthy peers. They also have lower muscle
strength, which may be a proxy for overall physical inactivity or could represent an independent predictor of CVD.
Physical activity is a well-recognized determinant of health and quality of life, but physical activity’s effects on
muscle strength may be compromised in CKD. Characterizing the relationships between physical activity, muscle
strength and CVD can inform potential therapeutic targets to improve cardiac outcomes. Identification of effective
strategies to increase physical activity, and the extent to which physical activity and muscle strength mitigate
CVD complications are major knowledge gaps in pediatric CKD research.
Aim 1 will test the efficacy of a 12-week physical activity intervention in 64 adolescents with CKD. Guided by the
Multiphase Optimization Strategy (MOST) framework, an optimization trial will identify intervention components
that increase average daily moderate to vigorous physical activity by 15 min/day, a clinically meaningful increase.
The components will be grounded in established behavioral change theories and be delivered via Way to Health,
a web-based platform, to overcome barriers at the point of clinical care where time and resources are limited.
Aim 2 will leverage existing longitudinal data from the Chronic Kidney Disease in Children Study (CKiD) to
determine the extent to which physical activity and muscle strength mitigate CVD complications. This aim will
quantify the associations of self-reported physical activity and hand grip strength, a validated proxy of muscle
strength, with early changes in cardiac structure and function: left ventricular hypertrophy and diastolic
dysfunction. Left ventricular hypertrophy, defined by an elevated left ventricular mass index, is the most common
cardiac abnormality in children with CKD and is the strongest predictor of sudden cardiac events in adults with
CKD. Diastolic dysfunction occurs early in pediatric CKD and associates with death in adults with CKD.
These aims will advance knowledge by identifying the optimized digital-based intervention components, specific
to youth with CKD, to increase physical activity and by quantifying the impact of physical activity and muscle
strength on CVD. They are responsive to the NIDDK Strategic Plan for Research by utilizing 1) technology to
improve access to participants; 2) an innovative trial design; 3) direct participant feedback to engage
stakeholders; and 4) data from an existing NIH-funded cohort study. Within the outstanding research
environment of The Children’s Hospital of Philadelphia and the University of Pennsylvania and under the
mentorship of Drs. Sandra Amaral, Babette Zemel, and Knashawn Morales, this K23 provides training in
longitudinal data analysis, health behavior science, and clinical trial design and analysis, incorporating digitally
based tools. This will launch the PI’s career as a pediatric nephrology researcher with unique expertise in health
behavior change and digital-based interventions to improve the health and longevity of youth living with CKD.
Terms: <0-11 years old><21+ years old><Accelerometer><Active Follow-up><Address><Adolescent><Adolescent Youth><Adult><Adult Human><Award><Behavior><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral><Behavioral Conditioning Therapy><Behavioral Modification><Behavioral Therapy><Behavioral Treatment><Cardiac><Cardiac Abnormalities><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Cessation of life><Child><Child Youth><Childhood><Children (0-21)><Children's Hospital><Chronic Kidney Failure><Chronic Renal Disease><Chronic Renal Failure><Clinical><Clinical Trials><Clinical Trials Design><Cohort Studies><Concurrent Studies><Conditioning Therapy><Conduct Clinical Trials><Data><Data Analyses><Data Analysis><Death><Diet><Dysfunction><Echocardiogram><Echocardiography><Engineering><Environment><Epidemiology><Event><Exercise><Experimental Designs><Feedback><Functional disorder><Funding><Goals><Grip strength><Hand><Hand Strength><Health><Health Promotion><Health behavior><Health behavior change><Heart Abnormalities><Heart Vascular><Home><Improve Access><Intervention><Intervention Strategies><Intervention Studies><Investigators><Isometric Exercise><Isometrics><Knowledge><LV Mass><Left Ventricular Hypertrophy><Left Ventricular Mass><Length of Life><Longevity><Measurement><Measures><Mentors><Mentorship><Morbidity><Morbidity - disease rate><Muscle-Setting Exercise><NIDDK><NIH><National Institute of Diabetes and Digestive and Kidney Diseases><National Institutes of Health><Nephrology><Neurocognitive><Obesity><Outcome><Participant><Patient Self-Report><Pediatric Hospitals><Pennsylvania><Performance><Philadelphia><Physical activity><Physiopathology><Pilot Projects><Population><Position><Positioning Attribute><Proxy><Public Health><QOL><Quality of life><Randomized><Research><Research Activity><Research Personnel><Research Resources><Researchers><Resources><Running><Salutogenesis><Science><Self-Report><Static Exercise><Strategic Planning><Structure><Technology><Theory of Change><Time><Training><Transthoracic Echocardiography><United States National Institutes of Health><Universities><Visit><Youth><Youth 10-21><accelerometry><active followup><activity monitor><activity tracker><adiposity><adulthood><aged><behavior intervention><behavioral intervention><cardiovascular disorder><career><child patients><chronic kidney disease><circulatory system><clinical care><corpulence><data interpretation><decreased muscle strength><diets><digital><digital technology><dynapenia><effectiveness testing><efficacy testing><epidemiologic><epidemiological><exercise intervention><financial incentive><financial reward><follow up><follow-up><followed up><followup><hands><health determinants><health related behavior><heart sonography><homes><improved><indexing><innovate><innovation><innovative><internet based platform><internet platform><intervention research><interventional research><interventional strategy><interventional study><interventions research><juvenile><juvenile human><kids><lack of physical activity><low muscle strength><moderate-to-vigorous physical activity><monetary incentive><mortality><multidisciplinary><multiphase optimization strategy><muscle strength><muscle strength decline><new marker><novel><novel biomarker><novel marker><pathophysiology><patient oriented research><patient oriented study><pediatric><pediatric patients><peer><physical activity intervention><physical inactivity><pilot study><post intervention><primary outcome><promoting health><psychosocial><randomisation><randomization><randomly assigned><reduced muscle strength><remote health monitoring><remote patient monitoring><secondary outcome><skills><therapeutic target><tool><trial design><web based platform><web based system><web enabled platform><web platform><youngster>