The Effect of Home-Based Exercise on Chronic Kidney Disease Patients

Mini-Mental State Examination

Individuals scoring 24 points or higher on the scale will be included in the study. The Mini-Mental State Examination (MMSE) is a widely used cognitive screening instrument with a minimum score of 0 and a maximum score of 30. Higher MMSE scores indicate better global cognitive functioning, reflecting more intact orientation, attention, memory, language, and visuospatial abilities. Conversely, lower scores are associated with greater cognitive impairment. The MMSE is commonly employed in both clinical practice and research to assess cognitive status and to monitor changes in cognitive performance over time.

Time frame: 0. week

Modified Borg Scale

Participants included in the study group will be instructed to rate the perceived intensity of their pre-exercise activities using the modified Borg Scale before starting the exercise program. They will be taught to record their ratings on the chart within their profile accounts on the specially designed website for the study, or if they cannot adapt to the website, they will be instructed to note them on the chart provided to them after each exercise session. The Modified Borg Scale is a subjective rating scale used to quantify perceived exertion or dyspnea during physical activity. The scale ranges from a minimum value of 0, indicating no perceived exertion or breathlessness, to a maximum value of 10, representing maximal or very severe exertion or dyspnea. Higher scores on the Modified Borg Scale reflect greater symptom severity and therefore indicate a worse perceived physiological response to activity.

Time frame: 12 week

SARC-F Questionnaire

The SARC-F, a screening test for sarcopenia, will be administered to both the study and control groups before and after the program. The SARC-F Questionnaire is a brief, self-reported screening tool used to identify individuals at risk of sarcopenia. The total score ranges from a minimum of 0 to a maximum of 10, based on five items assessing strength, assistance with walking, rising from a chair, stair climbing, and falls. Higher SARC-F scores indicate poorer muscle function and a greater likelihood of sarcopenia, whereas lower scores reflect better physical performance. A total score of 4 or higher is commonly used as a cutoff to suggest an increased risk of sarcopenia.

Time frame: 0.-12. week

Anthropometric Measurement

Anthropometric assessments will be conducted as separate outcome measures, each reported with its corresponding unit of measurement. Body weight (kg) and height (m) will be measured independently and will be used to calculate body mass index (BMI, kg/m²) as a derived outcome. In addition, waist circumference (cm), upper arm circumference (cm), and calf circumference (cm) will be assessed as distinct measures of body composition and muscle mass. Each anthropometric variable will be evaluated individually to assess changes in the participant's health status and physical condition before and after the program.

Time frame: 0.-12. week

Mini Nutritional Assessment-Short Form (MNA-SF)

The Mini Nutritional Assessment-Short Form (MNA-SF) is a validated screening tool used to evaluate nutritional status in older adults. The total score ranges from a minimum of 0 to a maximum of 14. Higher MNA-SF scores indicate better nutritional status, reflecting adequate intake, stable weight, preserved mobility, and absence of psychological stress or acute disease. In contrast, lower scores are associated with malnutrition or risk of malnutrition. Commonly used thresholds classify scores of 12-14 as normal nutritional status, 8-11 as at risk of malnutrition, and 0-7 as malnourished. This questionnaire will be administered to both groups before and after the study, and the results will be compared.

Time frame: 0.- 12. week

The Kidney Disease Quality of Life Short Form (KDQOL-SF)

The KDQOL-SF consists of 80 items divided into 19 dimensions. Scores in each dimension range from 0 to 100, with higher scores reflecting better quality of life. This questionnaire will be administered to both groups before and after the study, and the results will be compared.

Time frame: 0.- 12. week

Hospital Anxiety and Depression Scale (HADS)

The Hospital Anxiety and Depression Scale (HADS) is a self-administered instrument designed to assess symptoms of anxiety and depression in clinical populations. It consists of 14 items, divided into two subscales: HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D), each comprising seven items. Scores for each subscale range from a minimum of 0 to a maximum of 21, yielding a possible total score range of 0 to 42. Higher scores indicate greater severity of anxiety and depressive symptoms and therefore represent a worse psychological outcome, whereas lower scores reflect fewer symptoms and better emotional well-being. The questionnaire will be administered to both groups before and after the study for comparison.

Time frame: 0.- 12. week

FACIT Fatigue Scale

The FACIT Fatigue Subscale is a 13-item scale that measures the level of fatigue experienced by an individual during their daily activities over the past seven days. Fatigue level is measured on a four-point Likert scale (4 = Not at all tired, 0 = Very tired). The score range is 0-52, with a score of less than 30 indicating severe fatigue. The higher the score, the better the quality of life. The scale will be administered to both groups before and after the study, and the results will be compared.

Time frame: 0.- 12. week

Pittsburgh Sleep Quality Index (PSQI)

The Pittsburgh Sleep Quality Index (PSQI) is a standardized self-report instrument used to assess sleep quality and sleep disturbances over the previous month. The PSQI yields a global score ranging from a minimum of 0 to a maximum of 21, derived from seven component scores. Higher PSQI scores indicate poorer sleep quality and more severe sleep disturbances, whereas lower scores reflect better overall sleep quality. A global PSQI score greater than 5 is commonly used to distinguish poor sleepers from good sleepers in both clinical and research settings. The scale will be administered to both groups before and after the study, and the results will be compared.

Time frame: 0.- 12. week

6-Minute Walk Test

The 6-Minute Walk Test measures the distance a patient can walk quickly within a 6-minute period. It is conducted in a straight corridor of at least 30 meters, where the patient walks as quickly as possible without running. The distance walked is measured. Additionally, oxygen saturation and pulse will be monitored using a pulse oximeter before exercise, after exercise, and as needed during exercise. The test will be conducted before and after the study for both groups.

Time frame: 0.- 12. week

10-Meter Walk Test

10-Meter Walk Test is used to assess an individual's physical capacity. The test measures the time it takes for the person to walk a distance of 10 meters. The individual is asked to walk the 10 meters at their own normal pace and return to the starting line as quickly as possible. The measurement is repeated twice, and the best result is recorded and interpreted. The test will be conducted before and after the study for both groups, and the results will be compared.

Time frame: 0.-12. week

Five Times Sit to Stand Test

In this test, a standard chair is used to determine the speed of sitting and standing. Participants are asked to "stand up and sit down 5 times as quickly as possible." The time from the start of the movement to the completion of the 5th standing position is measured in seconds using a stopwatch. Two repetitions are performed, and the average of these 2 values is taken. This test is conducted to assess participants' lower extremity muscle strength and mobility, providing information about their functional capacity. The test will be conducted before and after the study for both groups, and the results will be compared.

Time frame: 0.- 12. week

Manual Muscle Testing

Manual Muscle Testing (MMT) is a clinical assessment method used to evaluate voluntary muscle strength. Muscle strength is typically graded on an ordinal scale ranging from a minimum score of 0 to a maximum score of 5. A score of 0 indicates no visible or palpable muscle contraction, while a score of 5 represents normal muscle strength against full resistance. Higher MMT scores reflect greater muscle strength and better functional performance, whereas lower scores indicate varying degrees of muscle weakness. MMT is widely used in clinical practice and research to assess neuromuscular function and to monitor changes in muscle strength over time. Patients included in the study will be evaluated for muscle strength in shoulder flexors/extensors, elbow flexors/extensors, wrist flexors/extensors, hip flexors/extensors, knee flexors/extensors, and ankle dorsiflexors/plantar flexors. Both groups will be assessed before and after the study, and the results will be compared.

Time frame: 0.- 12. week

Hand Grip Strength

This measurement, to be conducted on both groups, will interpret hand grip strength obtained with a hand dynamometer based on these cutoff points, and values before and after the study will be compared.

Time frame: 0.- 12. week

Blood parameters

At the beginning and end of the study, routine laboratory parameters will be evaluated as separate outcome measures, each reported using its standard unit of measurement. These will include complete blood count parameters (reported individually according to standard hematological units), serum calcium (mg/dL), serum phosphorus (mg/dL), parathyroid hormone (pg/mL), and serum creatinine (mg/dL). Each laboratory variable will be analyzed independently to assess changes in the patient's biochemical status over the course of the study, based on data obtained from the medical records.

Time frame: 0.- 12. week