Factors Associated With Physical Inactivity of Recipients of a Kidney Transplant: Results From the ADHERE BRAZIL Multicenter Study
Authors: Sertorio Emiliana S , Colugnati Fernando A B , Denhaerynck Kris , De Smet Stefan , Medina Jose O P , Reboredo Maycon M , De Geest Sabina , Sanders-Pinheiro Helady ,   ADHERE BRAZIL Study team, Sertorio Emiliana , Colugnati Fernando , Denhaerynck Kris , De Smet Stefan , Medina Jose , Reboredo Maycon , De Geest Sabina , Sanders-Pinheiro Helady 
Published: April 2024

Abstract

Objective
Physical activity is recommended for recipients of a kidney transplant. However, ADHERE BRAZIL study found a high prevalence (69%) of physical inactivity in Brazilian recipients of a kidney transplant. To tackle this behavior, a broad analysis of barriers is needed. This study aimed to identify factors (patient and transplant center levels) associated with physical inactivity among recipients of a kidney transplant.

Methods
This was a subproject of the ADHERE BRAZIL study, a cross-sectional, multicenter study of 1105 recipients of a kidney transplant from 20 kidney transplant centers. Using a multistage sampling method, patients were proportionally and randomly selected. Applying the Brief Physical Activity Assessment questionnaire, patients were classified as physically active (≥150 min/wk) or physically inactive (&lt;150 min/wk). On the basis of an ecological model, 34 factors associated with physical inactivity were analyzed by sequential logistic regression.

Results
At the patient level, physical inactivity was associated with smoking (odds ratio = 2.43; 95% CI = 0.97–6.06), obesity (odds ratio = 1.79; 95% CI = 1.26–2.55), peripheral vascular disease (odds ratio = 3.18; 95% CI = 1.20–8.42), &gt;3 posttransplant hospitalizations (odds ratio = 1.58; 95% CI = 1.17–2.13), family income of &gt;1 reference salary ($248.28 per month; odds ratio = 0.66; 95% CI = 0.48–0.90), and student status (odds ratio = 0.58; 95% CI = 0.37–0.92). At the center level, the correlates were having exercise physiologists in the clinical team (odds ratio = 0.54; 95% CI = 0.46–0.64) and being monitored in a teaching hospital (undergraduate students) (odds ratio = 1.47; 95% CI = 1.01–2.13).

Conclusions
This study identified factors associated with physical inactivity after kidney transplantation that may guide future multilevel behavioral change interventions for physical activity.

Impact
In a multicenter sample of recipients of a kidney transplant with a prevalence of physical inactivity of 69%, we found associations between this behavior and patient- and center-level factors. At the patient level, the chance of physical inactivity was positively associated with smoking, obesity, and patient morbidity (peripheral vascular disease and hospitalization events after kidney transplantation). Conversely, a high family income and a student status negatively correlated with physical inactivity. At the center level, the presence of a dedicated professional to motivate physical activity resulted in a reduced chance of physical inactivity. A broad knowledge of barriers associated with physical inactivity can allow us to identify patients at a high risk of not adhering to the recommended levels of physical activity.