Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners
Rationale & Objective: Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged i...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-03-01
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| Series: | Kidney Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059523001978 |
| _version_ | 1797295184731439104 |
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| author | Anoop Sheshadri Jessica R. Elia Gabriel Garcia Gary Abrams Deborah B. Adey Jennifer C. Lai Rebecca L. Sudore |
| author_facet | Anoop Sheshadri Jessica R. Elia Gabriel Garcia Gary Abrams Deborah B. Adey Jennifer C. Lai Rebecca L. Sudore |
| author_sort | Anoop Sheshadri |
| collection | DOAJ |
| description | Rationale & Objective: Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. Study Design: Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing. Setting & Participants: Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of ≤10) and their care partners. Analytical Approach: All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model. Results: Patients’ median age was 60 years (57 ± 63.5) and care partners’ median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation. Limitations: Participants geographically limited to Northern California. Conclusions: Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function. Plain-Language Summary: Although exercise can improve the fitness of older adults treated with dialysis for kidney transplantation and reduce posttransplant complications, many such individuals do not exercise. We sought to elicit perspectives on barriers and facilitators to prekidney transplant exercises from older adults treated with dialysis and their care partners. We found that although patients and care partners had unique perspectives, they shared many barriers (such as physical and/or cognitive impairment, difficulty scheduling around dialysis, lack of guidance on exercise, and reduced exercise motivation related to dialysis) and several facilitators (such as desire to regain functionality and participate in life and motivation for successful transplantation). A shared interest among patients and care partners in joint participation in structured and home-based exercise may represent a tool to overcome barriers to pretransplant exercise. |
| first_indexed | 2024-03-07T21:43:06Z |
| format | Article |
| id | doaj.art-016fdbbc5c444b51af4483a09d8dfd98 |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-03-07T21:43:06Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-016fdbbc5c444b51af4483a09d8dfd982024-02-26T04:16:11ZengElsevierKidney Medicine2590-05952024-03-0163100779Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care PartnersAnoop Sheshadri0Jessica R. Elia1Gabriel Garcia2Gary Abrams3Deborah B. Adey4Jennifer C. Lai5Rebecca L. Sudore6Division of Nephrology, Department of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, California; Address for Correspondence: Anoop Sheshadri, MD, MAS, 4150 Clement St, Bldg. 203, Rm 3A-32, San Francisco, CA 94131.Division of Nephrology, Department of Medicine, University of California, San FranciscoDivision of Nephrology, Department of Medicine, University of California, San FranciscoUniversity of California Weill Institute for Neurosciences, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, CaliforniaDivision of Gastroenterology/Hepatology, Department of Medicine, University of California, San FranciscoSan Francisco Veterans Affairs Medical Center, San Francisco, California; Division of Geriatrics, Department of Medicine, University of California, San Francisco, CaliforniaRationale & Objective: Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. Study Design: Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing. Setting & Participants: Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of ≤10) and their care partners. Analytical Approach: All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model. Results: Patients’ median age was 60 years (57 ± 63.5) and care partners’ median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation. Limitations: Participants geographically limited to Northern California. Conclusions: Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function. Plain-Language Summary: Although exercise can improve the fitness of older adults treated with dialysis for kidney transplantation and reduce posttransplant complications, many such individuals do not exercise. We sought to elicit perspectives on barriers and facilitators to prekidney transplant exercises from older adults treated with dialysis and their care partners. We found that although patients and care partners had unique perspectives, they shared many barriers (such as physical and/or cognitive impairment, difficulty scheduling around dialysis, lack of guidance on exercise, and reduced exercise motivation related to dialysis) and several facilitators (such as desire to regain functionality and participate in life and motivation for successful transplantation). A shared interest among patients and care partners in joint participation in structured and home-based exercise may represent a tool to overcome barriers to pretransplant exercise.http://www.sciencedirect.com/science/article/pii/S2590059523001978Physical activityexercisedialysiscare partnermotivationsbarriers |
| spellingShingle | Anoop Sheshadri Jessica R. Elia Gabriel Garcia Gary Abrams Deborah B. Adey Jennifer C. Lai Rebecca L. Sudore Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners Kidney Medicine Physical activity exercise dialysis care partner motivations barriers |
| title | Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners |
| title_full | Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners |
| title_fullStr | Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners |
| title_full_unstemmed | Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners |
| title_short | Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners |
| title_sort | barriers and facilitators to exercise in older adults awaiting kidney transplantation and their care partners |
| topic | Physical activity exercise dialysis care partner motivations barriers |
| url | http://www.sciencedirect.com/science/article/pii/S2590059523001978 |
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