Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners

Abstract

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.

Keywords: Physical activity; barriers; care partner; dialysis; exercise; facilitators; motivations; pretransplant; qualitative.

Figure 1

Barriers and facilitators to exercise among older patients awaiting transplantation and their care partners—the COM-B model. ^aCOM-B, capability: ability to enact the behavior, motivation: beliefs or emotions that active or inhibit behavior, opportunity: factors in the environmental or cultural milieu that influence behavior. Barriers are noted with an X. Facilitators are noted with a +. P, C, and PC are used for themes that are patient-specific (P), care partner-specific (C), or apply to both (PC).

Figure 2

Evidence-based intervention strategies to overcome patient and care partner barriers to pretransplant exercise and activity. COM-B, capability: ability to enact the behavior, motivation: beliefs or emotions that active or inhibit behavior, opportunity: factors in the environmental or cultural milieu that influence behavior. TDF, theoretical domains framework; P-C, patient-care partner.