Fear of movementand lack of confidence deter patients from exercising after kidney transplant

Patients who are anxious about exercising are less physically active after a kidney transplant. This is largely because they do not feel confident about their ability to do sports or take more exercise. These are the results of research carried out by Dr Dorien Zelle and the Departments of Nephrology and Epidemiology in the University Medical Center Groningen (UMCG). Health care professionals should focus on building patients’ confidence after a kidney transplant, to improve their chances of leading a healthy life and adhering to effective lifestyle intervention programmes. The researchers have published an article on their research in the scientific journal PLOS One.

Patients who undergo a kidney transplant are four to six times more likely to develop cardiovascular disease. 50 percent of deaths in patients who have had a kidney transplant are due to cardiovascular disease. Diabetes, hypertension and obesity occurring after a transplant play a major role in the development of cardiovascular disease, which is why it is important to prevent and treat these risk factors in post-transplant patients.

Previous research has shown that patients who are more physically active after a kidney transplant have a higher life expectancy. However, half of all patients do not meet the daily exercise guidelines after a kidney transplant. Chronic kidney disease and years of dialysis before the transplant, as well as the effects of long-term medication, have taken their toll on the stamina and muscle strength of these patients. Many of them are severely restricted in their day-to-day activities, and may also be anxious about damaging or rejecting the new kidney. Although patients often have difficulty resuming an active lifestyle after a transplant, little is known about why some patients are more successful than others.

This research provides the first scientific evidence that anxiety about exercise actually deters patients from being physically active after a kidney transplant. The more anxious a patient is, the less exercise he/she will take: 54 percent of kidney transplant patients who are not anxious about exercising meet the guidelines for daily exercise, compared with 38 percent of the patients who are anxious. It also became apparent that patients with a high level of anxiety about exercising were more likely to have had a stroke or heart attack in the past. The negative effect of anxiety about exercising on physical activity can largely be explained by the patients’ lack of confidence in their ability to be physically active.

According to the researchers, health care professionals should focus on increasing patients’ confidence in their health after a kidney transplant, and trying to address their fear of exercise. Behaviour change interventions can help in this respect, as can giving patients information about the benefits of exercise after a transplant. If patients are helped to start exercising under the supervision of a physiotherapist, they can learn that ‘symptoms’, such as getting out of breath, are a normal reaction to physical activity and not a reason to stop. This may help them to overcome their fear. Transplantation is one of the three focus areas of or patient care at the UMCG. This research is part of a larger project being run by the UMCG ‘Lifestyle Medicine’ and ‘Groningen Institute of Organ Transplantation’ research institutes, in which alongside regular patient care, the UMC Groningen Transplantation Center is paying more attention to lifestyle, nutrition and exercise as a way of improving quality of life and social participation for organ transplant patients. The results of the research described above will now be used in the Netherlands Kidney Foundation-funded ‘ACTive care after transplantation’ project, which is examining how a rehabilitation programme and nutrition intervention affect kidney transplant patients in the long term.

Article in PLOS One

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