Fear of Movement and Low Self-Efficacy Are Important Barriers in Physical Activity after Renal Transplantation

Abstract

BackgroundPhysical activity (PA) and exercise are commonly used as preventive measures for cardiovascular disease in the general population, and could be effective in the management of post-transplantation cardiovascular risk. PA levels are low after renal transplantation and very few renal transplant recipients (RTR) meet the PA guidelines. Identification of barriers to regular PA is important to identify targets for intervention to improve PA levels after renal transplantation. We investigated fear of movement and physical self-efficacy as barriers to PA in RTR.MethodsRTR were investigated between 2001–2003. The Tampa Score of Kinesiophobia–Dutch Version (TSK-11) was used to assess fear of movement. Physical self-efficacy was measured with the LIVAS-scale. PA was assessed using validated questionnaires (Tecumseh Occupational Activity Questionnaire and the Minnesota Leisure Time Physical Activity Questionnaire).ResultsA total of 487 RTR (age 51±12 years, 55% men) were studied. Median score [interquartile range] on TSK-11 was 22 [17–26]. Low physical self-efficacy (Exp B:0.41[0.31–0.54], p<0.001) and history of myocardial infarction, transient ischemic attack and cerebrovascular accident (Exp B:1.30[1.03–1.63],p = 0.03) were independent determinants for fear of movement. Fear of movement was associated with lower daily PA, occupational, sports and leisure time PA. Mediation-analysis showed that a large part (73%) of the effect of fear of movement on PA was explained by low physical self-efficacy.ConclusionsThis study was the first to examine fear of movement and self-efficacy in relation to PA in RTR. Fear of movement was associated with a low PA level, and the larger part of this relation was mediated by low physical self-efficacy. Both fear of movement and physical self-efficacy level are important targets for intervention during rehabilitation after renal transplantation.

Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel

“…Patient education focused around the benefits of exercise, for example, prevention of muscular atrophy and improved mood has the potential to increase motivation, but education should have a broader focus and include increasing patients’ awareness about the safety of exercise to target negative perceptions of exercise as a treatment. Fear of movement may result in emotional distress, avoidance of perceived health threat and poor self‐efficacy . Persuasive education on topics such as safety when using dialysis access arm for exercise including weight lifting thresholds, participating in moderate intensity exercise even with a history of cardiovascular disease, etc is crucial to improving patients’ exercise self‐efficacy.…”

“…Offering a graded approach to exercise allows patients to build relevant exercise skills and incur desired benefits, and an opportunity to experience small accomplishments in their performance which is one of the most powerful sources of self‐efficacy . Persuading patients that they have the capacity to perform a task, and encouragement to do so may also increase self‐efficacy . Exercise counseling, when combined with an exercise program, can greatly increase a patient's self‐efficacy and result in improved outcomes and high adherence …”

“…Fear of movement may result in emotional distress, avoidance of perceived health threat and poor self-efficacy. 50 Persuasive education on topics such as safety when using dialysis access arm for exercise including weight lifting thresholds, participating in moderate intensity exercise even with a history of cardiovascular disease, etc is crucial to improving patients' exercise selfefficacy. This type of patient education could be included as part of a holistic wellness paradigm, whereby patients receive information about exercise alongside dietary advice.…”

“…53 Persuading patients that they have the capacity to perform a task, and encouragement to do so may also increase self-efficacy. 50 Exercise counseling, when combined with an exercise program, can greatly increase a patient's self-efficacy and result in improved outcomes and high adherence. 1,54 Furthermore, digital technology including mobile health applications and wearable technologies may be useful when combined with patient education and behavioral theory as a way increase levels of physical activity and exercise.…”

Solid Organ Transplant Recipients' Opinions of Pre- and Post-Transplant Supervised Exercise Programmes: A Brief Report

“…These factors may be fear of movement, low physical self-efficacy, 3 and symptom distress. 4 To date, no study has investigated the factors that might influence the participation of SOT recipients in pre-and post-transplant exercise programmes in Canada.…”