Perceived barriers and facilitators to exercise in kidney transplant recipients: a qualitative study

Background: Exercise has the potential to attenuate the high levels of cardiovascular morbidity and mortality present in kidney transplant recipients (KTRs). Despite this, activity levels in KTRs remain low. The aim of this qualitative study was to explore the barriers and facilitators of exercise in KTRs. Methods: Thirteen KTRs (8 males; mean ±SD; age 53 ±13 years; eGFR 53 ±21 mL/min/1.73m2) were recruited and completed semi-structured one-to-one interviews at University Hospitals of Leicester NHS Trust. All KTRs were eligible if their kidney transplant was completed >12 weeks prior to interview and their consultant considered them to have no major contraindications to exercise. All interviews were audio recorded, transcribed verbatim, and subject to framework analysis in order to identify and report themes. Results: Themes were organised into personal, behavioural, and environmental factors based on social cognitive theory (SCT). Facilitators of exercise were largely internal: enjoyment, exercise for general health and health of the transplanted kidney, and desire to maintain normality. Social interaction, support and guidance of healthcare professionals, and goal setting were perceived as motivational. Harming the kidney, a lack of guidance, self-motivation, and accessibility were barriers to exercise. Conclusion: These results provide detailed insight for the development of interventions designed to increase physical activity in KTRs. They provide strong evidence that specific exercise guidelines are required for this population and that the healthcare system could have a key role in supporting KTRs to become more physically active. Interventions need to be multifaceted to appeal to the differing levels of support desired by KTRs.