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Physical Activity and Cardiovascular Risk among Kidney Transplant Patients

KANG, AUGUSTINE W.1,2; GARBER, CAROL EWING3; EATON, CHARLES B.4,5,6; RISICA, PATRICIA M.1,2,6; BOSTOM, ANDREW G.4,5

Medicine & Science in Sports & Exercise: June 2019 - Volume 51 - Issue 6 - p 1154–1161
doi: 10.1249/MSS.0000000000001886
EPIDEMIOLOGY
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Purpose Research examining the relationship between physical activity (PA) and cardiovascular disease (CVD) risk factors among kidney transplant recipients (KTR) is limited. Accordingly, we sought to 1) describe the levels of PA in KTR and 2) analyze the associations between PA levels and CVD risk factors in KTR.

Methods Baseline data from KTR participants in a large multiethnic, multicenter trial (the Folic Acid for Vascular Outcome Reduction in Transplantation) were examined. PA was categorized in tertiles (low, moderate, and high) derived from a modified PA summary score from the Yale Physical Activity Survey. CVD risk factors were examined across levels of PA by ANOVA, Kruskal–Wallis rank test, and hierarchical multiple regression.

Results The 4034 participants were 37% female (mean ± SD = 51.9 ± 9.4 yr of age, 75% White, 97% with stage 2T–4T chronic kidney disease, and 20% with prevalent CVD. Participants in the “high” PA tertile reported more vigorous PA and walking, compared with participants in moderate and low tertiles (both P < 0.001). No differences were observed in daily household, occupational, or sedentary activities across PA tertiles. More participants in the “low” PA tertile were overweight/obese, had a history of prevalent diabetes, and/or had CVD compared with more active participants (all P < 0.001). Hierarchical modeling revealed that younger age (P = 0.002), cadaveric donor source (P = 0.006), shorter transplant vintage (P = 0.025), lower pulse pressure (P < 0.001), and no history of diabetes (P < 0.001) were associated with higher PA scores.

Conclusion The most active KTR engaged in more intentional exercise. Lower levels of PA were positively associated with more CVD risk factors. Higher PA levels were associated with younger age and with more positive KTR outcomes.

1Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI;

2Center for Health Equity Research, Brown University, Providence, RI;

3Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY;

4Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI;

5Center for Primary Care and Prevention, Kent Hospital, Warwick, RI; and

6Department of Epidemiology, Brown University School of Public Health, Providence, RI

Address for correspondence: Carol E. Garber, Ph.D., F.A.H.A., F.A.C.S.M., F.N.A.K., Teachers College, Columbia University, 525 W. 120th Street, Box 93, New York, NY 10027; E-mail: garber@tc.columbia.edu.

Submitted for publication August 2018.

Accepted for publication December 2018.

© 2019 American College of Sports Medicine