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Correlates and Outcomes of Low Physical Activity Posttransplant

A Systematic Review and Meta-Analysis

Berben, Lut, PhD, RN1; Engberg, Sandra J., PhD, RN2; Rossmeissl, Anja, MD3; Gordon, Elisa J., PhD, MPH4; Kugler, Christiane, PhD, RN5; Schmidt-Trucksäss, Arno, MD, MA3; Klem, Mary Lou, PhD, MLIS6; Sereika, Susan M., PhD, MPH2,7; De Simone, Paolo, MD, PhD8; Dobbels, Fabienne, PhD, Msc1,9; De Geest, Sabina M., PhD, PN, FRCN1,9 for the B-SERIOUS consortium

doi: 10.1097/TP.0000000000002543
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Background. Little is known about associations between low physical activity (PA) and its correlates and outcomes in solid organ transplant recipients. This systematic review with meta-analysis examined correlates and outcomes associated with low PA (ie, not meeting individual study’s definition of being physically active) following solid organ transplantation.

Methods. We searched PubMed, CINAHL, PsycINFO, and EMBASE from inception to February 2016 to identify peer-reviewed data-based articles. Articles published in English, German, Spanish, French, Italian, Portuguese, or Dutch that examined correlates or outcomes associated with low PA in adult single, solid organ transplant recipients were included. Studies’ quality was assessed using a 14-item checklist. Pooled odds ratios and 95% confidence intervals were computed for correlates and outcomes examined in ≥5 studies.

Results. Of 7401 publications screened, 34 studies met inclusion criteria and were included in the overall synthesis with 15 included in the meta-analysis. Most focused on renal transplantation (n = 18, 53%) and used cross-sectional designs (n = 26, 77%). Of 30 correlates examined, [condition-related (n = 11), social/economic-related (n = 9), patient-related (n = 4), healthcare system-related (n = 3), and treatment-related (n = 3)], only 4 were examined ≥5 times and included in meta-analyses. None were significantly related to low PA. Of 19 outcomes assessed, only physical health-related quality of life was examined ≥5 times. Low PA was significantly associated with low physical health-related quality of life (odds ratio = 0.172, 95% confidence interval = 0.08–0.37).

Conclusions. We found few studies examining most correlates and outcomes related to low PA despite growing evidence that improving PA might be an effective intervention in improving posttransplant outcomes.

1 Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.

2 School of Nursing, University of Pittsburgh.

3 Department of Sport, Exercise and Health, Division of Sports- and Exercise Medicine, Medical Faculty, University of Basel, Basel, Switzerland.

4 Department of Surgery-Division of Transplantation, Center for Healthcare Studies, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine.

5 Faculty of Medicine, Institute of Nursing Science, University of Freiburg, Germany.

6 Health Sciences Library System, University of Pittsburgh.

7 Department of Health and Community Systems, Center for Research and Evaluation, School of Nursing, University of Pittsburgh.

8 Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.

9 Academic Centre for Nursing and Midwifery, KU Leuven—University of Leuven, Belgium.

Received 11 June 2018. Revision received 30 September 2018.

Accepted 23 October 2018.

* A list of B-SERIOUS consortium participants is given in Acknowledgments section.

Protocol registration: PROSPERO protocol CRD42015003333.

L.B., S.J.E., A.R., and E.J.G. participated in research design, performance of the research (design of search strategy, title and abstract screening, full-text evaluation, data extraction), data analysis (effect size calculation) and wrote the article. F.D., C.K., and A.S.-T. participated in research design, performance of the research (design of search strategy, title and abstract screening, full-text evaluation, data extraction), data analysis (effect size calculation) and critically reviewed the article. M.L.K. participated in the design of search strategy, programming of searches in different databases, gave feedback on methodology used to conduct the systematic review and critically reviewed the article. S.M.S. participated in the design of the Access databases for data input, advised on methodology to be used for effect size calculation, reviewed the statistical analyses, and critically reviewed the article. P.D.S. participated in the design of the study, overall project management and quality control of methodology followed and critically reviewed the article. F.D. and S.M.D.G. participated in the design of the study, overall project management and quality control of methodology followed and critically reviewed the article.

The authors declare no conflicts of interest.

The research has received funding for a consortium meeting from the Brocher Foundation, a Swiss non-profit private foundation.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Sabina De Geest, Department of Public Health, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, Basel, Switzerland. (sabina.degeest@unibas.ch).

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