Abstract
Background: Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life. Objective: The objective of this study was to examine accelerometer-based physical activity and sedentary time profiles among kidney transplant recipients and examine possible demographic and clinical correlates of physical activity and sedentary time. Design: Cross-sectional. Setting: Edmonton, Alberta, Canada. Patients: Kidney transplant recipients were recruited (N = 1,284) from the Northern Alberta Renal Program’s Nephrology Information System database (1993-2016). Measurements: Participants wore an ActiGraph GT3X+ accelerometer on their hip during waking hours for seven consecutive days. Methods: Kidney transplant recipients (1993-2016) recruited from the Northern Alberta Renal Program’s Nephrology Information System database wore an accelerometer and completed a self-reported questionnaire. Multiple linear regression was used to determine associations between activity level, demographic, and clinical characteristics. Results: Participants’ (n = 133; 11% response rate) mean age (SD) was 58 (14) years and 56% were female. Mean total sedentary time was 9.4 (1.4) hours per day; total moderate-to-vigorous physical activity (MVPA) time was 20.7 (19.6) minutes per day. MVPA was significantly associated with age where each additional year was associated with 0.48 fewer min/day (ie, ~30 seconds) (unstandardized beta: B = −0.48 min/day, 95% confidence interval [95% CI]: −0.75, −0.22). Sedentary time was significantly associated with age (B = 1.0 min/day, 95% CI: 0.03, 1.9), body mass index (B = 2.7 min/day, 95% CI: 0.2, 5.13), education (B = 39.1 min/day, 95% CI: 12.3, −65.8), and inversely associated with income (B = −44.9 min/day, 95% CI: −73.1, −16.8). Limitations: Limitations include the cross-sectional design, poor response rate, and limited generalizability of the results. Conclusions: Kidney transplant recipients showed high volumes of sedentary time and low volumes of health-enhancing physical activity. Understanding correlates of these behaviors may aid in the development of interventions to favorably change these behaviors.
| Original language | English |
|---|---|
| Journal | Canadian Journal of Kidney Health and Disease |
| Volume | 6 |
| DOIs | |
| Publication status | Published - 2019 |
Keywords
- accelerometer
- kidney transplantation
- physical activity
- sedentary behavior
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In: Canadian Journal of Kidney Health and Disease, Vol. 6, 2019.
Research output: Contribution to journal › Journal Article › peer-review
TY - JOUR
T1 - Prevalence and Correlates of Accelerometer-Based Physical Activity and Sedentary Time Among Kidney Transplant Recipients
AU - Vallance, Jeff K.
AU - Johnson, Steven T.
AU - Thompson, Stephanie
AU - Wen, Kevin
AU - Lam, Ngan N.
AU - Boyle, Terry
AU - Juárez, Itzel
AU - Shojai, Soroush
N1 - Funding Information: Although several studies have examined accelerometer assessed physical activity and sedentary time in other chronic disease groups (eg, cancer, diabetes), few have examined kidney transplant recipients. Studies have used a variety of measurement devices, and different operationalizations of physical activity have been implemented. In one cross-sectional study (n = 24), recipients were engaging in 126 min/day of habitual physical activity (ie, light, moderate, and vigorous intensity combined assessed by the SenseWear Armband) and 564 min/day of sedentary time (9.4 hr/day). 15 In a prospective study (n = 24), recipients accumulated ~90 min/day of MVPA (assessed by the SenseWear Armband) 12 months after transplantation. 13 In another study, 23 kidney transplant recipients wore a DynaPort activity monitor and engaged in 311 min/day of activity time, 205 min/day of standing time, 288 min/day of sitting time, and 86 min/day of lying time. 12 Activity time was defined as the sum of walking and standing time. Beddhu et al 16 used the National Health and Nutrition Examination Survey (NHANES) and identified 383 participants with chronic kidney disease who wore an earlier version of the ActiGraph accelerometer. These participants engaged in 7 min/day of MVPA and 511 min/day (8.5 hr/day) of sedentary time. Although it is difficult to compare these findings to our physical activity and sedentary time estimates given the varying estimates, definitions of activity, and assessment devices used, the previous studies that used an objective measure recorded substantially higher MVPA compared to our study that suggested 21 min/day. However, there is consistency in sedentary time across the studies when we compare our sedentary time estimate (9.4 hr/day) to the sum of the sedentary domains of standing, sitting, and lying time variables (9.7 hr/day and 8.5 hr/day). We also reported accelerometer-based light intensity physical activity and step counts. We found that kidney transplant recipients averaged 250 min/day (~4 hr/day) of light intensity physical activity. Other studies have yielded similar results. For example, Beddhu et al 16 reported kidney transplant recipients engaged in approximately 185 min/day (~3 hr/day) of light intensity activity. Our study found recipients took approximately 5500 steps/day. Several studies have reported kidney transplant recipients engage in anywhere from ~4000 to ~9700 steps/day. 12 , 13 , 15 , 17 Inconsistency in step counts across these studies may be due to a variety of factors including type of device used (step pedometer vs. accelerometer) and varying differences in time since transplant across samples. However, these studies all suggest kidney transplant recipients engage in low amounts of walking. A review by Tudor-Locke recommended individuals with disability or chronic illness engage in 6500 to 8500 steps/day. 18 Few studies have examined correlates of physical activity and sedentary behaviors in the solid organ transplant context. 10 Our study is one of the first to examine correlates of accelerometer-based physical activity, light intensity activity, steps, and sedentary time in kidney transplant recipients. While MVPA was inversely associated with age, steps/day was inversely associated with age and positively associated with income. Light intensity activity was positively associated with education and income, and inversely associated with BMI. Sedentary time was positively associated with age, BMI and education, and inversely associated with income. These findings suggest that further exploration of the barriers to reducing sedentary time for older patients and those with higher BMI is needed; however, this recommendation is not unique to the population of kidney transplant recipients. Of note, our findings suggesting more highly educated participants had higher sedentary time is not consistent with research often suggesting higher education is inversely associated with sedentary time 19 and positively associated with MVPA. 20 It is possible that participants with higher education had more opportunities to take time off from employment (eg, sick leave). No clinical variables were significantly associated with activity or sedentary time. While previous work has indicated individuals with chronic kidney disease with low eGFR have a higher likelihood of being sedentary, 21 our study found no associations between sedentary time, physical activity, and eGFR. It is worth noting the Glavinovic study analyzed eGFR as a categorical variable (>60, 60-45, <45) while our study analyzed eGFR as a continuous variable. Limitations of this study include the cross-sectional design, low recruitment rate (11%), and generalizability, given data collection occurred at a single center and the majority of participants were Caucasian with a relatively high income and education. While study participants were not significantly different than nonresponders on age and gender, they were significantly more proximal to their transplant date compared to nonresponders. Furthermore, the accelerometer used in this study does not distinguish between sitting and stationary standing (ie, sedentary time may include periods of standing still as well as sitting) and may undercount steps in those individuals who walk slow. 22 Our study only included transplant recipients who were at least one-year post transplant. It is likely that recipients who are immediately post-transplant are less active and more sedentary, and therefore, time since transplantation should still be an important factor to consider in the rehabilitation context. Finally, our study only examined potential sociodemographic and clinical correlates of activity and sedentary behaviors. There are likely other correlates of these behaviors in this population and may include social cognitive (eg, self-efficacy, attitude) and neighborhood/environment (eg, access to parks and green space) correlates. Future research should utilize more rigorous study designs (eg, prospective studies or interventions) and recruit larger and more representative samples of kidney transplant recipients. Future research should also use devices with inclinometers to better able differentiate between sitting and standing (eg, activPAL). Few studies to date have examined activity and sedentary behaviors among kidney transplant recipients using device-based measures. In this study, we report that the majority of kidney transplant recipients that were more than 12 months post-transplant were accumulating low amounts of MVPA (~20 min/day) and high amounts of sedentary time (exceeding 9 hr/day). We also reported correlates of different physical activity behaviors and sedentary time in this population. Interventions need to be developed to facilitate activity and reduce sedentary time in this population. List of Abbreviations BMI, body mass index; 95% CI, 95% confidence interval; METs, metabolic equivalents; MVPA, moderate-to-vigorous physical activity; NIS, Nephrology Information System. Ethics Approval and Consent to Participate This study was approved by the University of Alberta Health Research Ethics Board (ID: Pro00063054) and the Athabasca University Research Ethics Board (ID: 22180). All participants provided written consent to participating in this study. Consent for Publication All co-authors reviewed this final manuscript and consented to its publication. Availability of Data and Materials Data and materials may be made available upon written request to the corresponding author. Reasonable requests for data access will be assessed in consultation with the appropriate Research Ethics Boards. Author Contributions J.K.V. provided study funding, participated in the study conception, research design, writing of the paper, performance of the research, and in data analysis. S.S. participated in the study conception, editing of the paper, and providing access to the Nephrology Information Database. S.T., N.N.L., and K.W. participated in the research design and editing of the paper. S.J. participated in the study conception, research design, and editing of the paper. I.J. extracted database variables. T.B. processed the accelerometer data and participated in the editing of the paper. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. ORCID iDs Jeff K. Vallance https://orcid.org/0000-0003-1135-8772 Ngan N. Lam https://orcid.org/0000-0002-0129-7091 Publisher Copyright: © The Author(s) 2019.
PY - 2019
Y1 - 2019
N2 - Background: Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life. Objective: The objective of this study was to examine accelerometer-based physical activity and sedentary time profiles among kidney transplant recipients and examine possible demographic and clinical correlates of physical activity and sedentary time. Design: Cross-sectional. Setting: Edmonton, Alberta, Canada. Patients: Kidney transplant recipients were recruited (N = 1,284) from the Northern Alberta Renal Program’s Nephrology Information System database (1993-2016). Measurements: Participants wore an ActiGraph GT3X+ accelerometer on their hip during waking hours for seven consecutive days. Methods: Kidney transplant recipients (1993-2016) recruited from the Northern Alberta Renal Program’s Nephrology Information System database wore an accelerometer and completed a self-reported questionnaire. Multiple linear regression was used to determine associations between activity level, demographic, and clinical characteristics. Results: Participants’ (n = 133; 11% response rate) mean age (SD) was 58 (14) years and 56% were female. Mean total sedentary time was 9.4 (1.4) hours per day; total moderate-to-vigorous physical activity (MVPA) time was 20.7 (19.6) minutes per day. MVPA was significantly associated with age where each additional year was associated with 0.48 fewer min/day (ie, ~30 seconds) (unstandardized beta: B = −0.48 min/day, 95% confidence interval [95% CI]: −0.75, −0.22). Sedentary time was significantly associated with age (B = 1.0 min/day, 95% CI: 0.03, 1.9), body mass index (B = 2.7 min/day, 95% CI: 0.2, 5.13), education (B = 39.1 min/day, 95% CI: 12.3, −65.8), and inversely associated with income (B = −44.9 min/day, 95% CI: −73.1, −16.8). Limitations: Limitations include the cross-sectional design, poor response rate, and limited generalizability of the results. Conclusions: Kidney transplant recipients showed high volumes of sedentary time and low volumes of health-enhancing physical activity. Understanding correlates of these behaviors may aid in the development of interventions to favorably change these behaviors.
AB - Background: Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life. Objective: The objective of this study was to examine accelerometer-based physical activity and sedentary time profiles among kidney transplant recipients and examine possible demographic and clinical correlates of physical activity and sedentary time. Design: Cross-sectional. Setting: Edmonton, Alberta, Canada. Patients: Kidney transplant recipients were recruited (N = 1,284) from the Northern Alberta Renal Program’s Nephrology Information System database (1993-2016). Measurements: Participants wore an ActiGraph GT3X+ accelerometer on their hip during waking hours for seven consecutive days. Methods: Kidney transplant recipients (1993-2016) recruited from the Northern Alberta Renal Program’s Nephrology Information System database wore an accelerometer and completed a self-reported questionnaire. Multiple linear regression was used to determine associations between activity level, demographic, and clinical characteristics. Results: Participants’ (n = 133; 11% response rate) mean age (SD) was 58 (14) years and 56% were female. Mean total sedentary time was 9.4 (1.4) hours per day; total moderate-to-vigorous physical activity (MVPA) time was 20.7 (19.6) minutes per day. MVPA was significantly associated with age where each additional year was associated with 0.48 fewer min/day (ie, ~30 seconds) (unstandardized beta: B = −0.48 min/day, 95% confidence interval [95% CI]: −0.75, −0.22). Sedentary time was significantly associated with age (B = 1.0 min/day, 95% CI: 0.03, 1.9), body mass index (B = 2.7 min/day, 95% CI: 0.2, 5.13), education (B = 39.1 min/day, 95% CI: 12.3, −65.8), and inversely associated with income (B = −44.9 min/day, 95% CI: −73.1, −16.8). Limitations: Limitations include the cross-sectional design, poor response rate, and limited generalizability of the results. Conclusions: Kidney transplant recipients showed high volumes of sedentary time and low volumes of health-enhancing physical activity. Understanding correlates of these behaviors may aid in the development of interventions to favorably change these behaviors.
KW - accelerometer
KW - kidney transplantation
KW - physical activity
KW - sedentary behavior
UR - http://www.scopus.com/inward/record.url?scp=85074296370&partnerID=8YFLogxK
U2 - 10.1177/2054358119882658
DO - 10.1177/2054358119882658
M3 - Journal Article
AN - SCOPUS:85074296370
VL - 6
JO - Canadian Journal of Kidney Health and Disease
JF - Canadian Journal of Kidney Health and Disease
ER -