Perceptions towards physical activity in adult lung transplant recipients with cystic fibrosis

Abstract

Background Barriers and motives towards physical activity (PA) in lung transplant (LTx) recipients with cystic fibrosis (CF) are largely unknown. We aimed to explore perceptions towards PA in LTx recipients with CF to better understand individuals' needs and preferences. Methods Participants completed an online survey at two Swiss LTx and one follow-up shared care centre between June and December 2018. Results One hundred and eleven individuals completed the survey (87.4% response rate). Overall, survey participants perceive PA as important for their daily life and health. Perceived motives of PA were improving muscle strength, endurance and quality of life (QoL), to feel better, fun, to achieve personal goals and having more energy for everyday life. Fatigue was the most common perceived barrier to PA and associated with poorer QoL (r =-0.43, p<0.001) and health status (r =-0.31, p = 0.001). Participants with lung allograft dysfunction (LAD, n = 20) reported lower habitual PA (p = 0.009) and health status (p = 0.011), and rated shortness of breath, bad weather and concerns regarding lung rejection higher than those without LAD (all p<0.05). When we asked how an optimal training programme should look like, the majority would prefer individual, non-supervised (60%), outdoor (77%), endurance training (90%), once or twice a week (47%) for 40-60 minutes (48%). Only a minority of patients (14%) would be willing to use exercise applications for their home-based training.

Recommended shielding against COVID-19 impacts physical activity levels in adults with cystic fibrosis

“…Interestingly, the strict lockdown measures did not appear to impact on LTX recipients perceived health status [i.e., feeling thermometer (EQ-5D VAS, Figure S1 )]. The reported health status of LTX recipients during lockdown is perfectly comparable to a previously conducted survey in Swiss LTX recipients [28] . The study including 111 adult LTX recipients with comparable clinical profile (i.e., 18% chronic lung allograft dysfunction) and gender distribution showed a similar perceived health status as assessed with the EQ-5D VAS [28] .…”

“…The reported health status of LTX recipients during lockdown is perfectly comparable to a previously conducted survey in Swiss LTX recipients [28] . The study including 111 adult LTX recipients with comparable clinical profile (i.e., 18% chronic lung allograft dysfunction) and gender distribution showed a similar perceived health status as assessed with the EQ-5D VAS [28] . This is supported by the fact that – on a population level – LTX recipients with CF do not fear SARS-CoV-2 infection or worsening of their lung disease ( Figure S2 ).…”

“…This is supported by a recent international survey showing that individuals who reported a negative change in physical activity during early COVID-19-related restrictions stated lower mental and physical health compared to their more active counterparts [27] . It is well described that many individuals with CF value physical activity as important for their (lung) health, overall well-being, and daily life [28] . Moreover, many people with CF incorporate physical activity and exercise into their airway clearance regimen and – according to recent surveys among individuals within the CF community – almost half of individuals have used exercise as substitute for traditional airway clearance techniques [ 29 , 30 ].…”

Physical Activity Behaviour in Solid Organ Transplant Recipients: Proposal of Theory-Driven Physical Activity Interventions

“…The barriers and motivators were classified according to COM-B and TDF (Table 4) and subsequently embedded and discussed below according to the context dimension of CICI. The identified barriers and motivators were related to participation in physical activity and/or exercise [8,11,54,[69][70][71][72][73][74][75][76][77][78][79], exercise-based rehabilitation [80][81][82][83], or participation in the World Transplant Games [84]. The terms physical activity and exercise were often used interchangeably, making it impossible to make a clear distinction between these variables.…”

“…E.g., studies evaluating barriers and motivators for physical activity asked patients whether 'exercise or sports gave them unpleasant bodily signals' [69] and whether 'negative attitudes towards exercise' [79] were considered barriers to participating in physical activity. Increase mobility [74] and muscle strength [11,69] (K/M) Manage weight [11,69,81] (K/M) Improve endurance [73] (Lu) Consequences of inactivity [11,82] (K/M) Longevity of the transplanted kidney [74] (K) Improvements in body and transplant conditions and feeling the transplant becoming stronger [83] (H) Recognition that PA is essential for prolonging their lives and maintain the quality of their health [77] (M)…”