Correlates and Outcomes of Low Physical Activity Posttransplant: A Systematic Review and Meta-Analysis

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 (i.e. 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 7,401 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 four 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 (OR=0.172, 95% CI=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 post-transplant outcomes. Address for Correspondence: Sabina De Geest, Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, Basel, Switzerland, Tel +41 61 2070951, sabina.degeest@unibas.ch Protocol registration: PROSPERO protocol CRD42015003333 Authership contributions: Lut Berben: 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 paper. Sandra J. Engberg: Participated in research design, performance of the research (design of search strategy, full text evaluation, data extraction), data analysis (effect size calculation), participating in writing the paper. Anja Rossmeissl: Participated in research design, performance of the research (design of search strategy, title and abstract screening, full text evaluation, data extraction), and participating in writing the paper. Elisa J. Gordon: Participated in research design, performance of the research (design of search strategy, title and abstract screening, full text evaluation, data extraction), and participating in writing the paper. Fabienne Dobbels: 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 critical review of the paper. Christiane Kugler: 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 critical review of the paper. Arno Schmidt-Trucksäss: 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 critical review of the paper. Mary Lou Klem: Design of search strategy, programming of searches in different databases, feedback on methodology used to conduct the systematic review; critical revision of the paper. Susan M. Sereika: Design of the Access databases for data input, advice on methodology to be used for effect size calculation, review of statistical analyses, and critical revision of the paper. Paolo De Simone: Participated in the design of the study, overall project management and quality control of methodology followed, and critical revision of the paper. Fabienne Dobbels: Participated in the design of the study, overall project management and quality control of methodology followed, and critical revision of the paper. Sabina M. De Geest: Participated in the design of the study, overall project management and quality control of methodology followed, and critical revision of the paper. Disclosure No author states any conflicts of interest. Funding The research has received funding for a consortium meeting from the Brocher Foundation, a Swiss non-profit private foundation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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