Fatores associados à inatividade física em transplantados renais brasileiros: subprojeto do estudo multicêntrico ADERE Brasil

Abstract

Even though regular physical activity is a recommendation for kidney transplant recipients, results from ADHERE Brazil study revealed a high prevalence of physical inactivity (69.1%). The design of strategies for tackling this behavior depends on a broader identification of barriers in this population. We identified multilevel, in 2 levels (patient and transplant center) factors associated with physical inactivity in kidney transplant recipients. This is a cross-sectional and multicenter design, a subproject of ADHERE Brazil study which included 20 kidney transplant centers and 1,105 kidney transplant recipients (data collection: Dec/15 to Jun/17). Using a multistage sampling method, based on the geographical region (South/Southeast and North/Northeast/MidWest) and transplant activity of the centers, patients were proportionally and randomly selected. Physical activity was assessed by questionnaire, the Brief Physical Activity Assessment Tool, and we adopted the World Health Organization (WHO) (2010) definition to classify kidney transplant recipients as inactive (<150min/week) or active (>150min/week). Following Bronfenbrenner´s ecological model, we analyzed multilevel factors associated with physical inactivity by sequential logistic regression. Results: In the sample of 1105 patients, 58.5% were male, 51.4% were white, and the mean age was 47.6±12.6 years. Most reported having a stable partner (59.9%), had a family income higher than the reference salary (74.6%) and had at least 8 years of study (85.1%). Most patients had hemodialysis (93%) before transplantation, had been at least 5 years since transplantation (51.2%) and received an organ from a deceased donor (65.2%). The diagnosis of hypertension was frequent (72.2%) and 18.7% of patients were obese. Factors associated with physical inactivity were at patient level: familiar income >1 reference wage (OR 0.66; CI 95% 0.48-0.90; p=0.01), student (OR 0.58; CI 95% 0.37-0.92; p=0.019), smoking (OR 2.43; CI 95% 0.97-6.06; p=0.058), obesity (OR 1.79; CI 95% 1.26-2.55; p<0.001), peripheral vascular disease (OR 3.18; CI 95% 1.20-8.42; p=0.021), post-transplant hospitalizations >3 (OR 1.58; CI 95% 1.17-2.13; p=0.003); at center level: physical educator as part of the team (OR 0.54; CI 95% 0.46-0.64; p<0.001), teaching hospital (graduation students) (OR 1.47; CI 95% 1.01-2.13; p=0.041). This is the first multicenter study evaluating physical inactivity and associated multilevel factors (patient level and meso level) in Brazilian kidney transplant recipients and one of the largest samples evaluating physical activity after kidney transplantation. Our results suggest we need multilevel strategies, beyond those directed to patient´s characteristics, for reducing physical inactivity after kidney transplantation.