THE CURRENT STATUS AND PREDICTORS OF EXERCISE IN KIDNEY TRANSPLANT RECIPIENTS: A PROSPECTIVE STUDY USING THE HEALTH ACTION PROCESS APPROACH

Abstract

Objectives: Exercise is of crucial importance for kidney transplant recipients to prevent or decrease cardiovascular disease, which has been reported as the main cause of death among kidney transplant recipients. Accordingly, this research aims to investigate the exercise behavior of kidney transplant recipients, and explore the influencing factors of exercise behavior and exercise intention based on the health action process approach (HAPA) model. Methods: A prospective design was used. Participants were required to take part in two assessments. At the first assessment, participants were measured by the general information questionnaire, the motivational subscales of the HAPA (pre-actional self-efficacy, outcome expectations, risk perception, intention), exercise social support scale, the Tampa Scale for Kinesiophobia-13 (TSK-13)and the exercise stage scale. Three months later, participants were investigated by the volitional subscales of the HAPA(planning, coping self-efficacy, recovery self-efficacy, exercise behavior). Exercise behavior was assessed using the leisure-time subscale of the International physical activity questionnaire. SAS version 9.40 was used for the descriptive analysis. Amos 21.0 was used to explore the impact of latent variables on exercise behavior and exercise intention. Results: A total of 320 participants took part in the first assessment, and among them, only 252 participants completed the second assessment. The median exercise of the 252 kidney transplant recipients was 924.00 MET-min/week. The final model had a significant consistence with the data. The exercise behavior could be explained 19.8% of the variance. Exercise planning (coefficient of direct effect 0.395) and recovery self-efficacy (0.126) could influence exercise directly; exercise social support (0.009), positive outcome expectations (0.020), negative outcome expectations (-0.022), pre-actional self-efficacy (0.079), coping self-efficacy (0.228) could influence exercise indirectly, among which, exercise intention influence exercise via chain mediation of coping self-efficacy and exercise planning. Exercise intention could be accounted for 50.8% of the variance with pre-action self-efficacy (0.529), negative outcome expectations (-0.332), positive outcome expectations (0.297), and exercise social support (0.139), and all of them influence exercise intention directly. Conclusion: The exercise behavior among kidney transplant recipients was not quite good. Although there was a relatively large mount of exercise, most of them was walking, the moderate-to-vigorous physical activity needs to be improved. The structural model based on the HAPA was able to explain exercise and exercise intention among kidney transplant recipients. Exercise planning is the most important factor affecting exercise, followed by coping self-efficacy and recovery self-efficacy. It is suggested that the medical stuff should focus on the exercise planning and exercise self-efficacy in order to improve the kidney transplant recipients’ exercise.