{"doi":"10.1016/j.xkme.2023.100779","title":"Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners","abstract":"Rationale & ObjectiveDespite guidelines calling to improve physical activity in older adults, and evidence suggesting that pre-kidney transplant physical function is highly associated with post-transplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners.Study DesignIndividual, in-depth, cognitive interviews conducted separately for patients and care partners via secure web-conferencing.Setting& Participants: Twenty-three patients (≥50 years of age, on dialysis from the UCSF Kidney Transplantation Clinic, with a Short Physical Performance Battery ≤ 10) and their care partners.Analytical ApproachAll audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior (COM-B) model.ResultsPatients’ median ages were 60 years (57, 63.5) and care partners’ 57 years (49.5, 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as Black, and 47% of dyads were spouse/partner relationships. Major themes for barriers to pre-transplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized/structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence/functionality or to promote successful transplantation.LimitationsParticipants geographically limited to Northern CaliforniaConclusionsAlthough patients and care partners report numerous barriers to pre-transplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pre-transplant physical function. Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that pre-kidney transplant physical function is highly associated with post-transplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. Individual, in-depth, cognitive interviews conducted separately for patients and care partners via secure web-conferencing. & Participants: Twenty-three patients (≥50 years of age, on dialysis from the UCSF Kidney Transplantation Clinic, with a Short Physical Performance Battery ≤ 10) and their care partners. All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior (COM-B) model. Patients’ median ages were 60 years (57, 63.5) and care partners’ 57 years (49.5, 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as Black, and 47% of dyads were spouse/partner relationships. Major themes for barriers to pre-transplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized/structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence/functionality or to promote successful transplantation. Participants geographically limited to Northern California Although patients and care partners report numerous barriers to pre-transplant exercise and activity, they a","journal":"Kidney Medicine","year":2023,"id":376220,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9568,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1139470,"name":"Jessica R. Elia","orcid":null,"position":1,"is_corresponding":false},{"id":1139010,"name":"Gabriel García","orcid":"0000-0002-4193-6142","position":2,"is_corresponding":false},{"id":426627,"name":"Gary Abrams","orcid":"0000-0001-5377-0373","position":3,"is_corresponding":false},{"id":896445,"name":"Deborah Adey","orcid":"0000-0001-9090-9135","position":4,"is_corresponding":false},{"id":257558,"name":"Jennifer C. Lai","orcid":"0000-0003-2092-6380","position":5,"is_corresponding":false},{"id":237755,"name":"Rebecca L. Sudore","orcid":"0000-0003-4436-2209","position":6,"is_corresponding":false},{"id":441316,"name":"Anoop Sheshadri","orcid":"0000-0002-1139-0169","position":0,"is_corresponding":true}],"reference_count":84,"raw_metadata":null,"created_at":"2026-07-19T01:16:28.318749Z","pmid":"38419789","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}