Projektname
Prevalence, evolution, determinants, and outcomes of self-reported physical activity among solid organ transplant groups: Analysis of the prospective Swiss Transplant Cohort Study. 

Projektleitung
Sabina De Geest

INS-Projektteam
Janette Ribaut
Nadine Beerli
Oliver Mauthner
Sabina De Geest

Externe Projektpartner
KU Leuven, Leuven, Belgium (Amaryllis H. Van Craenenbroeck, Marieke Vandecruys, Stefan De Smet (Co-PI))
Patient advisory board, STCS, Basel (Bigna Fischer, Karin Mettler)
Federal University of Juiz de Fora, Juiz de Fora, Brazil (Hélady Sanders-Pinheiro)
Kantonsspital St. Gallen, St. Gallen, (Isabelle Binet)
Universität Bern, Bern, (Vanessa Banz)

Ort der Datenerhebung
Basel, Bern, Geneva, Lausanne, St.Gallen, Zürich

Laufzeit
2022 bis 2025

Projektbeschreibung
Background
After transplantation, regular physical activity is important to promote physical and mental well-being. The World Health Organization (WHO) recommends adults with chronic conditions, such as for example transplant recipients, to limit sedentary behavior time and to regularly engage in moderate- and/or vigorous-intensity activities. However, previous studies have indicated that the majority of organ transplant recipients are less physically active compared to the general population and do not meet the WHO’s physical activity recommendations. To date, no studies have described the evolution in physical activity from pretransplant to long-term posttransplant. Furthermore, our current understanding of what influences posttransplant physical activity and to which extent it modulates physical and mental well-being is limited. Such insights are essential to provide optimal care after transplantation.

Goals
The main goals of this study are:

1. To describe prevalence and evolution of self-reported physical activity in solid organ transplant recipient groups from pretransplant to a maximum follow-up period of 10 years posttransplant;
2. To compare the prevalence and evolution of self-reported physical activity among solid organ transplant recipient groups from pretransplant to a maximum follow-up period of 10 years posttransplant;
3. To assess pre- and posttransplant determinants of posttransplant self-reported physical activity;
4. To assess clinical outcomes associated with self-reported pre- and posttransplant physical activity in solid organ transplant recipients. Primary outcomes include mortality and cause of death, cardiovascular events, graft loss, and health-related quality of life.

Methods
PROSPECTFIT is nested within the STCS and the GERAS sub-study. The STCS is an open prospective cohort study including all solid organ transplant recipients in Switzerland. We will use data collected by the STCS based on medical records as well as the Psychosocial Questionnaire. We will also include data on physical frailty, cognitive frailty, and inflammatory markers in kidney transplant recipients (n = 250) gathered through the GERAS sub-study. PROSPECTFIT will evaluate data from about 3500 adult patients transplanted between 2012 and 2018, with a maximum follow-up period of four (recruited in 2018) to 10 (recruited in 2012) years. Neither patients receiving a re-transplantation nor patients receiving multi-organ transplantation will be excluded. However, because of statistical issues associated with small sample sizes, small bowel and pancreas transplant recipients will be excluded from the present study.
Since 2012, the STCS assesses self-reported physical activity as part of the STCS’ Psychosocial Questionnaire at listing, six months posttransplant, one year posttransplant, and yearly thereafter. The physical activity questionnaire constitutes of one item and three subitems. Respondents replied whether they participate in regular physical activity (e.g., walking, cycling, cleaning the house, yard work; yes or no). Individuals answering ‘no’ will be considered physically inactive and assigned 0 minutes of weekly physical activity. Individuals answering ‘yes’ were asked about their physical activity frequency (days·week^-1), duration (min·session^-1), and level of exertion (very easy, easy, somewhat hard, hard, or very hard; 1–5). Moderate to vigorous physical activity will be operationalized as physical activity perceived as somewhat hard, hard, or very hard. The proportion of physically inactive recipients (%), total weekly physical activity time (min·week^-1), and total weekly moderate to vigorous physical activity (min·week^-1) will be analysed based on data of the total sample using mixed regression analysis.

Relevance for clinical practice
An in-depth comprehension of posttransplant physical activity behaviour, encompassing its evolution, determinants, and outcomes, will serve as a vital foundation for devising effective physical activity interventions in transplant recipients.