Increasing physical activity in pediatric heart transplant recipients: Insights from patients and their families to inform intervention design and implementation
7 affiliations
- 1Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- 2Mixed Methods Research Lab, Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- 3Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA
- 4Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
- 5Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA
- 6Departments of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- 7Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Medical Center, New York, NY
Abstract
Background: Survival after pediatric heart transplantation (HT) remains limited, and recipients face a heightened burden of modifiable cardiovascular risk factors. Despite the well-established benefits of physical activity (PA), pediatric HT recipients demonstrate reduced exercise capacity and low participation in moderate-to-vigorous physical activity (MVPA). Effective interventions require a nuanced understanding of behavioral determinants influencing PA engagement. This study sought to characterize perceived barriers, facilitators, and intervention preferences among pediatric HT recipients and their caregivers using the Capability–Opportunity–Motivation Behavior (COM-B) framework.
Methods: We conducted semi-structured interviews with pediatric HT recipients aged 6–22 years and their caregivers at a single tertiary transplant center. Participants were purposively sampled to ensure variation in age at transplant, diagnosis, time since transplant, and prior exposure to PA interventions. Interviews explored current activity patterns, perceived barriers and facilitators, and preferences for structured exercise programs. Transcripts were analyzed using an integrated thematic approach combining a priori COM-B constructs with inductively derived themes.
Results: Thirty-four interviews were completed with 17 caregiver–patient dyads and one independent adult participant. Participants generally viewed PA as safe, enjoyable, and emotionally beneficial, reflecting strong intrinsic motivation and preserved psychological capability. Social influences—including peers, family members, and opportunities to connect with other transplant recipients—emerged as powerful motivators for sustained engagement. In contrast, logistical factors such as transportation, scheduling conflicts, and distance from the transplant center were the most frequently cited barriers, highlighting limitations in physical opportunity rather than medical constraints. Caregivers emphasized the importance of professional oversight to enhance confidence, while patients and caregivers identified goal setting and progress tracking as key motivational supports. Many participants favored home-based or virtually delivered interventions to improve accessibility.
Conclusions: Pediatric HT recipients appear both willing and capable of participating in physical activity; however, sustained engagement is largely determined by opportunity and social motivation rather than physiologic limitations. Interventions that prioritize accessibility, incorporate peer connection, and provide structured feedback may promote durable behavior change. These findings offer a theory-informed foundation for designing scalable PA interventions aimed at improving long-term cardiovascular health in pediatric HT recipients.
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BibTeX
@article{edelson2026increasing,
title = {{Increasing physical activity in pediatric heart transplant recipients: Insights from patients and their families to inform intervention design and implementation}},
author = {Jonathan B. Edelson and Caroline S. O’Brien and Trent Leung and Debra Lefkowitz and Lakshmi Parvathinathan and Stephen Paridon and Sara King-Dowling and Jonathan A. Mitchell and Steven M. Kawut and Meghan Lane-Fall},
journal = {JHLT Open},
year = {2026},
month = oct,
doi = {10.1016/j.jhlto.2026.100702},
url = {https://doi.org/10.1016/j.jhlto.2026.100702},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Increasing physical activity in pediatric heart transplant recipients: Insights from patients and their families to inform intervention design and implementation
AU - Jonathan B. Edelson
AU - Caroline S. O’Brien
AU - Trent Leung
AU - Debra Lefkowitz
AU - Lakshmi Parvathinathan
AU - Stephen Paridon
AU - Sara King-Dowling
AU - Jonathan A. Mitchell
AU - Steven M. Kawut
AU - Meghan Lane-Fall
PY - 2026
DA - 2026/10/12
JO - JHLT Open
DO - 10.1016/j.jhlto.2026.100702
UR - https://doi.org/10.1016/j.jhlto.2026.100702
AB - Background: Survival after pediatric heart transplantation (HT) remains limited, and recipients face a heightened burden of modifiable cardiovascular risk factors. Despite the well-established benefits of physical activity (PA), pediatric HT recipients demonstrate reduced exercise capacity and low participation in moderate-to-vigorous physical activity (MVPA). Effective interventions require a nuanced understanding of behavioral determinants influencing PA engagement. This study sought to characterize perceived barriers, facilitators, and intervention preferences among pediatric HT recipients and their caregivers using the Capability–Opportunity–Motivation Behavior (COM-B) framework. Methods: We conducted semi-structured interviews with pediatric HT recipients aged 6–22 years and their caregivers at a single tertiary transplant center. Participants were purposively sampled to ensure variation in age at transplant, diagnosis, time since transplant, and prior exposure to PA interventions. Interviews explored current activity patterns, perceived barriers and facilitators, and preferences for structured exercise programs. Transcripts were analyzed using an integrated thematic approach combining a priori COM-B constructs with inductively derived themes. Results: Thirty-four interviews were completed with 17 caregiver–patient dyads and one independent adult participant. Participants generally viewed PA as safe, enjoyable, and emotionally beneficial, reflecting strong intrinsic motivation and preserved psychological capability. Social influences—including peers, family members, and opportunities to connect with other transplant recipients—emerged as powerful motivators for sustained engagement. In contrast, logistical factors such as transportation, scheduling conflicts, and distance from the transplant center were the most frequently cited barriers, highlighting limitations in physical opportunity rather than medical constraints. Caregivers emphasized the importance of professional oversight to enhance confidence, while patients and caregivers identified goal setting and progress tracking as key motivational supports. Many participants favored home-based or virtually delivered interventions to improve accessibility. Conclusions: Pediatric HT recipients appear both willing and capable of participating in physical activity; however, sustained engagement is largely determined by opportunity and social motivation rather than physiologic limitations. Interventions that prioritize accessibility, incorporate peer connection, and provide structured feedback may promote durable behavior change. These findings offer a theory-informed foundation for designing scalable PA interventions aimed at improving long-term cardiovascular health in pediatric HT recipients.
SN - 2950-1334
ER -