Physical activity experiences in children post-liver transplant: Developing a foundation for rehabilitation interventions.

Physical Activity (PA) plays an important role in the physical and psychosocial health of children and is beneficial in the treatment and prevention of comorbidities associated with transplantation. Despite this, PA participation in pediatric liver transplant recipients remains low compared to healthy peers. This qualitative-focused mixed-methods study explored the PA experiences and parental perception of these experiences, including perceived facilitators and barriers to PA in children post-liver transplant. Eighteen participants (9 children [median age 10.8 years] and 9 parents) took part in semi-structured interviews and completed the PedsQL Multidimensional Fatigue Scale and PAQ. Most children reported they were physically active (PAQ median 3.08 [IQR] 2.60-3.51), participating in PA for its enjoyment, regardless of their level of motor proficiency. Levels of fatigue (median 65.28 [IQR] 56.25-90.97) were higher than healthy norms and impacted PA participation in some children. Children and parents perceived PA as central to post-transplant recovery and valued its social and mental health benefits; however, parents struggled with ongoing uncertainty and perceived physical vulnerability of their child. This study indicates the need for continuing PA support and education and provides valuable information for family-centered interventions to increase PA and improve health outcomes in children post-transplant.