A Qualitative Study to Explore Patient and Staff Perceptions of Intradialytic Exercise

Abstract

Background and objectives Randomized, controlled trials show that regular exercise is beneficial for patients on hemodialysis. Intradialytic exercise may have additional benefits, such as amelioration of treatment-related symptoms. However, the factors that influence the implementation of intradialytic exercise are largely unknown.Design, setting, participants, & measurements Individual semistructured interviews were conducted with a purposive sample of patients on hemodialysis who had participated in a pilot randomized, controlled trial on intradialytic exercise and dialysis staff that worked in the unit during the trial. The trial took place from July to December of 2014 and enrolled 31 patients. Interviews were conducted from April to December of 2014. Interview coding followed an inductive and broad-based approach. Thematic analysis was used to group codes into common themes, first individually and then, across staff and patient interviews.Results Twenty-five patients and 11 staff were interviewed. Three themes common to both groups emerged: support, norms (expected practices) within the dialysis unit, and the role of the dialysis nurse. The support of the kinesiologist enhanced patients' confidence and sense of capability and was a key component of implementation. However, the practice of initiating exercise at the start of the shift was a barrier to staff participation. Staff focused on the technical aspects of their role in intradialytic exercise, whereas patients viewed encouragement and assistance with intradialytic exercise as the staff's role. An additional theme of no time (for staff to participate in intradialytic exercise) was influenced by its low priority in their workflow and the demands of the unit. The staff's emphasis on patients setting up their own equipment and enhanced social interaction among participants were additional themes that conveyed the unintended consequences of the intervention. ConclusionsThe kinesiologist-patient interactions and staff readiness for intradialytic exercise were important factors in the implementation of intradialytic exercise. Understanding how unit workflow and the personal values of staff can influence implementation may improve the design of intradialytic exercise interventions.

Implications of Frailty for Peritransplant Outcomes in Kidney Transplant Recipients

“…Physical or exercise therapy delivery in the advanced CKD population is challenging. Implementation of intradialytic or supervised interdialytic exercise is limited by staffing challenges, competing priorities, and reimbursement 38,39 . Home-based exercise therapy may result in a modest improvement in 6-minute walk test performance and lower extremity strength 40 How the positive effects persist beyond the study period is unknown.…”

Barriers and facilitators for engagement and implementation of exercise in end‐stage kidney disease: Future theory‐based interventions using the Behavior Change Wheel

“…Lack of awareness of exercise recommendations, opportunities to exercise, and a general lack of information including how to exercise at an appropriate intensity, were considered barriers to exercise by patients. A lack of awareness of exercise guidelines was also indicated as a barrier to exercise promotion by HCPs …”

“…Health care professionals, friends and family, and peer support were reported to be influential for encouraging exercise . However, the current lack of an “exercise culture” for dialysis patients was a reported barrier .…”

“…However, the current lack of an “exercise culture” for dialysis patients was a reported barrier . Patients reported receiving limited exercise counseling from HCPs and questioned levels of nursing involvement in supporting their exercise . Some studies reported how patients perceived exercise counseling as part of the nurses’ role, but others reported patient concerns over staff workload and how patients were keen to not be perceived as a bother to staff .…”

“…However, having a trusting relationship with their doctor, and doctor approval for exercise was as a facilitator for exercise engagement, as was peer support and seeing others exercise . Exercise was perceived as a way to develop camaraderie and positive common identities with others . Still, HCPs described a lack of support from management, and felt that it would be beneficial to have a dedicated exercise professional to promote and engage patients with exercise …”