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Table 4 Barriers to intra-dialytic exercise program

From: Knowledge, barriers and facilitators of exercise in dialysis patients: a qualitative study of patients, staff and nephrologists

Safety-related limitations of Exercise
Patients • It might make your blood pressure go up [Interview 2, M, 80 yo, White]
• Can’t move that arm, you’re locked into that position for however how long your treatment is. …also on your other free arm you have a blood pressure cuff. So you’re really kind of locked on both sides. Any movement in either one of those arms is gonna cause the machine’s alarm to go off. [Interview 8, M, 65 yo, Black]
Staff • They could dislodge a needle possibly …. it would also cause them pain, and it could really cause some large damage to their access…the biggest barrier that I could see…. Just moving around too much and cause an infiltrate [Interview 17, 67 yo, Nurse]
• If they do too much movement they won’t get a good treatment because they will constantly alarm. [Interview 18, 35 yo, Technician]
• Sometimes just moving around causes cramping in a patient [Interview 24, 28 yo, Technician]
• When people put their feet down you know blood pressure drops so it would definitely make it a little more challenging as far as making sure that the vitals are staying stabilized. [Interview 24, 28 yo, Technician]
Physicians • How do you interpret high blood pressures when you’re exercising? I don’t think you can. So it does create some issues that would have to be [addressed] [Interview 36, M, 39 yo, private practice]
• People passed out on Dialysis. If they are doing something else that’s directing blood flow elsewhere again it’s just sort of not an ideal combination. If someone’s inclined because they tend to drop their blood pressure, if you’re going to make them exercise you’re going to exacerbate [hypotension] [Interview 32, F, 43 yo, private practice]
• They’re almost like sort of tied up to the machine. one hand is immobile so that pretty much you know they just have the use of one hand and we don’t like the patients to be really moving their arm too much because then the needles would move and there is chances of them infiltrating [Interview 33, F, 39 yo, academic]
Limitation related to Type of Exercise and Exercise Equipment
Patients • Getting it [stationary bike] up to the chair would be a challenge. It would probably be too big and clunky of a device to put in there [Interview 4, M, 64 yo, Black]
• I found that [stationary bike that he used in a past research study] to be very boring, I didn’t like it……….. And I don’t think anybody did because I don’t see anybody doing it now” [Interview 8, M, 65yo, Black]
Staff • Buying equipment so we would need to get permission with [the administrator] with the budget. I don’t know if we’re going to want to spend all this money on some sort of equipment and have half the patients not use it [Interview 19, 35 yo, Dietitian]
• Some kind of equipment becomes cumbersome for patients.[Interview 23, 60 yo, Social worker]
• Depending on the exercise, you have space limitations[Interview 28, 58 yo, Nurse]
• Some of them used it [stationary bike] for a short time and then they lost interest in it [Interview 29, 58 yo, Administrator]
Physicians • It would be a little bit expensive because I guess it would involve some sort of equipment. [Interview 31, F, 66 yo, academic]
Lack of privacy during exercising
Patients • I don’t like to be what I think is doing performing in front of people because I don’t think I would do it well. [Interview 12, M, 75 yo, White]
Staff • I think for some people it could be a self-conscious thing and maybe they you know some people don’t like to go to the gym because they don’t want others to see them. [Interview 19, 35 yo, Dietitian]
Impact on staff workload
Patients • Yes it would [impact workload] and guarantee they wouldn’t have time to add that to their load. They’re extremely busy the whole time. …so adding one more responsibility to them I don’t think is realistic [Interview 11, F, 65 yo, White]
Staff • As far as the staff goes I don’t think we would have the time to do any really one-on-one [exercise]. [Interview 18, 35 yo, Technician]
• It would have to be very minimal. As our staffing doesn’t provide for helping them exercise. I mean just setting them up for it is you know is extra work. we don’t always have the staff and we don’t always have the time.[Interview 21, 52 yo, Nurse]
• With the bicycle[stationary bike]…that did add to our work load and not that it was a bad thing but you know it was a good thing for the patients but….I really don’t have a minute to spare” Interview 28,58 yo, Nurse]
Physicians • Nurses and techs, they’re on their toes all the time, they are busy and there’s the machines are alarming, someone you know needs attention all the time, and they are not like over-staffed, they are under-staffed so this would be something extra [Interview 33, F, 39 yo, private practice]
• There are so many patients per nurse, how attentive can they be when there's another variable in play. [Interview 36, M, 39 yo, private practice]
Resistance to changing dialysis routine
Patients • If you did it [exercise in dialysis unit prior to starting HD] none of us want to stay there any longer than we have to….you just don’t want to be there. It’s a mental thing, you just want to get out. [Interview 10, F, 54 yo, Black]
• I go [to dialysis] early in the morning so I ain’t gonna be doing no exercise early in the morning I like to sleep during the dialysis mostly [Interview 3, M, 54 yo, Black]
Staff • The exercising…..we try to encourage them as much as … some people can be very….strong-willed [in adopting changes to their HD routine]. [Interview 18, 35 yo, Technician]
• I just don’t see them being willing to, ….. they want to get on the machine, they want to either go to sleep or they want to sit there and do nothing and watch TV.. [Interview 21, 52 yo, Nurse]
Physicians • It not really part of the culture of during Dialysis….. some of them have been on Dialysis for a long time and they’re used to their routine and they come in and they do whatever they do and ….. I’m not sure that would be completely easy to change…its going to be an uphill battle to get them to exercise right now … they have their routine [Interview 31, F, 66 yo, academic]
• A lot of the patients are not receptive to new ideas …..it’s going to be a big change[Interview 33, F, 39 yo, private practice]
  1. Abbreviation. yo years old