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Table 6 Recommendations for Intra-dialytic Exercise

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

WHY intra-dialytic exercise might work? – Provide time distraction and convenience
Patients • If you could do it [exercise during dialysis] that would be great. It’s kind of torture sitting in a chair for 3 h. I’ve always questioned why there wasn’t something for us to do there besides sit there. It would be good for us mentally to have something else to do there while we are sitting in those chairs [Interview 10, F, 54 yo, Black]
Staff • The convenience too, if they were here for 3–4 h, you know, some people get pretty bored…..but if they were able to do some exercise, that would be a way to spend the time. [Interview 17, 67 yo, Nurse]
• They would see how much fun other people were having doing it, and if the staff gets into it, just walking around and doing their work, they’ll be playing around with it, and it just makes for a very light and fun afternoon, time will go fast. [Interview 23, 60 yo, Social worker]
• You’re not doing it outside of dialysis which is precious time to our patients….. trying something new in a very routine and monotonous process that they live with every week. It may end up that something like that is motivating because it’s different.[Interview 30, 54 yo, Administrator]
Physicians • There is such a time thing for dialysis itself, it would be nice to somehow turn that time into productivity. I think accessibility would be good… you might have more compliance because you’re stuck there for four hours [Interview 36, M, 39 yo, private practice]
HOW intra-dialytic exercise might work? – Build “Exercise culture” in dialysis unit
Patients • I’m the kind of person says that if you can do it, I can do it [if you saw someone else exercise, could that be motivating?] [Interview 12, M, 75 yo, White]
Staff • It’s that mentality if you see someone else trying to improve themselves and then you kind of like feel bad about yourself …….. And then maybe if they are seeing their friends across the aisle doing it, then that might motivate them to do it as well. [Interview 19, 35 yo, Dietitian]
• I would think that it[exercise during dialysis] would hopefully kind of be a chain reaction sort of thing – somebody saw someone doing it, you know, while they were on the machine, and then maybe they can get a couple [of other patients] to follow suit. [Interview 25, 46 yo, Nurse]
• If they saw somebody that was on dialysis for many, many years, kind of embracing this new philosophy…..That could possibly light the fire for others. [Interview 25, 46 yo, Nurse]
• Most of the staff I think would encourage the patients and have fun with it and help the patient have fun with it. [Interview 26, 41 yo, Nurse]
Physicians • It’s a social environment and what one person is doing it going to possibly influence another and that can be positive results so other people who see that person exercising may want to do it. If the whole team sort of supported them trying it then I think some of them would do that[Interview 31, F, 66 yo, academic]
WHAT type of intra-dialytic exercise might work? – Individualized, engaging, group activity
Patients • I think before the exercise is implemented they should give an example to see how the exercise is, if they would be able to do them and how far they should go because we’re not in that position to do all that they might want us to do [Interview 14, F, 68 yo, Black]
• Yeah more flexible type because I can choose the intensities because when I get tired or when I’ve had enough, I’m going to stop. [Interview 4, M, 64 yo, Black]
Staff • Have a spirited person to try to engage them, and just kind of make it fun. Group activities where you see other people enjoying it and you feel like you want to participate. [Interview 23, 60 yo, Social worker]
• Being involved in group activities not necessarily them being pin-pointed you know all by themselves? [Interview 24, 28 yo, Technician]
Physicians • I can even imagine having different regimens at higher and lower levels where you have the fitter or more stable patients do something that’s more like high level and maybe the less fit do sort of the leg lifts or other exercises. [Interview 36, M, 39 yo, private practice]
WHAT components to include? – Education about exercise
Patients • They should put something like that [information on exercise] on the wall [in dialysis unit][Interview 7, F, 43 yo, Black]
Staff • I think what would be best initially is just to do some pretty heavy education on the benefits. You know especially kind of hitting home the role of exercise with giving them energy… you need to get stronger so you can live on your own again leave the nursing home, get back to home and this is something that can help you reach those goals. [Interview 19, 35 yo, Dietitian]
HOW to motivate? - Incentive to exercise
Patients • You have to find some kind of a benefit from what you’re doing or you’re not going to do it and when I do it, I feel good. I feel good about myself. I feel good because I’ve done it. And that’s the only payment you can get from it. [Interview 12, M, 75 yo, White]
Staff • Maybe testimonials [from patients about benefits of exercise] ….if they could see that [Interview 28, 58 yo, Nurse]
• It would be every few months, do some sort of contest or raffle or something they could earn if they do their exercise,[like we did for fluid gains][Interview 19, 35 yo, Dietitian]
• I’m sure that [gift cards] would be incentive but that’s costly. Everybody likes money! [Interview 26, 41 yo, Nurse]
Physicians • Maybe in the beginning offering some sort of encouragement or incentive chance whether it’s you know they can have TV or something …. maybe a raffle or … a prize or something. That’d be key to get them motivated to want to do it. [Interview 34, M, 42 yo, academic]