title: Patient and Staff Perceptions of Intradialytic Exercise before and after Implementation: A Qualitative Study.
abstract: BACKGROUND
  Despite guidance and evidence for the beneficial effects of intradialytic exercise (IDE), such programmes are rarely adopted within practice and little is known about how they may best be sustained. The Theoretical Domains Framework (TDF) was used to guide the understanding of the barriers and facilitators to initial and ongoing IDE participation and to understand how these are influential at each stage.
  
  
  METHODS
  Focus groups explored patient (n=24) and staff (n=9) perceptions of IDE prior to the introduction of a programme and, six months later, face to face semi-structured interviews captured exercising patients (n=11) and staffs' (n=8) actual experiences. Data were collected at private and NHS haemodialysis units within the UK. All data were audio-recorded, translated where necessary, transcribed verbatim and subject to framework analysis.
  
  
  RESULTS
  IDE initiation can be facilitated by addressing the pre-existing beliefs about IDE through the influence of peers (for patients) and training (for staff). Participation was sustained through the observation of positive outcomes and through social influences such as teamwork and collaboration. Despite this, environment and resource limitations remained the greatest barrier perceived by both groups.
  
  
  CONCLUSIONS
  Novel methods of staff training and patient education should enhance engagement. Programmes that clearly highlight the benefits of IDE should be more successful in the longer term. The barrier of staff workload needs to be addressed through specific guidance that includes recommendations on staffing levels, roles, training and skill mix.
authors.affiliation: Leicester Kidney Exercise Team, Academic Unit, Leicester General Hospital, Leicester, United Kingdom.
authors.forename: Hannah M L
authors.initials: HM
authors.lastname: Young
authors.affiliation: School of Applied Social Sciences, De Montfort University, Leicester, United Kingdom.
authors.forename: Nicky
authors.initials: N
authors.lastname: Hudson
authors.affiliation: Leicester Kidney Exercise Team, Academic Unit, Leicester General Hospital, Leicester, United Kingdom; Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, United Kingdom.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Clarke
authors.affiliation: Leicester Kidney Exercise Team, Academic Unit, Leicester General Hospital, Leicester, United Kingdom; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.
authors.forename: Maurice
authors.initials: M
authors.lastname: Dungey
authors.affiliation: John Walls Renal Unit, Leicester General Hospital University Hospitals of Leicester NHS Trusts, Leicester, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Feehally
authors.affiliation: Leicester Kidney Exercise Team, Academic Unit, Leicester General Hospital, Leicester, United Kingdom.
authors.forename: James O
authors.initials: JO
authors.lastname: Burton
authors.affiliation: Leicester Kidney Exercise Team, Academic Unit, Leicester General Hospital, Leicester, United Kingdom; Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, United Kingdom.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D006435:Renal Dialysis