Increasing the uptake of exercise programs in the dialysis unit: a protocol for a realist synthesis.
BACKGROUND
For people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment (intradialytic exercise) may promote exercise adherence and enhance aspects of the dialysis treatment. However, intradialytic exercise programs are complex and how to adapt program components to local context so that the program is more likely to attain its intended health outcomes have not been well described. To increase the uptake of exercise in clinical practice, more evidence is needed on how contextual factors influence the program's impact.


METHODS
Using the realist approach, we aim to understand how the processes and structures of intradialytic exercise programs work to influence patient participation according to different contextual factors. The focus of a realist review is explanatory and aims to develop and test theory on how contextual factors trigger specific processes or behaviors (or "mechanisms") to produce outcomes. Using the realist context-mechanism-outcome configuration of theory development, we will use a range of sources to develop initial candidate theories: a scoping review of published papers and the gray literature, and discussion with stakeholders. To provide a theoretical basis for how contextual factors could work to influence patient participation in intradialytic exercise (IDE), several of our preliminary theories will be based on dominant theories of exercise adherence and behavior change. To support or refute these initial theories, we will synthesize data from a systematic literature review and semi-structured interviews with intradialytic exercise program stakeholders, sampled from a range of programs worldwide.


CONCLUSIONS
The complexity of intradialytic exercise programs poses challenges to their implementation. Using the "context, mechanism, outcome" approach, the knowledge gained from this study will be used to develop general recommendations for renal care providers and administration on how to adapt components of an intradialytic exercise programs according to different contextual factors in order to promote patient participation.


BACKGROUND
PROSPERO CRD42016033335.
University of Alberta, 3064-8308 114 Street, Edmonton, Alberta, T6G 2V2, Canada. th11@ualberta.ca.
Stephanie
S
Thompson
Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
Alex
A
Clark
Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
Anita
A
Molzahn
Division of Nephrology, University of Alberta, 11-107 CSB, Edmonton, Alberta, T6G 2C3, Canada.
Scott
S
Klarenbach
Division of Nephrology, University of Calgary, TRW Building, 7th Floor, 3280 Hospital Drive NW, 7D12, Calgary, Alberta, T2N 4Z6, Canada.
Marcello
M
Tonelli
D005081:Exercise Therapy; D006436:Hemodialysis Units, Hospital; D006801:Humans; D006435:Renal Dialysis; D012107:Research Design; D000078202:Systematic Reviews as Topic
Contextual factors; Exercise; Hemodialysis; Intradialytic exercise; Realist synthesis