Perceptions of healthcare providers on benefits, risks and barriers regarding intradialytic exercise among haemodialysis patients

ABSTRACT

Purpose

Clinical guidelines call for the inclusion of exercise interventions in every patient’s dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE).

Methods

We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®.

Results

Participants reported the benefits of IDE as improvements in patients’ physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients’ exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care.

Conclusions

Safe and sustainable implementation of IDE, which might improve a patient’s well-being, need to be prescribed in alignment with the patient’s clinical profile, be delivered individually according to the patient’s characteristics and requires adjustments in the available resources.

KEYWORDS:

• Haemodialysis
• intradialytic exercise
• qualitative research
• benefits
• risks
• barriers
• implementation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17482631.2023.2287597

Additional information

Funding

This work was supported by the Slovak Research and Development Agency under Grant APVV-16-0490 and the Internal Research Grant System of Pavol Jozef Safarik University under Grant VVGS-2019-1069. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

Notes on contributors

Aurel Zelko

Aurel Zelko is a junior researcher at the Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and a Ph.D. candidate in the Faculty of Medical Sciences, University of Groningen. His Ph.D. project focuses on the effectiveness and applicability of intradialytic exercise in chronic kidney disease patients.

Ivana Skoumalova

Ivana Skoumalova is a senior researcher at the Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice. Her main research interests are patient safety and the second victim phenomenon; and qualitative research activities for DIPEx (Database of Individual Patient Experiences).

Denisa Kravcova

Denisa Kravcova is a research fellow at the Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice.

Zuzana Dankulincova Veselska

Zuzana Dankulincova Veselska is an associate professor of social psychology dedicated to building research in the field of social determinants of health of vulnerable groups of the population (currently especially adolescents with emotional and behavioural problems).

Jaroslav Rosenberger

Jaroslav Rosenberger is a senior researcher at the Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice. His medical activities are arranged in the Transplantation Department of the University Hospital L. Pasteur Kosice (and II. Internal Clinic Medical Faculty PJ Safarik University) and FMC – dialysis services Slovakia where he treats nephrological, dialysed and transplanted patients. His primary focus is on quality of life, adherence, health literacy, malnutrition, epidemiology and chronic kidney disease – mineral and bone disorder. Apart from his medical activities in the field of nephrology, his research activities are mainly focused on the quality of life in patients with several chronic diseases.

Andrea Madarasova Geckova

Andrea Madarasova Geckova is a professor of social psychology and head of the Department of Health Psychology and Research Methodology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice. She is leading the research team mapping new developmental challenges of Generation Z, and another one focusing on mental health challenges associated with providing health care.

Jitse P. van Dijk

Jitse P. van Dijk is an associate professor of public health affiliated to the Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen. He is a professor at the Palacky University Olomouc and a member of the Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Pavol Jozef Safarik University in Kosice. His main research interests are social determinants of health in adolescents, on chronic disease and their participation in society.

Sijmen A. Reijneveld

Sijmen A. Reijneveld is a professor of community and occupation medicine at the Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen. His main research interests are community medicine and its management. His expertise concerns public health and epidemiology, in particular prevention, early treatment and promotion of health-related social participation and current research concerns youth and deprived groups.