Background: The use of leg cycle ergometers (LCEs) during hemodialysis (HD) has been shown to have a number of benefits including improved adequacy of HD and blood pressure reduction while also improving exercise capacity, physical function and quality of life in patients with end stage kidney disease. LCEs have been implemented at several dialysis centres in major Canadian cities, however no known location in British Columbia. Furthermore, a gap exists in the literature with respect to the feasibility of implementing such programs in small or rural HD centres. We examined the feasibility of implementing LCEs concurrent with HD in a rural community hemodialysis unit.

Methods: Study participants included patients and clinical care providers (CCPs) recruited from an independent community HD unit in Prince George, British Columbia. Descriptive statistics were used to indicate frequency, intensity and length of cycle utilization. Barriers and facilitators to participation were captured in individual semi-structured interviews conducted with patient and CCPs at the end of the study period. Transcribed interviews were coded and analyzed using a theoretical framework scaffolded by constructs of acceptability and feasibility of implementation (O’Cathian et al. 2015). 

Results: Of 14 eligible patients, 9 enrolled of which 6 actively participated in the study. Over 1 to 4 months patients used LCEs an average of 85% (63%-100%) of their dialysis sessions. Duration of LCEs use increased over time from a low of 15 minutes to an average of 1 hour (15-120 minutes) at an “easy” rate on the Perceived Exertion Scale with no adverse events reported. Thematic analysis of 14 interviews (9 patients; 5 CCPs) identified key elements for successful implementation: patient and CCP orientation and a structured support process aided in acceptability, resulting in minimal disruption to workflow and generating motivation to participate and a positive patient and CPP experience. 

Conclusion: Exercising during HD is acceptable, feasible, and safe when implemented in a rural/small community HD unit using a structured team-based approach. It does not add workload for clinical staff and can be incorporated in the workflow. Patients reported an overall positive experience and recommended the creation of an education tool to aid in recruitment.

Feasibility of intradialytic exercise in a rural community hemodialysis unit: mixed methods analysis of implementation