Patient-led identification and prioritization of exercise interventions for fatigue on dialysis: a workshop report
Authors: Ju Angela , Scholes-Robertson Nicole , Johnson David W , Cho Yeoungjee , van Zwieten Anita , Manera Karine , Howell Martin , Viecelli Andrea K , Jesudason Shilpanjali , Evangelidis Nicole , Polkinghorne Kevan , Gutman Talia , Wyburn Kate , Craig Jonathan C , Tong Allison ,   for the M-FIT workshop investigators, Charalambous Angela , Beach Barrymore , Larkin Bernard , Beach Carol , Clive Cornish , Dingle Danilo , Thomas Danny , Blake David , Baker Deane , Underwood Debbie , McLaren Dianne , Demagante Faye , Jennings Gaye , Jeff Helen , Mewburn Irene , Wooldridge Joy , Ellis Julianne , Widders Kass , Young Kay , McLaren Ken , Yew Ken , Ellis Melinda , Blake Michelle , Scholes-Robertson Nicole , Scholes-Robertson Neil , Grant Paul , Kennedy Paul , Walter Pauline , Yew Pauline , Jeff Raymond , Wooldridge William 
Published: January 2020

Abstract

Background
Fatigue is one of the most important symptoms among patients receiving dialysis and is nominated as a core outcome to be reported in all clinical trials in this setting. However, few trials of interventions targeting fatigue have been conducted. Patients historically have rarely been involved in the design of interventions, which can limit acceptability and uptake. When asked, they have indicated a preference for lifestyle interventions, such as exercise, to improve fatigue. While some research has focussed on intradialytic exercise for patients receiving haemodialysis, patients have also indicated a preference for a convenient method of exercising with guidance, but on their own time outside of dialysis hours. In response to this, a mobile phone application was proposed as the method of delivery for a home-based exercise intervention targeting fatigue.

Methods
We convened a workshop with five breakout group sessions in Australia, with 24 patients on dialysis (16 haemodialysis and 8 peritoneal dialysis) and 8 caregivers to identify, prioritize and discuss exercise interventions for fatigue in patients receiving dialysis and the delivery of this through a mobile application.

Results
Of the 21 types of exercise identified, the top-ranked were walking outdoors, walking on a treadmill and cardio and resistance training. Six themes were identified: (i) ‘an expectation of tangible gains from exercise’, including strengthening and protecting against bodily deterioration related to dialysis; (ii) ‘overcoming physical limitations’, meaning that comorbidities, baseline fatigue and fluctuating health needed to be addressed to engage in exercise; (iii) ‘fear of risks’, which reinforced the importance of safety and compatibility of exercise with dialysis; (iv) ‘realistic and achievable’ exercise, which would ensure initial readiness for uptake; (v) ‘enhancing motivation and interest’ , which expected to support sustained use of the exercise intervention and (vi) ‘ensuring usability of the mobile application’ , which would require simplicity, convenience and comprehensibility.

Conclusion
Exercise interventions that are expected by patients to improve health outcomes and that are safe, realistic and easy to adopt may be more acceptable to patients on dialysis.