Development of an Exercise Intervention Program During Dialysis for Patients on Maintenance Hemodialysis Based on the Health Belief Model

OBJECTIVE: This study aims to develop an exercise intervention program for maintenance hemodialysis patients during dialysis based on the Health Belief Model, providing a scientific reference for the implementation and clinical guidance of intradialytic exercise interventions. METHODS: Guided by the evidence pyramid model, a comprehensive computer-based search was conducted to identify literature related to intradialytic exercise in maintenance hemodialysis patients. The search covered publications from database inception to October 2023. The quality of the included studies was assessed using a standardized literature quality evaluation system. Based on the Health Belief Model, the available evidence was synthesized to formulate a preliminary exercise intervention program, which was subsequently refined through expert consultation to establish the final intervention program for maintenance hemodialysis patients during dialysis. RESULTS: A total of 15 eligible studies were included, consisting of 1 clinical decision, 2 guidelines, 3 expert consensus statements, and 9 systematic reviews. The evidence was summarized into five key domains: the necessity of exercise, pre-exercise preparation, exercise prescription, exercise monitoring, and exercise support. Following expert consultation, the final exercise intervention program was established, comprising 5 first-level items, 15 second-level items, and 44 third-level items. CONCLUSION: The evidence-based summary of intradialytic exercise for maintenance hemodialysis patients, developed within the Health Belief Model framework, demonstrates strong scientific validity and practical applicability. This program provides a reliable foundation for future implementation and clinical guidance of exercise interventions during dialysis, while also promoting patients' voluntary participation in healthy exercise behaviors and improving exercise adherence. Nursing managers can use this exercise intervention as a foundation to develop unit-specific standardized protocols and incentive systems for intradialytic exercise. They should integrate exercise intervention into nurses' routine duties and organize targeted training programs. Additionally, establishing quality monitoring indicators will help promote the sustainable implementation of intradialytic exercise.