Using behavioural theory to explore barriers and facilitators to physical activity in haemodialysis patients: an updated systematic review of qualitative evidence

Background Physical activity (PA) improves health indicators for people receiving haemodialysis; however, participation remains low, and PA provision in routine care is inconsistent, despite recommendations from clinical practice guidelines. This review updates and integrates existing evidence on the attitudes towards PA and applies behaviour change theory to move beyond feasibility and identify components that support sustainable integration into routine clinical care.Methods Five databases were systematically searched for studies reporting qualitative data on barriers and/or facilitators to PA (or its delivery) for adults undergoing maintenance haemodialysis and staff facilitating and observing. The findings were mapped to the Theoretical Domains Framework (TDF) and linked Capability, Opportunity, Motivation (COM-B) components, with candidate intervention functions identified through the Behaviour Change Wheel. A frequency analysis identified prominent domains from staff and patient data, and inductive thematic analysis within TDF domains identified barrier and facilitator themes.Results Seventeen papers met the inclusion criteria. There were similarities in prominent TDF domains and themes between patient and staff data, and all areas of the COM-B were implicated as relevant. While all nine Behaviour Change Wheel intervention functions were identified, the APEASE-based assessment highlighted training, environmental restructuring, education, modelling, and enablement as the most feasible and relevant, with illustrative behaviour change techniques provided to support translation into practice.Conclusion These findings identify areas of congruence in perceptions of barriers and facilitators across staff and patient groups, as well as key areas to consider when developing future interventions. Addressing these areas through the proposed intervention functions may enhance participation in PA and support sustained behaviour change.