{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:54:46Z","timestamp":1781650486988,"version":"3.54.5"},"reference-count":66,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":40,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Res Involv Engagem"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Currently there is insufficient evidence to inform the co-design of an exercise intervention as part of a multimodal intervention for renal cachexia. Co-design is an effective approach in collaborating with service users, carers and healthcare professionals to identify acceptable methods of improving delivery of care. The aim of this study was to use a co-design process to adapt an exercise intervention for patients with or at risk of renal cachexia as part of a cRCT for a multimodal intervention (NCT07107087)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The objectives were as follows: (1) To co-design a strategy to promote optimal recruitment and adherence to an exercise intervention for those with or at risk of renal cachexia receiving HD, (2) To produce a conceptual model in relation to the implementation of an exercise intervention for this group. Using Bird and colleagues generative co-design framework for healthcare innovation, we adopted three stages of pre-design, co-design, and post-design. Accordingly, three workshops were conducted to correspond to each stage and the operational decisions recorded in seven steps to report the iterative design of the exercise intervention. The co-design workshops took place in November 2023 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), June 2024 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911) and February 2025 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096). Public co-design partners from Northern Ireland and England representing Kidney Care UK, Northern Ireland Kidney Patients Association and Northern Ireland Kidney Research Fund, participated in the workshops.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Contexts, intervention factors, mechanisms and outcomes which influence the uptake of, and adherence to, an exercise intervention within this patient population were identified. These included: the exercise intervention with an individualised and flexible approach; ensuring the exercise programme is manageable for patients receiving HD (session duration, timing and fistula awareness); ensuring the content of the exercise booklets is relatable and achievable (using household items rather than traditional exercise equipment and accrediting everyday activities as part of exercise log); providing support during the intervention (weekly telephone calls and progress tracking); and invitation to patients receiving HD considered most promising to encourage recruitment, sustain involvement and maximise impact from trusted healthcare professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Using the generative co-design framework for healthcare innovation, a conceptual model has been produced to promote optimal recruitment and adherence to an exercise intervention as part of a multimodal intervention for renal cachexia management in practice. This has informed component design, the wider implementation plan and evaluation design of a multimodal intervention for renal cachexia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40900-026-00875-8","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T07:39:04Z","timestamp":1776411544000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using a generative co-design framework to adapt an exercise intervention as part of a multimodal intervention for patients\u2019 receiving haemodialysis with or at risk of renal cachexia"],"prefix":"10.1186","volume":"12","author":[{"given":"Carolyn","family":"Blair","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Slee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"McKeaveney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander P.","family":"Maxwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faizan","family":"Awan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Carson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinead","family":"Comer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Davenport","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian","family":"Fogarty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Fouque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oonagh","family":"Gooding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"McKinley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Hutchinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamyar","family":"Kalantar-Zadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Magee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Mullan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Noble","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Porter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Seres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Shields","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Swaine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles D.","family":"Witham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Reid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"875_CR1","first-page":"507","volume-title":"Prevalence and clinical impact of cachexia in chronic illness in Europe, USA, and Japan: facts and numbers update 2016","author":"S von Haehling","year":"2016","unstructured":"von Haehling S, Anker MS, Anker SD. Prevalence and clinical impact of cachexia in chronic illness in Europe, USA, and Japan: facts and numbers update 2016. Wiley Online Library; 2016. 507\u201309."},{"issue":"3","key":"875_CR2","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1002\/jcsm.12421","volume":"10","author":"L Koppe","year":"2019","unstructured":"Koppe L, Fouque D, Kalantar-Zadeh K. Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers. J Cachexia, Sarcopenia Muscle. 2019;10(3):479\u201384. https:\/\/doi.org\/10.1002\/jcsm.12421.","journal-title":"J Cachexia, Sarcopenia Muscle"},{"key":"875_CR3","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.maturitas.2018.11.013","volume":"122","author":"D Sanchez-Rodriguez","year":"2019","unstructured":"Sanchez-Rodriguez D, Annweiler C, Cederholm T. A translational approach for the clinical application of recently updated definitions of malnutrition (GLIM) and sarcopenia (EWGSOP2). Maturitas. 2019;122:89\u201390. https:\/\/doi.org\/10.1016\/j.maturitas.2018.11.013.","journal-title":"Maturitas"},{"issue":"5","key":"875_CR4","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1177\/1758834017698643","volume":"9","author":"Z Aversa","year":"2017","unstructured":"Aversa Z, Costelli P, Muscaritoli M. Cancer-induced muscle wasting: latest findings in prevention and treatment. Ther Adv Med Oncol. 2017;9(5):369\u201382. https:\/\/doi.org\/10.1177\/1758834017698643.","journal-title":"Ther Adv Med Oncol"},{"issue":"3","key":"875_CR5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1097\/MCO.0000000000001022","volume":"27","author":"A Slee","year":"2024","unstructured":"Slee A, Reid J. Exercise and nutrition interventions for renal cachexia. Curr Opin Clin Nutr Metab Care. 2024;27(3):219\u201325. https:\/\/doi.org\/10.1097\/MCO.0000000000001022.","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"1","key":"875_CR6","doi-asserted-by":"publisher","first-page":"43","DOI":"10.21037\/apm.2018.12.08","volume":"8","author":"J Crawford","year":"2019","unstructured":"Crawford J. What are the criteria for response to cachexia treatment? Ann Palliat Med. 2019;8(1):43\u201349.","journal-title":"Ann Palliat Med"},{"key":"875_CR7","doi-asserted-by":"publisher","unstructured":"Reid J, Blair C, Dempster M, McKeaveney C, Slee A, Fitzsimons D. Multimodal interventions for cachexia management. Cochrane Database Syst Rev. 2025;3(3): CD015749. https:\/\/doi.org\/10.1002\/14651858.CD015749.pub2.","DOI":"10.1002\/14651858.CD015749.pub2"},{"issue":"2","key":"875_CR8","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1093\/advances\/nmaa111","volume":"12","author":"C McKeaveney","year":"2021","unstructured":"McKeaveney C, Maxwell P, Noble H, Reid J. A critical review of multimodal interventions for cachexia. Adv Nutr. 2021;12(2):523\u201332. https:\/\/doi.org\/10.1093\/advances\/nmaa111.","journal-title":"Adv Nutr"},{"issue":"6","key":"875_CR9","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1053\/j.jrn.2019.09.005","volume":"29","author":"K Kalantar-Zadeh","year":"2019","unstructured":"Kalantar-Zadeh K, Moore LW. Improving muscle strength and preventing Sarcopenia and cachexia in chronic Kidney disease and transplanted patients by physical activity and exercise. J Ren Nutr. 2019;29(6):465\u201366. https:\/\/doi.org\/10.1053\/j.jrn.2019.09.005.","journal-title":"J Ren Nutr"},{"issue":"8","key":"875_CR10","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1111\/sms.12714","volume":"26","author":"TJ Wilkinson","year":"2016","unstructured":"Wilkinson TJ, Shur NF, Smith AC. \u201cExercise as medicine\u201d in chronic kidney disease. Scand J Med Sci Sports. 2016;26(8):985\u201388. https:\/\/doi.org\/10.1111\/sms.12714","journal-title":"Scand J Med Sci Sports"},{"issue":"4","key":"875_CR11","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1002\/jcsm.12088","volume":"6","author":"SD Anker","year":"2015","unstructured":"Anker SD, Morley JE. Cachexia: a nutritional syndrome? J Cachexia, Sarcopenia Muscle. 2015;6(4):269\u201371. https:\/\/doi.org\/10.1002\/jcsm.12088.","journal-title":"J Cachexia, Sarcopenia Muscle"},{"issue":"8","key":"875_CR12","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1007\/s00421-013-2628-5","volume":"113","author":"EL Watson","year":"2013","unstructured":"Watson EL, Kosmadakis GC, Smith AC, Viana JL, Brown JR, Molyneux K, et al. Combined walking exercise and alkali therapy in patients with CKD4-5 regulates intramuscular free amino acid pools and ubiquitin E3 ligase expression. Eur J Appl Physiol. 2013;113(8):2111\u201324. https:\/\/doi.org\/10.1007\/s00421-013-2628-5.","journal-title":"Eur J Appl Physiol"},{"issue":"1","key":"875_CR13","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1186\/s12882-025-04057-8","volume":"26","author":"Y Rahbar Saadat","year":"2025","unstructured":"Rahbar Saadat Y, Abbasi A, Hejazian SS, Hekmatshoar Y, Ardalan M, Farnood F, et al. Combating chronic kidney disease-associated cachexia: a literature review of recent therapeutic approaches. BMC Nephrol. 2025;26(1):133. https:\/\/doi.org\/10.1186\/s12882-025-04057-8.","journal-title":"BMC Nephrol"},{"key":"875_CR14","doi-asserted-by":"crossref","unstructured":"Yoon M-S. mTOR as a key regulator in maintaining skeletal muscle mass. Frontiers in physiology. 2017 8:788.","DOI":"10.3389\/fphys.2017.00788"},{"key":"875_CR15","doi-asserted-by":"publisher","first-page":"111017","DOI":"10.1016\/j.exger.2020.111017","volume":"139","author":"SRG Moura","year":"2020","unstructured":"Moura SRG, Correa HL, Neves RVP, Santos CAR, Neto LSS, Silva VL, et al. Effects of resistance training on hepcidin levels and iron bioavailability in older individuals with end-stage renal disease: a randomized controlled trial. Exp Gerontol. 2020;139:111017. https:\/\/doi.org\/10.1016\/j.exger.2020.111017.","journal-title":"Exp Gerontol"},{"issue":"3","key":"875_CR16","doi-asserted-by":"publisher","first-page":"647","DOI":"10.3390\/ijms20030647","volume":"20","author":"ME Rubio-Ruiz","year":"2019","unstructured":"Rubio-Ruiz ME, Guarner-Lans V, Perez-Torres I, Soto ME. Mechanisms underlying metabolic syndrome-related Sarcopenia and possible therapeutic measures. Int J Mol Sci. 2019;20(3):647. https:\/\/doi.org\/10.3390\/ijms20030647.","journal-title":"Int J Mol Sci"},{"issue":"10","key":"875_CR17","doi-asserted-by":"publisher","first-page":"1919","DOI":"10.1093\/ndt\/gfaa174","volume":"36","author":"C McKeaveney","year":"2021","unstructured":"McKeaveney C, Slee A, Adamson G, Davenport A, Farrington K, Fouque D, et al. Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study. Nephrol Dial Transpl. 2021;36(10):1919\u201326. https:\/\/doi.org\/10.1093\/ndt\/gfaa174.","journal-title":"Nephrol Dial Transpl"},{"issue":"3","key":"875_CR18","doi-asserted-by":"publisher","first-page":"100092","DOI":"10.1016\/j.esmoop.2021.100092","volume":"6","author":"J Arends","year":"2021","unstructured":"Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P, et al. Cancer cachexia in adult patients: ESMO clinical practice Guidelines(\u2606). ESMO Open. 2021;6(3):100092. https:\/\/doi.org\/10.1016\/j.esmoop.2021.100092.","journal-title":"ESMO Open"},{"key":"875_CR19","doi-asserted-by":"publisher","unstructured":"Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO, 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4):S117\u2013314. https:\/\/doi.org\/10.1016\/j.kint.2023.10.018","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"875_CR20","doi-asserted-by":"publisher","unstructured":"Taryana AA, Krishnasamy R, Bohm C, Palmer SC, Wiebe N, Boudville N, et al. Physical activity for people with chronic kidney disease: an international survey of nephrologist practice patterns and research priorities. BMJ Open. 2019;9(12):e032322. https:\/\/doi.org\/10.1136\/bmjopen-2019-032322.","DOI":"10.1136\/bmjopen-2019-032322"},{"key":"875_CR21","doi-asserted-by":"publisher","unstructured":"Clyne N, Cupisti A, Grupp C, Kouidi E, Segura-Orti E, Provenzano PF, et al. Lack of physiotherapy resources restricts exercise prescription for patients with chronic kidney disease-the EUropean SUrvey on REnal EXercise (EUSUREX). Clin Kidney J. 2025;18(11):sfaf291. https:\/\/doi.org\/10.1093\/ckj\/sfaf291.","DOI":"10.1093\/ckj\/sfaf291"},{"issue":"5","key":"875_CR22","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1586\/17476348.2016.1157472","volume":"10","author":"J De Brandt","year":"2016","unstructured":"De Brandt J, Spruit MA, Derave W, Hansen D, Vanfleteren LE, Burtin C. Changes in structural and metabolic muscle characteristics following exercise-based interventions in patients with COPD: a systematic review. Expert Rev Respir Med. 2016;10(5):521\u201345. https:\/\/doi.org\/10.1586\/17476348.2016.1157472.","journal-title":"Expert Rev Respir Med"},{"key":"875_CR23","doi-asserted-by":"publisher","unstructured":"Grande AJ, Silva V, Sawaris Neto L, Teixeira Basmage JP, Peccin MS, Maddocks M. Exercise for cancer cachexia in adults. Cochrane Database Syst Rev. 2021;3(3):Cd010804. https:\/\/doi.org\/10.1002\/14651858.CD010804.pub3.","DOI":"10.1002\/14651858.CD010804.pub3"},{"issue":"9","key":"875_CR24","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1111\/nep.12752","volume":"21","author":"D Hristea","year":"2016","unstructured":"Hristea D, Deschamps T, Paris A, Lefrancois G, Collet V, Savoiu C, et al. Combining intra-dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: towards better quality of life and autonomy. Nephrol (Carlton). 2016;21(9):785\u201390. https:\/\/doi.org\/10.1111\/nep.12752.","journal-title":"Nephrol (Carlton)"},{"key":"875_CR25","doi-asserted-by":"crossref","unstructured":"Solheim TS, Laird BJ, Balstad TR, Stene GB, Baracos V, Bye A, et al. Results from a randomised, open-label trial of a multimodal intervention (exercise, nutrition and anti-inflammatory medication) plus standard care versus standard care alone to attenuate cachexia in patients with advanced cancer undergoing chemotherapy. Am Soc Clin Oncol. 2024.","DOI":"10.1200\/JCO.2024.42.17_suppl.LBA12007"},{"key":"875_CR26","doi-asserted-by":"publisher","unstructured":"Lambert K, Lightfoot CJ, Jegatheesan DK, Gabrys I, Bennett PN. Physical activity and exercise recommendations for people receiving dialysis: a scoping review. PLoS One. 2022;17(4):e0267290. https:\/\/doi.org\/10.1371\/journal.pone.0267290.","DOI":"10.1371\/journal.pone.0267290"},{"issue":"4","key":"875_CR27","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1159\/000502447","volume":"50","author":"M Huang","year":"2019","unstructured":"Huang M, Lv A, Wang J, Xu N, Ma G, Zhai Z, et al. Exercise training and outcomes in Hemodialysis patients: systematic review and Meta-analysis. Am J Nephrol. 2019;50(4):240\u201354. https:\/\/doi.org\/10.1159\/000502447.","journal-title":"Am J Nephrol"},{"key":"875_CR28","doi-asserted-by":"publisher","unstructured":"Greenwood SA, Young HML, Briggs J, Castle EM, Walklin C, Haggis L, et al. Evaluating the effect of a digital health intervention to enhance physical activity in people with chronic kidney disease (Kidney BEAM): a multicentre, randomised controlled trial in the UK. Lancet Digit Health. 2024;6(1):e23\u201332. https:\/\/doi.org\/10.1016\/S2589-7500(23)00204-2.","DOI":"10.1016\/S2589-7500(23)00204-2"},{"issue":"11","key":"875_CR29","doi-asserted-by":"publisher","first-page":"100720","DOI":"10.1016\/j.xkme.2023.100720","volume":"5","author":"M Jhamb","year":"2023","unstructured":"Jhamb M, Devaraj SM, Alemairi M, Lavenburg LM, Shiva S, Yabes JG, et al. A comprehensive exercise (COMEX) intervention to optimize exercise participation for improving patient-centered outcomes and physical functioning in patients receiving Hemodialysis: development and pilot testing. Kidney Med. 2023;5(11):100720. https:\/\/doi.org\/10.1016\/j.xkme.2023.100720.","journal-title":"Kidney Med"},{"issue":"3","key":"875_CR30","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1093\/ckj\/sfab239","volume":"15","author":"J Mayes","year":"2022","unstructured":"Mayes J, Billany RE, Vadaszy N, Young HML, Castle EM, Bishop NC, et al. The rapid development of a novel kidney-specific digital intervention for self-management of physical activity and emotional well-being during the COVID-19 pandemic and beyond: kidney Beam. Clin Kidney J. 2022;15(3):571\u201373. https:\/\/doi.org\/10.1093\/ckj\/sfab239.","journal-title":"Clin Kidney J"},{"issue":"4","key":"875_CR31","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1111\/hex.12888","volume":"22","author":"T Greenhalgh","year":"2019","unstructured":"Greenhalgh T, Hinton L, Finlay T, Macfarlane A, Fahy N, Clyde B, et al. Frameworks for supporting patient and public involvement in research: systematic review and co-design pilot. Health Expect. 2019;22(4):785\u2013801. https:\/\/doi.org\/10.1111\/hex.12888.","journal-title":"Health Expect"},{"issue":"1","key":"875_CR32","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40900-021-00252-7","volume":"7","author":"M Bird","year":"2021","unstructured":"Bird M, McGillion M, Chambers EM, Dix J, Fajardo CJ, Gilmour M, et al. A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework. Res Involv Engagem. 2021;7(1):12. https:\/\/doi.org\/10.1186\/s40900-021-00252-7.","journal-title":"Res Involv Engagem"},{"issue":"7","key":"875_CR33","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1136\/bmjqs-2015-004315","volume":"25","author":"M Batalden","year":"2016","unstructured":"Batalden M, Batalden P, Margolis P, Seid M, Armstrong G, Opipari-Arrigan L, et al. Coproduction of healthcare service. BMJ Qual Saf. 2016;25(7):509\u201317. https:\/\/doi.org\/10.1136\/bmjqs-2015-004315.","journal-title":"BMJ Qual Saf"},{"issue":"2","key":"875_CR34","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2752\/175630615X14212498964312","volume":"18","author":"S Donetto","year":"2015","unstructured":"Donetto S, Pierri P, Tsianakas V, Robert G. Experience-based Co-design and healthcare improvement: realizing Participatory design in the public sector. Des J. 2015;18(2):227\u201348. https:\/\/doi.org\/10.2752\/175630615X14212498964312.","journal-title":"Des J"},{"issue":"1","key":"875_CR35","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12961-020-0528-9","volume":"18","author":"P Slattery","year":"2020","unstructured":"Slattery P, Saeri AK, Bragge P. Research co-design in health: a rapid overview of reviews. Health Res Policy Syst. 2020;18(1):17. https:\/\/doi.org\/10.1186\/s12961-020-0528-9.","journal-title":"Health Res Policy Syst"},{"key":"875_CR36","doi-asserted-by":"publisher","unstructured":"Jolles MP, Fort MP, Glasgow RE. Aligning the planning, development, and implementation of complex interventions to local contexts with an equity focus: application of the PRISM\/RE-AIM framework. Int J Equity Health. 2024;23(1):41. https:\/\/doi.org\/10.1186\/s12939-024-02130-6.","DOI":"10.1186\/s12939-024-02130-6"},{"issue":"10","key":"875_CR37","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1136\/jech.2004.028662","volume":"60","author":"F Baum","year":"2006","unstructured":"Baum F, MacDougall C, Smith D. Participatory action research. J Epidemiol Community Health. 2006;60(10):854\u201357. https:\/\/doi.org\/10.1136\/jech.2004.028662.","journal-title":"J Epidemiol Community Health"},{"key":"875_CR38","doi-asserted-by":"crossref","unstructured":"Viswanathan M, Ammerman A, Eng E, Garlehner G, Lohr KN, Griffith D, et al. Community-based participatory research: assessing the evidence: summary. AHRQ Evidence Report Summaries. 2004.","DOI":"10.1037\/e439622005-001"},{"key":"875_CR39","first-page":"1","volume-title":"What is community-based participatory research? Community-based Participatory research for improved mental healthcare: a manual for clinicians and researchers","author":"LW Roberts","year":"2012","unstructured":"Roberts LW. What is community-based participatory research? Community-based Participatory research for improved mental healthcare: a manual for clinicians and researchers. Springer; 2012. p. 1\u20139."},{"key":"875_CR40","doi-asserted-by":"publisher","unstructured":"Reid J, Blair C, Slee A, McKeaveney C, Maxwell AP, Adell V, et al. Multi-modal integrated intervention combining exercise, anti-inflammatory, and dietary advice (MMIEAD) for adults with kidney cachexia: protocol for a mixed-methods feasibility cluster randomised controlled trial and process evaluation. Pilot Feasibility Stud. 2026. https:\/\/doi.org\/10.1186\/s40814-026-01784-z42.","DOI":"10.1186\/s40814-026-01784-z42"},{"issue":"1357","key":"875_CR41","first-page":"76","volume":"125","author":"H Boyd","year":"2012","unstructured":"Boyd H, McKernon S, Mullin B, Old A. Improving healthcare through the use of co-design. N Z Med J. 2012;125(1357):76\u201387. PMID: 22854362.","journal-title":"N Z Med J"},{"key":"875_CR42","doi-asserted-by":"publisher","unstructured":"Iniesto F, Littlejohn A, Charitonos K. A review of research with co-design methods in health education. Open Educ Stud. 2022. https:\/\/doi.org\/10.1515\/edu-2022-0017","DOI":"10.1515\/edu-2022-0017"},{"issue":"15","key":"875_CR43","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1001\/jama.2014.11100","volume":"312","author":"L Frank","year":"2014","unstructured":"Frank L, Basch E, Selby JV. Patient-centered outcomes research I. The PCORI perspective on patient-centered outcomes research. JAMA. 2014;312(15):1513\u201314. https:\/\/doi.org\/10.1001\/jama.2014.11100.","journal-title":"JAMA"},{"key":"875_CR44","doi-asserted-by":"publisher","DOI":"10.1017\/9781009237024","volume-title":"Co-producing and co-designing","author":"G Robert","year":"2022","unstructured":"Robert G, Locock L, Williams O, Cornwell J, Donetto S, Goodrich J. Co-producing and co-designing. Cambridge University Press; 2022."},{"issue":"3","key":"875_CR45","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1177\/0170840607088020","volume":"29","author":"D Denyer","year":"2008","unstructured":"Denyer D, Tranfield D, van Aken JE. Developing design propositions through research synthesis. Organ Stud. 2008;29(3):393\u2013413. https:\/\/doi.org\/10.1177\/0170840607088020.","journal-title":"Organ Stud"},{"issue":"7","key":"875_CR46","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1007\/s00520-023-07894-1","volume":"31","author":"M Brown","year":"2023","unstructured":"Brown M, Murphy MH, McAneney H, McBride K, Crawford F, Cole A, et al. Feasibility of home-based exercise training during adjuvant treatment for metastatic castrate-resistant prostate cancer patients treated with an androgen receptor pathway inhibitor (EXACT). Support Care Cancer. 2023;31(7):442. https:\/\/doi.org\/10.1007\/s00520-023-07894-1.","journal-title":"Support Care Cancer"},{"issue":"4","key":"875_CR47","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1681\/asn.2016030378","volume":"28","author":"F Manfredini","year":"2017","unstructured":"Manfredini F, Mallamaci F, D\u2019Arrigo G, Baggetta R, Bolignano D, Torino C, et al. Exercise in patients on dialysis: a multicenter, randomized clinical trial. J Am Soc Nephrol. 2017;28(4):1259\u201368. https:\/\/doi.org\/10.1681\/asn.2016030378.","journal-title":"J Am Soc Nephrol"},{"issue":"8","key":"875_CR48","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.2215\/cjn.03160322","volume":"17","author":"F Mallamaci","year":"2022","unstructured":"Mallamaci F, D\u2019Arrigo G, Tripepi G, Lamberti N, Torino C, Manfredini F, et al. Long-Term effect of physical exercise on the risk for hospitalization and death in dialysis patients: a post-trial Long-Term observational study. Clin J Am Soc Nephrol. 2022;17(8):1176\u201382. https:\/\/doi.org\/10.2215\/cjn.03160322.","journal-title":"Clin J Am Soc Nephrol"},{"issue":"6","key":"875_CR49","doi-asserted-by":"publisher","first-page":"1621","DOI":"10.1002\/jcsm.12791","volume":"12","author":"H Noor","year":"2021","unstructured":"Noor H, Reid J, Slee A. Resistance exercise and nutritional interventions for augmenting sarcopenia outcomes in chronic kidney disease: a narrative review. J Cachexia, Sarcopenia Muscle. 2021;12(6):1621\u201340. https:\/\/doi.org\/10.1002\/jcsm.12791.","journal-title":"J Cachexia, Sarcopenia Muscle"},{"key":"875_CR50","doi-asserted-by":"publisher","unstructured":"Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, et al. A new framework for developing and evaluating complex interventions: update of Medical research Council guidance. BMJ. 2021;374:n2061. https:\/\/doi.org\/10.1136\/bmj.n2061.","DOI":"10.1136\/bmj.n2061"},{"key":"875_CR51","doi-asserted-by":"crossref","unstructured":"Blair C, Slee A, Davenport A, Fouque D, Johnston W, Kalantar-Zadeh K, et al. editors. Developing an evidence and theory based multimodal integrative intervention for the management of renal cachexia: a theory of change. In: Healthcare. Multidisciplinary Digital Publishing Institute; 2022.","DOI":"10.3390\/healthcare10122344"},{"key":"875_CR52","doi-asserted-by":"publisher","first-page":"112376","DOI":"10.1016\/j.psychres.2019.04.025","volume":"283","author":"MS Bauer","year":"2020","unstructured":"Bauer MS, Kirchner J. Implementation science: what is it and why should I care? Psychiatry Res. 2020;283:112376. https:\/\/doi.org\/10.1016\/j.psychres.2019.04.025.","journal-title":"Psychiatry Res"},{"issue":"7","key":"875_CR53","doi-asserted-by":"publisher","first-page":"2371","DOI":"10.1007\/s00520-019-04749-6","volume":"27","author":"CC Hall","year":"2019","unstructured":"Hall CC, Cook J, Maddocks M, Skipworth RJE, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer. 2019;27(7):2371\u201384. https:\/\/doi.org\/10.1007\/s00520-019-04749-6.","journal-title":"Support Care Cancer"},{"issue":"1","key":"875_CR54","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1177\/08968608211055290","volume":"42","author":"PN Bennett","year":"2022","unstructured":"Bennett PN, Bohm C, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, et al. Physical activity and exercise in peritoneal dialysis: International Society for peritoneal dialysis and the global renal exercise Network practice recommendations. Perit Dial Int. 2022;42(1):8\u201324. https:\/\/doi.org\/10.1177\/08968608211055290.","journal-title":"Perit Dial Int"},{"issue":"8","key":"875_CR55","doi-asserted-by":"publisher","first-page":"2159","DOI":"10.1016\/j.ekir.2021.05.034","volume":"6","author":"SA Greenwood","year":"2021","unstructured":"Greenwood SA, Koufaki P, Macdonald JH, Bhandari S, Burton JO, Dasgupta I, et al. Randomized trial-PrEscription of intraDialytic exercise to improve quAlity of life in patients receiving Hemodialysis. Kidney Int Rep. 2021;6(8):2159\u201370. https:\/\/doi.org\/10.1016\/j.ekir.2021.05.034.","journal-title":"Kidney Int Rep"},{"issue":"6","key":"875_CR56","doi-asserted-by":"publisher","first-page":"1478","DOI":"10.1016\/j.kint.2021.02.027","volume":"99","author":"MPM Graham-Brown","year":"2021","unstructured":"Graham-Brown MPM, March DS, Young R, Highton PJ, Young HML, Churchward DR, et al. A randomized controlled trial to investigate the effects of intra-dialytic cycling on left ventricular mass. Kidney Int. 2021;99(6):1478\u201386. https:\/\/doi.org\/10.1016\/j.kint.2021.02.027.","journal-title":"Kidney Int"},{"key":"875_CR57","doi-asserted-by":"publisher","unstructured":"Anding-Rost K, von Gersdorff G, von Korn P, Ihorst G, Josef A, Kaufmann M, et al. Exercise during Hemodialysis in patients with chronic Kidney failure. NEJM Evid. 2023;2(9):EVIDoa2300057. https:\/\/doi.org\/10.1056\/EVIDoa2300057.","DOI":"10.1056\/EVIDoa2300057"},{"key":"875_CR58","doi-asserted-by":"publisher","unstructured":"Ng KP, Macdonald JH, Young R, March DS, Graham-Brown MPM, Mercer TH, et al. Body composition and intradialytic exercise in kidney disease: a combined analysis of the PEDAL and CYCLE-HD randomised controlled trials. J Cachexia, Sarcopenia Muscle. 2025;16(2):e13748. https:\/\/doi.org\/10.1002\/jcsm.13748.","DOI":"10.1002\/jcsm.13748"},{"issue":"2","key":"875_CR59","doi-asserted-by":"publisher","first-page":"268","DOI":"10.2215\/CJN.09700818","volume":"14","author":"D Moorman","year":"2019","unstructured":"Moorman D, Suri R, Hiremath S, Jegatheswaran J, Kumar T, Bugeja A, et al. Benefits and Barriers to and desired outcomes with exercise in patients with ESKD. Clin J Am Soc Nephrol. 2019;14(2):268\u201376. https:\/\/doi.org\/10.2215\/CJN.09700818.","journal-title":"Clin J Am Soc Nephrol"},{"key":"875_CR60","doi-asserted-by":"publisher","unstructured":"Clarkson MJ, Bennett PN, Fraser SF, Warmington SA. Exercise interventions for improving objective physical function in patients with end-stage kidney disease on dialysis: a systematic review and meta-analysis. Am J Physiol Renal Physiol. 2019;316(5):F856\u201372. https:\/\/doi.org\/10.1152\/ajprenal.00317.2018.","DOI":"10.1152\/ajprenal.00317.2018"},{"key":"875_CR61","doi-asserted-by":"publisher","first-page":"1573498","DOI":"10.3389\/fmed.2025.1573498","volume":"12","author":"H Liu","year":"2025","unstructured":"Liu H, Zhang M, Chen M, Chen L, Huang T, Ye Z. Meta-analysis of the effects of exercise interventions on dialysis patients with cardiac function disorders. Front Med (Lausanne). 2025;12:1573498. https:\/\/doi.org\/10.3389\/fmed.2025.1573498.","journal-title":"Front Med (Lausanne)"},{"key":"875_CR62","doi-asserted-by":"publisher","unstructured":"Bernier-Jean A, Beruni NA, Bondonno NP, Williams G, Teixeira-Pinto A, Craig JC, et al. Exercise training for adults undergoing maintenance dialysis. Cochrane Database Syst Rev. 2022;1(1):Cd014653. https:\/\/doi.org\/10.1002\/14651858.Cd014653.","DOI":"10.1002\/14651858.Cd014653"},{"issue":"12","key":"875_CR63","doi-asserted-by":"publisher","first-page":"4679","DOI":"10.1111\/jan.14960","volume":"77","author":"T Li","year":"2021","unstructured":"Li T, Lv A, Xu N, Huang M, Su Y, Zhang B, et al. Barriers and facilitators to exercise in haemodialysis patients: a systematic review of qualitative studies. J Adv Nurs. 2021;77(12):4679\u201392. https:\/\/doi.org\/10.1111\/jan.14960.","journal-title":"J Adv Nurs"},{"issue":"4","key":"875_CR64","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1002\/jcsm.12083","volume":"6","author":"K Fearon","year":"2015","unstructured":"Fearon K, Argiles JM, Baracos VE, Bernabei R, Coats A, Crawford J, et al. Request for regulatory guidance for cancer cachexia intervention trials. J Cachexia, Sarcopenia Muscle. 2015;6(4):272\u201374. https:\/\/doi.org\/10.1002\/jcsm.12083.","journal-title":"J Cachexia, Sarcopenia Muscle"},{"issue":"3","key":"875_CR65","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1002\/nur.10088","volume":"26","author":"S Ward","year":"2003","unstructured":"Ward S, Donovan HS, Serlin RC. An alternative view on \u201can alternative paradigm\u201d. Res Nurs Health. 2003;26(3):256. PMCID: PMC2526466 NIHMSID: NIHMS63468 PMID: 12754733.","journal-title":"Res Nurs Health"},{"key":"875_CR66","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1186\/1745-6215-15-267","volume":"15","author":"MJ De Silva","year":"2014","unstructured":"De Silva MJ, Breuer E, Lee L, Asher L, Chowdhary N, Lund C, et al. Theory of change: a theory-driven approach to enhance the medical research council\u2019s framework for complex interventions. Trials. 2014;15:267. https:\/\/doi.org\/10.1186\/1745-6215-15-267.","journal-title":"Trials"}],"container-title":["Research Involvement and Engagement"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40900-026-00875-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40900-026-00875-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40900-026-00875-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:16:08Z","timestamp":1781648168000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40900-026-00875-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":66,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["875"],"URL":"https:\/\/doi.org\/10.1186\/s40900-026-00875-8","relation":{},"ISSN":["2056-7529"],"issn-type":[{"value":"2056-7529","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]},"assertion":[{"value":"20 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"As a patient and patient public involvement and engagement (PPI) initiative ethical approval was not required, as confirmed by Queen\u2019s University Belfast Research Governance Department. All contributors to the co-design workshop gave their verbal consent to participate, they also confirmed via email that they were willing to engage in the co-design workshops.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"73"}}