BACKGROUND: Despite practice guidelines (KDOQI [Kidney Disease Outcomes Quality Initiative]) recommending regular assessment of physical function and encouragement of physical activity, few clinics in the United States objectively assess physical function/physical activity or provide recommendations for physical activity in their patient care. STUDY DESIGN: Qualitative methods were used to develop an understanding of practice patterns related to physical function assessment and physical activity encouragement by dialysis staff. SETTING & PARTICIPANTS: Data were collected in one outpatient university-based hemodialysis clinic. 15 patient care staff were interviewed and 6 patients were observed. METHODOLOGY: Semistructured interviews of patient care staff were conducted, along with nonparticipant observations of the clinic environment and operations and review of archival materials. ANALYTIC APPROACH: Coding of the interviews was descriptive, followed by interpretive coding by the research team. On-site field notes were transcribed for analysis. RESULTS: There was universal unawareness of the KDOQI guideline related to physical function/physical activity; however, all staff thought their patients would benefit from physical activity. There were no objective assessments of physical function and no resources or training to facilitate physical activity encouragement. Staff described deteriorating physical function in their patients, which was frustrating and disappointing. Barriers to physical activity included clinical/disease factors, staff "overaccommodation," and a system of dialysis care that facilitates sedentary behavior and does not require or incentivize clinics to promote physical activity. The patient care technicians were interested and thought that they had time to promote physical activity, but thought that they were unprepared to do so, indicating a need for education and training and a need to develop protocols to address the issue as routine practice. LIMITATIONS: This was a single university-based center; however, because hemodialysis procedures are prescribed by Centers for Medicare & Medicaid Services regulations, it is likely that practice in this clinic is representative of nationwide practice. CONCLUSIONS: Development of strategies to implement practice change that addresses low physical function and physical activity is warranted.