Barriers and Facilitators to Exercise Among Stroke Survivors

Damush, Teresa M.; Plue, Laurie; Bakas, Tamilyn; Schmid, Arlene A.; Williams, Linda S.

doi:10.1002/j.2048-7940.2007.tb00183.x

Cited by 167 publications

(197 citation statements)

References 47 publications

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“…185 The most commonly reported barriers were environmental (access, transport, cost), health problems, stroke-related impairments, embarrassment, and fear of recurrent strokes. 40,62,[186][187][188] Lack of knowledge about how and where to exercise and about the potential benefits of exercise 40 and lack of motivation were also found to be barriers. 40,186 The most commonly reported motivator was the possibility of meeting other stroke survivors, thus providing psychological and social support, 62,[186][187][188] and the benefit of professional support in guiding and facilitating physical activity.…”

Section: Motivators and Barriers To Physical Activity And Exercise Trmentioning

confidence: 99%

Physical Activity and Exercise Recommendations for Stroke Survivors

Billinger¹,

Arena

Bernhardt³

et al. 2014

Stroke

1,072

623

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2532Purpose-This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and indicate gaps in current knowledge. Results-Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence. Conclusions-The recommendation from this writing group is that physical activity and exercise prescription should be incorporated into the management of stroke survivors. The promotion of physical activity in stroke survivors should emphasize low-to moderate-intensity aerobic activity, muscle-strengthening activity, reduction of sedentary behavior, and risk management for secondary prevention of stroke. (Stroke. 2014;45:2532-2553.)

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Section: Motivators and Barriers To Physical Activity And Exercise Trmentioning

confidence: 99%

Physical Activity and Exercise Recommendations for Stroke Survivors

Billinger¹,

Arena

Bernhardt³

et al. 2014

Stroke

1,072

623

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“…Stroke survivors experience many barriers to exercise 37,38 and an important research need is finding effective ways for people with stroke to engage in community exercise. The study has several limitations.…”

Section: Chen and Rimmermentioning

confidence: 99%

Effects of Exercise on Quality of Life in Stroke Survivors

Chen

Rimmer

2011

Stroke

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Background and Purpose-One of the major consequences after stroke is the deterioration in health-related quality of life (HRQOL). Three previous systematic reviews indicated that exercise has limited to no effect in improving HRQOL in stroke survivors. The objective of this meta-analysis was to update the evidence on exercise and HRQOL in stroke survivors with additional new information on randomized controlled trials that have been published since these 3 previous reviews. Methods-MEDLINE, Cumulated Index to Nursing and Allied Health Literature, EMBASE, and SportsDiscus databases were searched for randomized controlled trials reporting the effects of exercise on HRQOL in stroke survivors from 1950 to March 2010. The methodological quality of each study was appraised using the Physiotherapy Evidence Database scale. Standardized mean difference was used to compute effect size and subgroup analysis was conducted to test the consistency of results across the subgroups with different characteristics. Results-A total of 1101 citations was identified and 9 studies met all criteria for a total sample of 426 stroke survivors.Eight studies were rated as good quality (ie, Physiotherapy Evidence Database scale Ն5). This meta-analysis provided evidence that exercise can have a small to medium effect on HRQOL outcomes (standardized mean difference, 0.32, PϽ0.01) at postintervention but not at follow-up after exercise was terminated (standardized mean difference, 0.17, Pϭ0.12). No adverse events related to exercise were reported. Conclusions-The results provide moderate support for the use of exercise to improve HRQOL in stroke survivors. However, the challenge for researchers is identifying effective strategies for sustaining these effects postintervention. (Stroke. 2011;42:832-837.)Key Words: exercise Ⅲ meta-analysis Ⅲ quality of life Ⅲ stroke Ⅲ systematic review S troke survivors report a poorer health-related quality of life (HRQOL) compared with the general population. 1-3 Although HRQOL is a multidimensional concept, it is usually measured by physical or mental attributes associated with overall health status. 4,5 For stroke survivors, the physical attributes of HRQOL include the interference they perceive in performing physical activities such as the ability to walk 1 block or by responses to pain levels associated with performing activities (eg, work outside the home and housework), 4,5 and mental attributes are often measured by the perception of subjective feelings of interference in participating in social activities. 4,5 Exercise may offset some of the decline in HRQOL in stroke survivors by (1) reducing secondary conditions such depression and pain; and/or (2) improving overall physical fitness, which leads to higher levels of physical function (eg, greater self-efficacy in performing activities of daily living). 6 The dozen or so systematic reviews that have been published on the effects of exercise in stroke survivors [7][8][9][10][11][12][13][14][15][16][17][18][19] have focused almost entirely on phys...

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“…5 Using the de-identified interview transcripts, at least two investigators independently summarized and coded open-ended questions. We independently reviewed and coded transcripts by assigning labels and codes to data segments.…”

Section: Analysesmentioning

confidence: 99%

National Implementation of Acute Stroke Care Centers in the Veterans Health Administration (VHA): Formative Evaluation of the Field Response

et al. 2014

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BACKGROUND:In 2011, the Veterans Health Administration (VHA) released the Acute Ischemic Stroke (AIS) Directive, which mandated reorganization of acute stroke care, including self-designation of stroke centers as Primary (P), Limited Hours (LH), or Supporting (S). OBJECTIVES: In partnership with the VHA Offices of Emergency Medicine and Specialty Care Services, the VA Stroke QUERI conducted a formative evaluation in a national sample of three levels of stroke centers in order to understand barriers and facilitators. DESIGN AND APPROACH: The evaluation consisted of a mixed-methods assessment that included a qualitative assessment of data from semi-structured interviews with key informants and a quantitative assessment of stroke quality-of-care data reporting practices by facility characteristics. PARTICIPANTS: The final sample included 38 facilities (84 % participation rate): nine P, 24 LH, and five S facilities. In total, we interviewed 107 clinicians and 16 regional Veterans Integrated Service Network (VISN) leaders. RESULTS: Across all three levels of stroke centers, stroke teams identified the specific need for systematic nurse training to triage and initiate stroke protocols. The most frequently reported barriers centered around quality-ofcare data collection. A low number of eligible veterans arriving at the VAMC in a timely manner was another major impediment. The LH and S facilities reported some unique barriers: access to radiology and neurology services; EMS diverting stroke patients to nearby stroke centers, maintaining staff competency, and a lack of stroke clinical champions. Solutions that were applied included developing stroke order sets and templates to provide systematic decision support, implementing a stroke code in the facility for a coordinated response to stroke, and staff resource allocation and training. Data reporting by facility evaluation demonstrated that categorizing site volume did indicate a lower likelihood of reporting among VAMCs with 25-49 acute stroke admissions per year. CONCLUSIONS: The AIS Directive brought focused attention to reorganizing stroke care across a wide range of facility types. Larger VA facilities tended to follow established practices for organizing stroke care, but the unique addition of the LH designation presented some challenges. S facilities tended to report a lack of a coordinated stroke team and champion to drive process changes.

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Barriers and Facilitators to Exercise Among Stroke Survivors

Cited by 167 publications

References 47 publications

Physical Activity and Exercise Recommendations for Stroke Survivors

Physical Activity and Exercise Recommendations for Stroke Survivors

Effects of Exercise on Quality of Life in Stroke Survivors

National Implementation of Acute Stroke Care Centers in the Veterans Health Administration (VHA): Formative Evaluation of the Field Response

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