Facilitators and barriers to health enhancing physical activity in individuals with severe functional limitations after stroke: A qualitative study

Abstract

BackgroundPatients with chronic conditions are less physically active than the general population despite knowledge of positive effects on physical and mental health. There is a variety of reasons preventing people with disabilities from achieving levels of physical activities resulting in health benefits. However, less is known about potential facilitators and barriers for physical activity (PA) in people with severe movement impairments. The aim of this study was to identify obstacles and facilitators of PA in individuals with severe disabilities.Materials and methodsUsing a qualitative approach to explore individuals’ subjective perspectives in depth, five community-dwelling adults (age 52–72, 2 female, 3 male) living with chronic mobility impairments after stroke that restrict independent PA were interviewed. A semi structured topic guide based on the theoretical domains framework was utilized. The interview data was analyzed thematically, and the theoretical domains framework constructs were mapped onto the main and sub-categories.ResultsThe six main categories of facilitators and barriers along the capability, opportunity, motivation–behavior (COM-B) framework were: (1) physical capabilities, (2) psychological capabilities, (3) motivation reflective, (4) motivation automatic, (5) opportunity physical, and (6) opportunity social. The physical capabilities to independently perform PA were variable between participants but were not necessarily perceived as a barrier. Participants were highly motivated to maintain and/or increase their abilities to master their everyday lives as independently as possible. It became clear that a lack of physical opportunities, such as having access to adequate training facilities can present a barrier. Social opportunities in the form of social support, social norms, or comparisons with others can act as both facilitators and barriers.ConclusionWhile confirming known barriers and facilitators that impact the ability of individuals with functional limitations to be active, the findings highlight the need and opportunities for comprehensive service models based on interdisciplinary collaborations.

Development and internal validation of two prediction models of walking dependence and restricted walking speed in individuals with subacute stroke

“…Previous qualitative studies suggest that stroke survivors could reduce sedentary behavior if they receive appropriate support from service staff and caregivers [42]. A lack of physical opportunities, such as having access to adequate training facilities, can present a barrier to reducing sedentary behavior [43]. Therefore, for patients who are predicted to be walking-dependent at discharge, engaging with them in a way that encourages activity, including measures taken to promote family education and service coordination, will be necessary during hospitalization.…”

Reduced physical activity level was associated with poorer quality of life during the early phase of the COVID-19 pandemic: a sub-study of the last-long trial

“…The lockdown during the COVID-19 pandemic in Norway has been shown to be associated with less physical activity in older adults ( 3 , 4 ) and increased sedentary behaviour in people with cardiovascular diseases ( 5 ). Even before the pandemic, people with stroke were less active than their healthy counterparts ( 6 , 7 ). The most common barriers to physical activity after stroke are lack of motivation, physical or cognitive disability, and fear of another stroke, while social support is reported to be a significant motivator ( 7 , 8 ).…”

“…Even before the pandemic, people with stroke were less active than their healthy counterparts ( 6 , 7 ). The most common barriers to physical activity after stroke are lack of motivation, physical or cognitive disability, and fear of another stroke, while social support is reported to be a significant motivator ( 7 , 8 ). Hence, it is likely that the stroke population is at increased risk of reducing their physical activity levels even more than the general population, due to COVID-19 restrictions.…”