Exploring perceived barriers and facilitators of exercise after stroke: a multi-perspective study (preprint)

ABSTRACT

Purpose: Many stroke survivors adopt or return to a sedentary lifestyle after stroke. This sedentarism, in turn, impacts on quality of life, physical function, and puts survivors at a significantly greater risk of another stroke, developing dementia, or chronic illness. There is little known about the barriers and facilitators of exercise after stroke and what could be done to minimise the effects of barriers and to build on facilitators of exercise. The aim of this study was to explore the barriers and facilitators of exercise after stroke from the perspective of stroke survivors, family caregivers, physiotherapists and occupational therapists. Methods: Semi-structured phone interviews with 13 stroke survivors, 8 family caregivers and 13 therapists (one focus group consisting of 4 therapists), exploring perceived barriers and facilitators to exercise after stroke were completed. Data were analysed using thematic analysis. Demographic information including current physical activity levels, stroke impact, and physical and mental fatigue were also collected. The themes generated were subsequently mapped onto the Theoretical Domains Framework to gain a deeper understanding of the factors that influence exercise behaviour and help identify appropriate techniques to address perceived barriers. Results: TDF domains that were perceived by all three groups were knowledge, beliefs about capabilities, beliefs about consequences, goals, memory attention and decision processes, environmental context and resources, social influences and emotion. The most reported TDF domains were environmental context and resources, social influences, emotion and beliefs about capabilities. The most common barriers that were perceived by all three groups were covid restrictions, access to services, lack of professional support, physical capability and fatigue. The most common facilitators that were perceived by all three groups were greater access to services and facilities, social support from others and group exercise programmes. Conclusions: Perceptions of the barriers and facilitators of exercise differ across stroke survivors, therapists and caregivers. It is vital that stroke services address the barriers to exercise after stroke and building on the facilitators to ensure that survivors receive optimal post-stroke care.