The Importance of Psychological and Social Factors in Influencing the Uptake and Maintenance of Physical Activity after Stroke: A Structured Review of the Empirical Literature
Table 9
Details of the quantitative studies included in the review regarding: method, participants, setting, summary of findings pertinent to psychological and social factors, and notes regarding theoretical models.
Survey: barriers to physical activity and disability survey
54.2 (8.2) 30 M, 70 F not reported
USA Health promotion programme
Psychological: competence: not knowing how and where to exercise main personal barriers to exercise, reported by 46% and 44% of participants. Motivation: lack of motivation ranked 4th personal barrier by (37%) of participants. Too lazy to exercise ranked 6th personal barrier by 33% of participants. Beliefs: 36% reported belief that exercise will not improve condition Social: importance of exercise professionals: personal trainer or exercise instructor unable to help reported by 36% of participants
No theoretical model used to underpin questionnaire or findings
people with stroke 40 F, 35 M Age not reported family members/friends 71 F, 29 M
Ireland Hospital physiotherapy services
Social: 91% of respondents with stroke believed that family member/friend had a role in assisting them with exercise after rehabilitation. 99% of family members/friends reported they would be willing to help with exercise after rehabilitation
No theoretical model used to underpin questionnaire or findings Not clear how questionnaire was developed. Validity and reliability not reported
Survey using the Short Self-Efficacy for Exercise Scale and the Short Outcome Expectations for Exercise Scale
Age 62.9 (11.7) F 177, M 127 60.2 months after stroke
USA Mailed survey distributed via the National Stroke Association
Psychological: self-efficacy, outcome expectations, exercise behaviour before stroke, and physician advice to exercise significantly associated with exercise behaviour. These variables predicted 33% of variance in exercise behaviour. Older participants and those experiencing fatigue had lower self-efficacy for exercise. Exercise history also significantly predicted exercise behaviour
Low response rate from national survey, attended stroke support groups therefore likely to be motivated
Longitudinal survey assessing outcomes at 10–20 days, one month after discharge, and six months after discharge Measures: (i) the recovery locus of control scale (ii) Exercise coping self-rating for frequency and duration (iii) HADS (iv) Barthel Index (v) Observer assessed disability
Age 69.4 years 35 F, 36 M 10–20 days after stroke to 6 months after stroke
Scotland Acute inpatients followed up after discharge
Psychological: perceived control predicts recovery from disability after stroke. Frequency of exercise not correlated with one month recovery locus of control (), nor with observer assessed recovery at 6 months (), suggests that exercise not a coping response that medicates between control cognitions and recovery
Amount of explained variance is small Some measures designed for the study—validity and reliability not tested fully
Survey National cross-sectional survey of individuals with disability Stage of change algorithm to assess stage, process of change measure, self-efficacy scale, decisional balance scale, and exercise barriers scale
52.5 (13.9) years 62% F Disabled population Stroke:
USA Recruitment by targeting voluntary organisations and hospitals
Psychological: transtheoretical model used to examine what constructs associated with stages. All major constructs associated with the stages of change. Largest portion of variance derived from behavioural processes of change and self-efficacy. Cognitive processes decrease and behavioural processes increase with stage progression. Cons decrease and pros increase with stage progression, self-efficacy increases with stage progression Social: helping relationships significantly associated with stage
Stroke participants formed only small proportion of sample therefore generalisation difficult Unable to extract specific data about behavioural processes and cognitive processes used
Survey Physical activity Social support Environmental factors Impairment and functioning (SF-36 physical functioning and role limitations) Psychological factors (SF36 mental health, role functioning emotional, self-efficacy) Social factors CHART short form and MOS social support survey
47.1 (10.1) years 386 F Stroke (6.5%)
USA National survey recruitment via disability service organisations and print and broadcast media
Psychological: self-efficacy highest for gentle flexibility, lowest for aerobic exercise 3 × per week. Physical activity significantly correlated with self-efficacy (, ) Model predicted 33.5% of variance. Self-efficacy predicts greater involvement in physical activity, pain and duration of disability predictive of less physical activity (; ) Social: physical activity significantly correlated with level of personal assistance (, )
Physically active population with 73% engaging in physical activity once a week. Self-report of physical activity Disabled sample, self-selected, and few people with stroke
Survey Sickness Impact Scale Stage of change Self-rated abilities for health: self-efficacy and outcome expectancy Barriers to health Activities for disabled persons
Age 47 (1.4 ) years Stroke 7% of sample
USA Community dwelling, recruited via disability support groups
Psychological: self-efficacy significantly higher for participants maintaining exercise () Motivational barriers scores significantly lower for exercise maintainers () People with higher motivational barriers less likely to maintain exercise (). Those with higher maintenance self-efficacy higher probability of maintenance Information about what to do a barrier to exercise behaviour ranked 4th behind impairment, money, and accessible facilities
Small proportion of sample are people with stroke Although some participants indicated that they were less active in previous year, reasons for this not explored External factors, access to facilities, transportation, money, social support, and physical and functional status not predictive of maintenance
RCT primary outcome: Physical Activity Scale for the Elderly
people with stroke able to walk unassisted Intervention group Control group Age 69.6 years (59.6–77.7) <90 days after onset
Centres in Denmark, China, Poland, and Estonia stroke units
No significant difference between the groups on PASE at 3,6,9,12, 18 or 24 month followup
Self-reported levels of physical activity—not assessed by accelerometer, pedometer, and so forth, or by other fitness measures. No qualitative evaluation of involvement in PA made
