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 8
Details of the qualitative studies included in the review regarding method, participants, setting, summary of findings pertinent to psychological and social factors, and notes regarding theoretical models.
Age: mean = 59 Gender: M = 8, F = 5 Time since stroke = < 12 months 85% AA, 15% white
Country: USA Service: Academic researchers, recruited from health service—local hospital
Barriers and facilitators to engage in PA. Barriers: Psychological: low mood, lack of motivation, and fear (pain, damage, and recurrence) Facilitators: intrinsic motivation, PA as meaningful activity Social: support from family, GP, physio, and other stroke survivors
Mixed methods Qualitative: interview (4 with stroke)
Age: mean for whole sample () = 47.5 years Gender: whole sample () M=40%, F=60% Time since stroke: not reported
Country: USA Service: local government researchers—recruited from local authority run conditioning classes
Psychological: PA increased personal control, self-esteem, and feeling of autonomy Social: increased self-esteem and independence lessens burden on carers and relationships. PA reduces social isolation, offers chance to meet others with disability—shared experience. Exercise in group acts as motivator to participate and adhere
Age: >60–73+ Gender: M = 5, F = 7 Time since stroke: 15–40 months, mean 26 months
Country: UK Service: university researchers—recruited from community stroke scheme
Psychological: loss of confidence, loss of role/purpose and doubts over competence limit engagement in PA PA increased self-esteem, confidence, and gave sense of achievement—negated fear of falling PA seen as substitute to physio and central to recovery Social: ex-instructors important for support and recovery Shared experience—PA offers learning from others, helped reestablish role in life and positive view of social self Group PA fun, increased self-esteem, and encouraged progress
Developed own theoretical model to underpin findings
Age: mean = 64 Gender: M = 12, F = 7 Time since stroke: 4.9 years
Country: Australia Service: physiotherapy researchers—recruited from stroke support groups
Psychological: fear of pain and harm, frustration, previous failure, low mood, feelings of incompetence (physical/cognitive), negative attitude from others, lack of self-determination, lack of access all limit engagement in PABut, negative attitudes from others also act as a motivator, and PA seen as important for recovery and progress Social: family often supportive but conversely also seen to encourage dependence Therapist important for support and recovery—but need to encourage self-management.Group PA offers camaraderie, humour, and information exchange
Developed own theoretical model to underpin findings
Age: range 45–85 Gender: M = 8, F = 6 Time since stroke: not reported
Country: Scotland Service: academic researchers, recruited from RCT
Psychological: vulnerability, anxiety, fear of falling, and concerns about communication act as barriers to PA Once engaged in PA: increased confidence and reduced anxiety PA offered feeling of empowerment—increased feelings of control PA class either acted as motivator to exercise at home or conversely PA not maintained as had learned all there was to learn Social: shared experience important—not feeling alone PA in group important for social self, valued social interaction, and group exercise fun
Locus of control discussed in part explanation of results
Age: over 45 Gender: M = 55, F = 45 Time since stroke: at least 6 months after stroke
Country: USA Service: academic researchers, recruited from community, attended university medical centre
Psychological: intrinsic self-determination, sense of routine, monitoring of health, and feeling physically better all motivators to engage in PA Offered increased sense of independence, offered something to do, helped keep active, and was enjoyable Social: support from family, health professionals, ex instructors encouraged adherence Not group based, but social interaction during transportation also encouraged adherence
Aspects of SCT self-efficacy used to underpin findings
Age: not reported Gender: not reported Time since stroke: not reported
Country: Ireland Service: physio researchers
Social: physios see family/friends play important role in rehab—continue work of physio Eases transition from acute to community family members often motivated to help with rehab although also acknowledged that family can be too critical, too intense, or too emotional
Age: not reported Gender: M = 5, F = 0 Time since stroke: not reported
Country: Northern Ireland/Canada Service: clinical psych researcher (NHS), recruited from community day centre
Psychological: focusing on disability and comparison with premorbid function and others = low self-confidence = barrier to PA. Conversely, PA seen as way to improve mood and offers encouragement to try other things and improve health PA offers way to replace loss of identity/role—competent and athletic versus disabled PA seen as way to push boundaries of society’s idea of disability PA retained role of active person and continued engagement in competitive sport—change perceptions of disablement Social: PA with others provides reference point for one’s own physical ability—either offers encouragement or conversely not conducive to progress—“no hopers” group PA fun and important opportunity for interaction and way to connect socially and regain degree of independence
Aspects of SCT self-efficacy used to underpin psychological factors Self-determination theory—increased autonomy and competence and social interaction increases intrinsic motivation to engage in PA
Qualitative interviews with stroke survivors () and ex-professionals () and focus groups and interviews physios ()
Age: mean = 18–78 Gender: M = 8, F = 1 Time since stroke: not specified 1993–2003
Country: UK Service: community EoP
Psychological: stroke survivors motivated to engage to maintain health and fitness and as alternative to physio after rehab, but ultimately just want more physio Physio see EoP as a bridge, ex professional see it as way to control own ex-regime Social: physios role seen as very important—stroke survivor seeks presence of physio throughout EoP—want more interaction between physio and ex professional. Physio uncomfortable as could encroach on ex professional domain Ex professional role—stroke survivors “left to own devices” and concerns reexpertise from stroke survivors, carers and physio. Ex professional confident in own ability but open to specialised training Group exercise: limited interaction with other stroke survivors. Physio see opportunity for learning but acknowledge limited interaction based on own experience. Ex professional think EoP social
Age: mean = 59.8 Gender: M = 6, F = 4 Time since stroke: not reported
Country: Australia Service: community Stroke maintenance exercise class
Psychological: PA improved confidence and increased motivation, within group exercise class setting, but also in achieving goals within the community Offered hope for recovery when see others with greater disability engaging and progressing in PA, which motivated to continue Self-efficacy: exercise class offered practical, emotional, and social support. PA increased feelings of confidence, motivation, and associated improved self-efficacy, leading to minimisation of physical symptoms and perceived improved functioning in daily activities Social: presence of health professionals important role in guiding exercises to do, but also in accessing ongoing support not accessible in community Observing other stroke survivors achieving personal goals/making progress motivator to continue with PA and achieve own goals. Social support from other group members offered encouragement to attempt new exercises and challenge self-perceived limitations Social benefits of exercising in a group setting important as they allow for exchange of experiences, support, and information with other stroke survivors. Created feeling of belonging and sense of community
