Abstract
To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. A cross-sectional descriptive study. In total, 208stroke survivors (70.25±9.08years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.
Highlights
Regular physical activity and exercise (PAE) after stroke is essential, but the adherence to PAE and its influential factors is rarely studied and unclear in developed countries
All the data were transformed into categorical variables so that it would be easier to test the differences of physical activity and exercise adherence between groups with different characters (Table 1)
The results showed that self-efficacy is an influencing factor but is an important determinant of physical activity and exercise adherence for stroke survivors
Summary
Regular physical activity and exercise (PAE) after stroke is essential, but the adherence to PAE and its influential factors is rarely studied and unclear in developed countries. In a study conducted by Gunnes [12] in Norway, the rate of adherence to long-term physical activity and exercise was 51.2% at the beginning and increased by 2.6% per month with individualized monthly coaching by a physical therapist. Another investigation conducted in USA revealed that only 65.3% of stroke patients who completed 6 months of rehabilitation with a professional organization reported adhering to at least part of the home exercise program [11]. It is very important to explore the reasons for adherence or non-adherence in order to design more effective and long-lasting interventions
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