What's keeping people after stroke from walking outdoors to become physically active? A qualitative study, using an integrated biomedical and behavioral theory of functioning and disability.

Jacqueline Outermans,Jacqueline Outermans,Japie Bakers,Jan Pool,Jan Pool,Japie Bakers,Ingrid Van De Port,Harriet Wittink

doi:10.1186/s12883-016-0656-6

Abstract

BackgroundIn general people after stroke do not meet the recommendations for physical activity to conduct a healthy lifestyle. Programs to stimulate walking activity to increase physical activity are based on the available insights into barriers and facilitators to physical activity after stroke. However, these programs are not entirely successful. The purpose of this study was to comprehensively explore perceived barriers and facilitators to outdoor walking using a model of integrated biomedical and behavioral theory, the Physical Activity for people with a Disability model (PAD).MethodsIncluded were community dwelling respondents after stroke, classified ≥ 3 at the Functional Ambulation Categories (FAC), purposively sampled regarding the use of healthcare. The data was collected triangulating in a multi-methods approach, i.e. semi-structured, structured and focus-group interviews. A primarily deductive thematic content analysis using the PAD-model in a framework-analysis’ approach was conducted after verbatim transcription.Results36 respondents (FAC 3–5) participated in 16 semi-structured interviews, eight structured interviews and two focus-group interviews. The data from the interviews covered all domains of the PAD model. Intention, ability and opportunity determined outdoor walking activity. Personal factors determined the intention to walk outdoors, e.g. negative social influence, resulting from restrictive caregivers in the social environment, low self-efficacy influenced by physical environment, and also negative attitude towards physical activity. Walking ability was influenced by loss of balance and reduced walking distance and by impairments of motor control, cognition and aerobic capacity as well as fatigue. Opportunities arising from household responsibilities and lively social constructs facilitated outdoor walking.ConclusionTo stimulate outdoor walking activity, it seems important to influence the intention by addressing social influence, self-efficacy and attitude towards physical activity in the development of efficient interventions. At the same time, improvement of walking ability and creation of opportunity should be considered.

Highlights

In general people after stroke do not meet the recommendations for physical activity to conduct a healthy lifestyle
All researchers were familiar with the people with a Disability model (PAD)-model and as clinicians experienced in using the international classification of functioning (ICF) in clinical reasoning
The first aim of the study was to give insight into perceived barriers and facilitators in all domains of the PADmodel describing outdoor walking activity to become physically active in individuals after stroke

Summary

Introduction

In general people after stroke do not meet the recommendations for physical activity to conduct a healthy lifestyle. A meta-analysis [6] showed that among 1105 people, between 3 months to 8,5 years after stroke, a mean of 4355 steps a day were taken, which is well below the current recommendation for people with a disability of 6500–8500 steps a day [7] This inactive lifestyle may perpetuate existing impairments and deconditioning. Deconditioning, resulting in low levels of physical fitness, aerobic capacity, has been recognized as a major problem in stroke [8] It is associated with health risks such as metabolic syndrome, cardiovascular disease or recurrent stroke [8, 9] as well as with reduced walking capacity [10]. Moderate to vigorous walking interventions on a treadmill were shown effective in improving aerobic capacity after stroke [12]

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