Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
In this qualitative, phenomenological study, 15 stroke survivors indicated that performing moderate to vigorous physical activity (PA), performing activities of daily living (ADLs), and avoiding sedentary behavior were important types of PA. For adults with stroke for whom moderate PA is challenging, performing ADLs may be an acceptable alternative. OT practitioners can assist clients to decrease sedentary behavior and increase PA through the performance of meaningful activities and occupations.
Primary Author and Speaker: Ryan Bailey
Contributing Authors: Jennifer Stevenson
PURPOSE: Physical activity (PA) is recommended for adults with stroke to improve physical health, well-being, and quality of life (Billinger et al., 2014). PA occurs along a continuum, extending from light PA (e.g. walking, performing activities of daily living [ADLs]) to moderate-to-vigorous PA (e.g. jogging, heavy yardwork). Stroke-related mobility impairment resulting from hemiparesis can make it difficult to engage in moderate-to-vigorous PA (Ivey et al., 2005); thus, increasing light PA may be an appropriate alternative. However, little is known about how people with stroke conceptualize PA; such an understanding may be important for designing occupation-based PA interventions. Therefore, the purpose of this study was to explore how adults with stroke conceptualize physical activity.
DESIGN: Qualitative, phenomenological study design. A convenience sample of 15 participants were recruited through purposive sampling from community-based support groups. Participants were eligible to participate if they were 18-80 years, >6 months post-stroke, community-dwelling, ambulatory (>50 feet) with or without an assistive device, and able to provide informed consent.
METHOD: Semi-structured interviews were conducted using an interview guide. Interviews were audio-recorded and transcribed for analysis. The study PI and a graduate student analyzed the transcripts using inductive content analysis. They created codes independently, consolidated codes into a codebook, and categorized codes across participants to identify key themes. Validity and reliability of the analytic process was accomplished through using 2 coders, triangulating responses across participants, achieving data saturation, and conducting member checks with 10/15 available participants following analysis.
RESULTS: Participant median age was 64 years and median time since stroke was 4.2 years. Participants were mostly White (n = 10), male (n = 9), and independent (n = 8) or modified independent (n = 6) for ambulation. Three key themes emerged. First, thirteen participants described exercise, sports, and leisure activities—activities consistent with moderate-to-vigorous PA--as important types of PA. For example, one participant stated, ‘My main kind of exercise is walking.' Second, twelve participants identified performing basic and instrumental ADLs (e.g. self-care, house chores, shopping) as their primary form of PA, indicating that participants didn't limit their perceptions of PA to exercise alone. One participant explained, ‘When a lot of people think of physical activity, they think of exercise equipment. But for me, it was cutting grass. It was working in my garden. Just nominal stuff. But to me, it all helps.' Third, nine participants stated that avoiding sedentary behavior by being physically active was important. Participants explained that not wanting to sit for long periods of time, avoiding boredom, and valuing being busy over being sedentary encouraged them to be physically active. As detailed by one participant, ‘Even if I'm at the computer for a long time, I'll get up and walk around a little bit just so you're not sitting for so long.'
CONCLUSION: Performing basic and instrumental ADLs and decreasing sedentary behavior were acceptable forms of PA for the study sample, and may be an acceptable alternative for adults with stroke who cannot engage in moderate-to-vigorous PA.
IMPACT STATEMENT: Findings suggest that decreasing sedentary behavior and increasing PA through the identification, modification, and performance of meaningful activities and occupations may be appropriate for adults with stroke, and should be empirically explored.
References
Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., . . . Tang, A. (2014). Physical Activity and Exercise Recommendations for Stroke Survivors: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 45(8), 2532-2553. https://doi.org/10.1161/str.0000000000000022
Ivey, F. M., Macko, R. F., Ryan, A. S., & Hafer-Macko, C. E. (2005). Cardiovascular health and fitness after stroke. Topics in Stroke Rehabilitation, 12(1), 1-16. https://doi.org/10.1310/GEEU-YRUY-VJ72-LEAR
Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Fini, N. A., Holland, A. E., Keating, J., Simek, J., & Bernhardt, J. (2017). How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis. Physical Therapy, 97(7), 707-717. https://doi.org/10.1093/ptj/pzx038
