Understanding the Experiences of People Living with Stroke Engaging in a Community-Based Physical-Activity Programme

1. Introduction

For individuals living with stroke, research has shown that regular exercise can provide physiological benefits such as improvement in vascular health measures (e.g., blood pressure, blood lipid profile), aerobic fitness [1,2] and strength, balance and gait [3], as well as improvements in psychosocial health outcomes [4,5]. In general, exercise has been shown to improve engagement in activities of daily living and quality of life for individuals living with stroke (see [6] for a review), and maintaining a physically active lifestyle is therefore proposed to be very beneficial for this population. However, in the United Kingdom (UK)high levels of stroke survivors do not meet recommended physical activity guidelines [7]. Clinical guidelines recommend that stroke survivors are active every day, with physical activity volume gradually progressing from low intensity so that 150 min or more of moderate intensity physical activity is achieved per week [8]. Muscle strengthening activities are recommended at least twice per week, as well as activities that improve balance and co-ordination to reduce risk of falls. In light of the importance of exercise, and the challenges for health providers to facilitate opportunities for exercise with this population, it is important for researchers to examine targeted community-based, outpatient physical activity programmes for individuals living with stroke.A number of qualitative studies have examined people’s experiences of living with stroke. This research has identified challenges faced when re-entering family life after a stroke [9], difficulties faced when engaging with health services [10], and problems encountered when returning to work [11,12]. For example, Pluta et al. [11] found working-age individuals living with stroke felt marginalised from their work life and this led to a sense of loss from their ‘previous life’ before the stroke. With regard to exploring experiences and long term needs when engaging with health services, findings illustrated how patients often felt they were not fully understood by healthcare services, with the authors suggesting healthcare professionals need to understand the individual needs of patients to allow them to successfully tailor support and set goals [10]. Researchers have also considered how to improve stoke care and highlighted how the needs of service users did not appear to be adequately addressed, with a lack of information and support given to patients [13]. These studies develop our understanding of some of the challenges faced by those living with stroke, thus providing an insight into how care might more effectively be offered in this recovery phase.When directly considering physical activity, a small number of studies have looked at the exercise experiences of individuals living with stroke. Such research has included a focus on patients’ motivation to exercise and the facilitators and barriers to exercise. For example, in a study with individuals recovering from stroke, social interaction, beliefs of benefits of exercise, high self-efficacy, and the necessity of routine behaviours were found to be the most commonly reported motivators [14]. In addition, lack of professional support on discharge from hospital and follow-up, as well as transport issues to structured classes or interventions, and lack of control and negative affect were the most commonly reported barriers. Research exploring a community-based rehabilitation programme in rural Australia found stroke-specific exercise groups led by health professionals were viewed positively because they enabled social support, increased confidence, improved mood and motivation, and provided an opportunity to acquire knowledge from others [15]. Moreover, group settings have been found to increase exercise participation for individuals living with stroke due to the social support and encouragement people receive from other group members [16]. In research conducted with longer-term stroke survivors, findings have shown that promoting the psychological well-being benefits of exercise, such as increased self-esteem and life satisfaction, and offering different activity formats in de-medicalised settings, increase participation for long-term stroke survivors [17]. Such an increase in activity was explained by exercise being viewed as a healthy lifestyle activity rather than a treatment, with the latter potentially perceived more negatively. Understanding these motivating factors, facilitators, and barriers to exercise is important to consider for those healthcare professionals who aim to promote physical activity participation for those living with stroke.In considering the literature around exercise provision for stroke survivors, Young and colleagues systematically reviewed the research on venue-based exercise programmes [18]. Findings of this review revealed that those living with stroke gain confidence and renewed identity through exercise participation, with participants reporting to enjoy stroke-specific exercise programmes in non-medical venues. Young et al. further suggested there is limited quality research in this area, highlighting a need to conduct research to examine stroke specific programmes, and furthermore, to consider ongoing, community-based exercise programmes designed specifically for individuals living with stroke. Our study therefore aims to build on the existing literature by considering the core research question of what are the experiences of people living with stroke who engage in a targeted exercise programme, in order to provide a more focussed analysis of the physical activity experiences of this clinical group. More specifically, we explore the experiences of individuals who engaged in a specific community physical activity programme, namely the HELP (Health Enhancing Lifestyle Programme) Hampshire Stroke Clinic. This programme was created to offer targeted physical activity and education interventions to individuals living with stroke following discharge from the NHS care pathway. In considering the experiences of these individuals, we aim to consider their perspectives of the delivery of this programme, and how it might support their rehabilitation and recovery from stroke. It is hoped that the findings from this study will allow us to more fully understand how exercise interventions for individuals living with stroke can be effectively developed, and in turn, provide healthcare providers with an underpinning evidence base to further develop and improve such exercise provision to support the recovery of those living with stroke.

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About the Author: Tung Chi