Barriers associated with exercise and community access for individuals with stroke.
Abstract written by Neil Cummins
The purpose of this study was to determine why increasing participation in physical activity among people with stroke seems to be challenging for healthcare professionals.
Participants with stroke were recruited to participate in a health program at a major university-based medical center in the Midwest. Eighty-three adults ranging from ages 30 to 70 years (mean = 54.2 years) with unilateral stroke were included in the study. A series of questions related to barriers to exercise were posed to candidates before their participation in the study. Additional eligibility requirements were as follows: ability to walk at least 50 feet without assistance; post-stroke at least 6 months; and written permission from their physician before participation.
The Barriers to Physical Activity and Disability Survey (B-PADS) was used to collect data on the types of barriers (personal/environmental/facility) that individuals with disabilities experience related to exercise participation. The B-PADS consists of 34 items. Of the 34 items, 31 contain two response choices: yes or no. The remaining 3 are open-ended, and 2 of them are follow-up questions that ask participants to explain a previous “yes” response.
Research assistants participated in a training session on B-PADS before conducting surveys. Each research assistant then did five 30- to 45-minute telephone interviews with five different participants who had experienced a stroke.
The project coordinator listened in during each call and independently scored each item. Afterwards, the research assistant’s scores were compared with those of the project coordinator. No significant results in scores were discovered, and test-retest stability for the 31 categorical items resulted in a Cohen k of 0.76, and interrater reliability for two independent raters resulted in a Cohen k of 0.86.
The five most common barriers were: (1) cost of the program (61%), (2) lack of awareness of a fitness center in the area (57%), (3) no means of transportation to a fitness center (57%), (4) no knowledge of how to exercise (46%), and (5) no knowledge of where to exercise (44%). The least common barriers were (1) lack of interest (16%), (2) lack of time (11%), and (3) concern that exercise would worsen their condition (1%).
Most participants (96%) were interested in starting the exercise program, with 91% feeling the program would improve their condition. Nearly 80 percent of the participants were encouraged by their physicians to exercise. Physicians seemingly preferred their patients to engage in certain post-stroke rehabilitation exercise rather than general exercise in fitness centers. Physicians also preferred their patients to participate in post-stroke exercises rather than home-based conditioning exercises.
The various personal and environmental/facility barriers that participants with stroke report are useful in providing insight in helping individuals with stroke and/or their caregivers overcome these barriers. It is of paramount importance that healthcare professionals systematically identify and remove barriers to exercise when referring patients with stroke from rehabilitation to community-based exercise in order to increase participation.