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Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.

ABSTRACT: Aim:To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. Methods:For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. Results:Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. Conclusion:The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.

SUBMITTER: Caetano LCG

PROVIDER: S-EPMC7073491 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.

Caetano Lívia C G LCG Pacheco Bruna D BD Samora Giane A R GAR Teixeira-Salmela Luci F LF Scianni Aline A AA

Stroke research and treatment 20200304

<h4>Aim</h4>To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke.<h4>Methods</h4>For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of ...[more]

PMID: 32190284

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Project description:BackgroundSocial and physical environmental factors affect real-world walking activity in individuals with stroke. However, environmental factors are often non-modifiable, presenting a challenge for clinicians working with individuals with stroke whose real-world walking is limited due to environmental barriers.ObjectiveThe purpose of this work was to test a model hypothesizing the relationships among environmental factors (specifically, living situation and area deprivation), modifiable factors, and real-world walking activity to understand opportunities for intervention. We hypothesized that balance self-efficacy would mediate the relationship between the environment and real-world walking and that physical capacity would moderate this mediation.MethodsThis was a cross-sectional study of 282 individuals with chronic (≥6 months) stroke. We tested the indirect effect to determine if mediation was present. Multiple group structural equation modeling was used to test if physical capacity moderated this mediation. A χ2 difference test was used to compare the moderation model against the null (no moderation) model.ResultsBalance self-efficacy mediated the relationship between area deprivation and real-world walking (indirect effect: β = -0.04, P = .04). Both the moderation and null models fit the data equally well statistically (χ2(5) = 6.9, P = .23). We therefore accepted the simpler (null) model and concluded that the mediation was not moderated.ConclusionsTargeting balance self-efficacy may be an effective approach to improving real-world walking in persons with stroke who experience barriers within the physical environment. A stroke survivor's physical capacity may not impact this approach. Future work should consider utilizing more specific measures of the social and physical environment to better understand their influences on real-world walking activity in individuals with stroke. However, the results of this work provide excellent targets for future longitudinal studies targeting real-world walking activity in stroke.

Project description:ImportanceThe relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated.ObjectiveTo examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture.Design, setting, and participantsThis prospective cohort study compared individuals with various degrees of walking ability limitation at 1000 m (a little limitation and a lot of limitation) and those without limitation (no limitation) accounting for age, falls, prior fractures, and weight. Participants from the ongoing population-based Sax Institute 45 and Up Study were followed from recruitment (2005-2008) for 5 years (2010-2013). Data analysis was conducted from July 2020 to September 2023.ExposureSelf-reported walking limitation.Main outcomes and measuresIncident fracture and site-specific fractures (hip, vertebral, and nonhip nonvertebral [NHNV] fractures).ResultsAmong the 266 912 participants enrolled in the 45 and Up Study, 238 969 were included, with 126 015 (53%) women (mean [SD] age, 63 [11] years) and 112 954 (47%) men (mean [SD] age, 61 [11] years). Approximately 20% reported a degree of limitation in walking 1000 m or less at baseline (39 324 women [24%]; 23 191 men [21%]). During a mean (SD) follow-up of 4.1 (0.8) years, 7190 women and 4267 men experienced an incident fracture. Compared with participants who reported no walking limitations, a little limitation and a lot of limitation were associated with higher risk of fracture (a little limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; a little limitation among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; a lot of limitation among men: HR, 2.03; 95% CI, 1.86-2.22). Approximately 60% of fractures were attributable to walking limitation. The association was significant for hip, vertebral, and NHNV fracture and ranged between a 21% increase to a greater than 219% increase.Conclusions and relevanceIn this cohort study of 238 969 participants, self-reported walking limitations were associated with increased risk of fracture. These findings suggest that walking ability should be sought by clinicians to identify high-risk candidates for further assessment.

Project description:IntroductionPhysical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation. We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency, duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation.Methods and analysisIndividuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited (target n=192 total). A stepped-wedge design will be employed; that is, the PROPEL intervention (group exercise plus self-management) will be 'rolled out' to each site at a random time within the study period. Prior to roll-out of the PROPEL intervention, sites will complete the control intervention (group aerobic exercise only). Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors, and standardised physical activity questionnaire. Adherence to exercise guidelines will be evaluated by (1) number of 'active minutes' per week (from the activity monitor), (2) amount of time per week when heart rate is within a target range (ie, 55%-80% of age-predicted maximum) and (3) amount of time per week completing 'moderate' or 'strenuous' physical activities (from the questionnaire). We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed-model logistic regression, with fixed effects of time and phase and random effect of cluster (site).Ethics and disseminationTo date, research ethics approval has been received from five of the six sites, with conditional approval granted by the sixth site. Results will be disseminated directly to study participants at the end of the trial, and to other stake holders via publication in a peer-reviewed journal.Trial registration numberNCT02951338; Pre-results.

Dataset Information

Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.

Publications

Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.

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