What influences acceptability and engagement with a high intensity exercise programme for people with stroke? A qualitative descriptive study.
BACKGROUND
Intensity refers to the amount of effort or rate of work undertaken during exercise. People receiving rehabilitation after stroke frequently do not reach the moderate to high intensity exercise recommended to maximise gains.


OBJECTIVE
To explore the factors that influence the acceptability of, and engagement with, a high intensity group-based exercise programme for people with stroke.


METHODS
This qualitative descriptive study included 14 people with stroke who had completed a 12-week, high intensity group-based exercise rehabilitation programme. Semi-structured interviews were used to explore the acceptability of high intensity exercise and the barriers and facilitators to engagement. Interviews were recorded, transcribed and analysed using qualitative content analysis.


RESULTS
The participants found high intensity exercise rehabilitation acceptable despite describing the exercise intensity as hard and reporting post-exercise fatigue. Participants accepted the fatigue as a normal response to exercise, and it did not appear to negatively influence engagement. The ease with which an individual engaged in high intensity exercise rehabilitation appeared to be mediated by inter-related factors, including: seeing progress, sourcing motivation, working hard, the people involved and the fit with the person and their life. Participants directly related the intensity of their effort to the gains that they made.


CONCLUSIONS
In this study, people with stroke viewed training at higher intensities as a facilitator, not a barrier, to engagement in exercise rehabilitation. The findings may challenge assumptions about the influence of exercise intensity on engagement.
Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
Nada
N
Signal
Health Research Council of New Zealand, Auckland, New Zealand.|Centre for Person Centered Research, AUT University, Auckland, New Zealand.
Kathryn
K
McPherson
Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
Gwyn
G
Lewis
Centre for Person Centered Research, AUT University, Auckland, New Zealand.
Nicola
N
Kayes
Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
Nicola
N
Saywell
Centre for Person Centered Research, AUT University, Auckland, New Zealand.
Suzie
S
Mudge
Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand.
Denise
D
Taylor
D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000523:psychology; D005081:Exercise Therapy / Q000379:methods / Q000523:psychology*; D005221:Fatigue / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D026741:Physical Therapy Modalities / Q000523:psychology; D010865:Pilot Projects; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D000071939:Stroke Rehabilitation / Q000379:methods / Q000523:psychology*
Stroke; engagement; exercise; intensity; qualitative; rehabilitation