title: An exploration of factors influencing physical activity levels amongst a cohort of people living in the community after stroke in the south of England.
abstract: OBJECTIVE
  To explore factors influencing physical activity (PA) reported by people living in rural/semi-rural communities in the south of England post-stroke, and to understand relationships between personal, interpersonal and environmental barriers and self-reported levels of PA.
  
  
  METHODS
  A survey was mailed to patients of NHS Trusts who were identified as potential participants. Self-reported PA levels, type, and frequency of reported barriers were tabulated. Spearman's rank correlation coefficient was used to explore associations between self-reported PA level and: age, gender, level of physical function, fear of falling, beliefs regarding PA, available supports, and socioeconomic status.
  
  
  RESULTS
  Seventy-six of 322 questionnaires distributed were returned (24%). Only 55.2% of respondents reported undertaking PA of sufficient intensity to meet current guidelines. Personal barriers included fear of falling, stroke-related disability, pain, and fatigue. Interpersonal and environmental barriers included lack of social support, transport, and inclement weather. Significant relationships existed between self-reported PA and fear of falling, functional mobility, and beliefs relating to PA.
  
  
  CONCLUSIONS
  Almost half of the survey cohort reported PA levels insufficient to meet current guidelines. Similar to barriers reported in previous studies in USA and other parts of the UK, numerous interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA were identified. Implications for Rehabilitation This study found that although more than 60% of the survey population were able to ambulate >200 m, only 55.2% reported undertaking sufficient PA to meet current guidelines, putting them at increased risk of further stroke and other co-morbidities. Participants reported a number of interlinking and overlapping personal, interpersonal, and environmental barriers to undertaking PA, which may explain this discrepancy between mobility status and self reported activity levels. Rehabilitation professionals and primary care providers are well positioned to address the barriers identified in this survey, such as providing interventions to reduce fear of falling, pain, and fatigue, providing support and education about safely increasing physical activity and addressing unhelpful beliefs about PA. Behaviour change strategies, such as increasing self-efficacy, and partnering with the person with stroke to problem solve strategies to address the barriers identified by this, and related research, are likely to be more successful in increasing PA than providing information alone.
authors.affiliation: a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia.|b Portsmouth Hospitals NHS Foundation Trust , Portsmouth , UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Jackson
authors.affiliation: c Western Sussex Hospitals NHS Foundation Trust , Worthing , UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mercer
authors.affiliation: a School of Surgery, FMDHS , The Centre for Musculoskeletal Studies, The University of Western Australia , Perth , Australia.
authors.forename: Barbara Jennifer
authors.initials: BJ
authors.lastname: Singer
mesh_terms: D000058:Accidental Falls; D000368:Aged; D015331:Cohort Studies; D006233:Persons with Disabilities; D004739:England / Q000453:epidemiology; D015444:Exercise; D005221:Fatigue / Q000453:epidemiology; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000453:epidemiology; D012944:Social Support; D020521:Stroke / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014186:Transportation; D014887:Weather
keywords: Barriers; balance; fear of falling; self-efficacy