A MATTER OF CHANGING HABITS: FACTORS RELATED TO HIGHLY SEDENTARY AND INACTIVE MOVEMENT BEHAVIOUR PATTERNS IN PEOPLE WITH STROKE

W. Hendrickx^1,2, R. Wondergem^3,1, M.F. Pisters^1,2,4, C. Lecluse¹, C. English^5,6, J.M.A. Visser-Meily⁷, C. Veenhof^2,8

¹Fontys University of Applied Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands, ²University Medical Center Utrecht, Utrecht University, Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, Utrecht, Netherlands, ³Fontys University of Applied Sciences, School of Sport Studies, Eindhoven, Netherlands, ⁴Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands, ⁵University of Newcastle, School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia, ⁶Florey Institute of Neuroscience and Hunter Medical Research Institute, Centre for Research Excellence in Stroke Recovery and Rehabilitation, Newcastle, Australia, ⁷University Medical Center Utrecht and De Hoogstraat Rehabilitation, Center of Excellence for Rehabilitation Medicine, Brain Center, Utrecht, Netherlands, ⁸University of Applied Sciences Utrecht, Research Group Innovation of Human Movement Care, Utrecht, Netherlands

Background: A large part of the people who have had a stroke are highly sedentary and have lower levels of physical activity than their healthy peers. High amounts of sedentary behaviour and low levels of physical activity increase the risk of cardiovascular disease. To develop effective interventions supporting people with stroke to improve their movement behaviour patterns, we need to know what factors, from the participants' perspective, are related to high-risk movement behaviour patterns.

Purpose: To identify capabilities, opportunities, and motivational factors influencing movement behaviour throughout the day in people with stroke who are highly sedentary and inactive.

Methods: A qualitative study was conducted using semi-structured interviews with people with stroke who have a high-risk movement behaviour pattern. An interview guide was created to explore all aspect related to movement behaviour, including those on a less conscious level. Therefore, the theoretical frameworks domains was used to understand behaviour. Interviews were transcribed and analysed by at least two authors in an iterative process to ensure saturation was reached. Quotes were retrieved from the abstract and were initially coded to the theoretical frameworks domains. Finally, the quotes were then combined for each domain to determine the constructs of factors related to high-risk movement behaviour.

Results: After eleven interviews saturation was reached. Participants stated a lack of knowledge when it comes to healthy movement behaviour patterns and a lack of insight into their own movement behaviour. Movement behaviour, especially sedentary behaviour, is highly dependent on reinforcing factors and, for the most part, driven by habits and daily routines. Active regulation when it comes to movement behaviour is lacking. Participants state hardly any prior intentions to change movement behaviour, apart from improving moderate to vigorous physical activity levels. Due to the insight into their movement behaviour obtained during the interview some intentions emerged. Several social and environmental elements were mentioned to influence movement behaviour. Some also describe physical and cognitive limitations, stroke and other comorbidities related, to influence their movement behaviour. The impact of the described factors on movement behaviour can be both positive and negative, which varied among participants.

Conclusions: The results of this study show that most people who have had a stroke are not aware of their movement behaviour and the related health risks. Movement behaviour patterns are mostly based on daily routine and personal habits.

Implications: These findings indicate a need for behaviour change interventions to support movement behaviour change in highly sedentary and inactive people after a stroke. These interventions need to include manners to provide insight and feedback on individuals’ movement behaviour and information about healthy movement behaviour. It should also have individualised support, taking into account personal capabilities, the social and environmental context to support sustainable movement behaviour change.

Funding acknowledgements: SIA-RAAK, The Dutch Organisation for Scientific Research (NWO), number RAAK.PUB05.021

Keywords:
Stroke
Sedentary behaviour
Behaviour change intervention

Topics:
Neurology: stroke
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: University Medical Centre Utrecht

Committee: Medical Ethics Research Committee of the University Medical Centre Utrecht

Ethics number: 16/715