Factors Affecting Physical Activity in Stroke

Stroke is the leading cause of disability and disability in adults (1). While 30% of stroke patients die within a year, one third of the survivors continue their daily lives as dependents (2). The participation of stroke individuals in physical activity is significantly lower than the general population (3). There is strong evidence to support the benefits of physical activity for both people with and without a history of stroke (4). Adequate physical activity reduces the secondary harmful changes that develop after stroke, such as skeletal muscle wasting, changes in muscle structure, loss of bone mass, and decreased cardiorespiratory capacity. Physical activity also helps prevent recurrent strokes by improving control of stroke risk factors (eg, diabetes, hypertension, dyslipidemia). In addition to medical benefits, physical activity in stroke individuals is seen as an important tool in adapting to life after stroke and in reaching the physical and social goals of the person (5). Despite the known benefits of physical activity after stroke, many studies have shown that post-stroke survivors have low levels of physical activity and are even less active than older adults with chronic non-neurological conditions. However, it is unclear which factors affect physical activity after stroke(5). There is little evidence for modifiable factors affecting objectively measured physical activity and inactivity in the chronic phase of stroke (6).

In the first meta-analysis study (7) on the subject, it was emphasized that low physical activity was associated with decreased walking ability and aerobic condition, decreased balance and depression also affected physical activity, and no relationship was found between age or other demographic variables and physical activity level. In another study, it was stated that balance, walking speed, walking capacity, quality of life and depression affect physical activity level, but age and gender did not have a significant relationship with physical activity level (8). In the last meta-analysis (5), age, gender, physical function, fatigue, falling self-efficacy, balance self-efficacy, depression and quality of life were found to be significant with post-stroke physical activity. In another study, in which it was stated that fear of falling and fatigue were not significantly predictive factors of physical activity and inactivity, it was emphasized that in order to increase physical activity in stroke patients, perceived obstacles should also be taken into account instead of focusing only on walking speed (6).

When the literature is examined, it has been seen that the evidence regarding the factors affecting physical activity after stroke is variable.The effects of demographic data such as age, gender, comorbidities, and fear of falling and fatigue on post-stroke physical activity differ between studies.The effect of the time elapsed since the stroke and the stroke factors is not fully clear.Therefore, in order to increase the success of interventions for physical activity, it is important to investigate and determine the factors affecting physical activity and to make the intervention plan in accordance with these factors.

The aim of our study is to examine the factors affecting the physical activity of individuals with stroke and to draw attention to the importance of these factors in interventions to improve the physical activity level of individuals with stroke.

Inclusion criteria

• Being 18 years or older, diagnosed with ischemic or hemorrhagic stroke, at least 4 weeks have passed since the stroke, no communication and cooperation problems (Mini Mental State Test total score ≥24), ability to walk with or without an assistive device.

Exclusion criteria

• Having received a warning about physical activity restriction by the specialist physician,having another orthopedic or neurological problem that will affect physical activity other than stroke (bone fracture, multiple sclerosis, Parkinson's, etc.),individuals with advanced cardiovascular disease and in whom mobilization is contraindicated were not included in the study.