Attitudes and understanding of exercise and healthy lifestyles in people with mild to moderate subacute

Transcription

1 Attitudes and understanding of exercise and healthy lifestyles in people with mild to moderate subacute stroke Nicola Clague-Baker, Prof Tom Robinson, Prof Sally Singh, Dr Chris Carpenter, Annegret Hagenberg, Sophie Drewry,

2 Background Attitudes towards Healthy lifestyles particularly Exercise Barriers to exercise physical, motivational and environmental (Damush 2007, Simpson 2011) chronic stroke Knowledge of Healthy lifestyles particularly exercise 33% stroke patients not given advice about physical exercise (HCs 2005) 54% stroke patients not given information about stroke prevention (SA 2006) Information confusing (Lawrence 2010) - chronic Information recall - poor (Hillsdon 2013) - chronic

3 Aim of study This study aimed to explore sub-acute stroke patients experiences after stroke and their attitudes to, and understanding of, recommended levels of exercise and living a healthy lifestyle.

4 Method Qualitative interpretive phenomenological approach. 20 participants with mild to moderate sub-acute stroke Semi-structured in-depth interviews Analysis by the PI and expert qualitative researcher Member checking 2 transcripts

5 Results 20 participants (12 male), mean age 66 years (range 30 to 88) Ethnicity - 14 Caucasian, 4 Asian and 2 Afro-Caribbean NIHSS mean score 3 (range 1 to 8) Average length of time post stroke in days 59 days (range ) Seven of the participants were accompanied by their carer

6 2 main themes Attitudes to Healthy Lifestyle Knowledge of Healthy Lifestyle

7 Attitudes to healthy lifestyle Positive Negative Giving up smoking Barriers Diet Doubts Exercise Lack of agreement

8 Summary - Attitudes towards a healthy lifestyle and fitness Majority of participants wanted to live a healthy lifestyle Most were active prior to the stroke but not enough to challenge their cardiovascular system A number of barriers to exercise were identified A number of patients had doubts about the impact of a healthy lifestyle

9 Knowledge of healthy lifestyle Fitness Risk factors Cause Advice

10 Knowledge of healthy lifestyle Fitness Risk factors Cause Advice Benefits Independence Guidelines I think it gives you a positive outlook P2 I looked at it that I m going to lose weight and that s it P14 Psychological Social Weight control we just went for the social aspect of it P1 No one mentioned the benefit of fitness and prevention of illness.

11 Knowledge of healthy lifestyle Fitness Benefits Guidelines Risk factors Cause Advice Majority had not ever thought about it: Only two participants could identify some idea of the recommended dose. Other participants had incorrect ideas about recommendations: It s not recommended to go every day P1 P3 I didn t think about it, I didn t realise that exercise could help with a stroke

12 Knowledge of healthy lifestyle Over half the participants did not know Fitness Risk factors Cause Advice any of the risk factors that could lead to a stroke with one saying: No I didn t know there were any risks P15 and he had diabetes.

13 Over half the participants did not know the cause of their stroke Participants identified the importance of knowing the cause of their stroke so they knew how to change their lifestyle Knowledge of healthy lifestyle Fitness Risk factors Cause Advice

14 Knowledge of healthy lifestyle Fitness Risk factors Cause Advice Very few talked about advice they had been given about maintaining their fitness Healthy Lifestyle advice other than exercise the lack of information was the main response They didn t talk about general fitness P6 I haven t been told anything P9 Exercise Other areas of advice Source

15 Knowledge of healthy lifestyle Fitness Risk factors Cause Advice Exercise Other areas of advice Source The majority of the participants (over 60 years old) did not feel comfortable using online information I have not had a chance to read them. They were useful but perhaps if someone did actually say well look if you have this or do that. P17 online written Verbal

16 Summary - Knowledge of Healthy Lifestyles No one mentioned the benefit of exercise related to prevention of illness Only two participants knew anything about cardiovascular fitness guidelines Over half the participants did not know any of the risk factors Over half the participants did not know why they had had a stroke Very few talked about advice they had been given about maintaining their fitness Very few participants had been given Healthy Lifestyle advice in person, a few had been given written information but had not read it.

17 Conclusion Sub-acute stroke patients appear to have positive attitudes towards exercise and healthy lifestyles. A number of barriers identified that limited participation in exercise Knowledge of cardiovascular exercise, healthy living, risk factors and prevention of illness is limited. Do not appear to have been given advice on cardiovascular exercise or healthy lifestyles

18 Take home message Despite recommendations stroke patients do not report hearing healthy lifestyle messages. Stroke Physiotherapists need to ensure they provide individualised advice for stroke patients on cardiovascular fitness, healthy living, risk factors and illness prevention. Future research is needed to identify the most effective way of providing this advice for people with stroke.

19 Thanks to: All the participants The Stroke Association University of Leicester University Hospitals of Leicester esp. all the stroke teams for help with recruitment Research Assistants Annegret Hagenberg and Sophie Drewry Contact details Stroke

20 References Damush, TM, Plue, L, Bakas, T, Schmid, A, Williams, LS (2007) Barriers and Facilitators to Exercise Among Stroke Survivors Rehabilitation Nursing 32, 6 Healthcare commission (2006) Survey of patients 2006 Caring for people after they have had a stroke Hillsdon, K M, Kersten, P, Kirk, HJS (2013) A qualitative study exploring patients experiences of standard care or cardiac rehabilitation post minor stroke and transient ischaemic attack. Clinical Rehabilitation 0(0) 1 9 Lawrence M, Kerr, S, Watson, H, Paton, G, Ellis, G (2010) An exploration of lifestyle beliefs and lifestyle behaviour following stroke: findings from a focus group study of patients and family members. BMC Family Practice 11:97 Simpson LA, Eng JJ, Tawashy, AE (2011) Exercise perceptions among people with stroke: Barriers and facilitators to participation. International Journal of Therapy and Rehabilitation 2011; 18(9): Sharma, H, Bulley, C, van Wijck, FMJ (2012) Experiences of an exercise referral scheme from the perspective of people with chronic stroke: a qualitative study. Physiotherapy 98 (2012) Stroke Association: Nobody told me... Highlighting the importance of information for stroke survivors when they leave hospital London: Stroke Association; 2005.