Exercise Literacy, Beliefs, and Preferences of Stroke Survivors living in a Developing Country

12 Feb 2021 International Journal of Stroke

Having access to stroke care is one thing, but understanding how and when to access care is the key to receiving the best care. Knowledge, beliefs, and preferences of stakeholders determine adherence to treatment. This means understanding the literacy and beliefs of stroke survivors, in this case toward post-stroke exercise, will pave way for better exercise implementation.

Mahmood, Amreen; English, Coralie; N, Manikandan; Solomon, John M

Dr Amreen Mahmood is a physiotherapist who completed her masters in neuroscience in Manipal, at Manipal Academy of Higher Education, and developed her PhD around stroke recovery and rehabilitation. An enthusiastic and dynamic young woman, she is passionate about connecting stroke patients to excellent post stroke rehabilitation.

While conducting her PhD, Dr Mahmood would visit stroke patients in their homes and realised to her dismay that very few had continued the advised exercise for post stroke recovery. ‘That intrigued me, why do they stop exercising once they are discharged from hospital?’ puzzled Dr Mahmood.

Dr Mahmood and team, supported by well renown Australian stroke recovery and rehabilitation researcher Prof. Coralie English, conducted a cross-sectional study among 66 stroke survivors using two questionnaires. They developed and validated a questionnaire on exercise literacy and beliefs and developed a review paper looking at the spectrum of evidence in low resource settings.

The Manipal Research Team (left to right): Dr John Solomon (Associate Professor, Senior Scale), Dr Amreen Mahmood (Assistant Professor) and Dr N Manikandan (Associate Professor, Senior Scale).

The questionnaires revealed that participants exhibited both positive and negative beliefs towards regular exercising. Negative beliefs were presented as:

did not like exercising,
difficulty in accomplishing their exercise goals,
difficulty in continuing home exercises if busy with other activities, and
discontinued exercises if it were hard to perform.

Positive beliefs were presented as:

Not afraid to do the exercises,
believed that exercises will help in faster return to work,
did not give up exercises due to difficulty in sticking to a schedule,
did not exercise with an intention to satisfy family,
did not look for alternatives to avoid doing exercises,
willing to restart exercises if interrupted due to illness or traveling, and
believed that they will definitely improve with exercises.

The main factors that appeared from the results and analysis of the questionnaire were:

supervision support; survivors felt that they needed someone to lead them through the process.
confidence challenge; survivors did not feel confident enough to undertake the exercises themselves without active support.
health and wellbeing; some survivors did not feel they had the strength or energy to undertake the suggested exercises, or felt unsteady and unsafe engaging in the movement as suggested.
exercise context, survivors had difficulty understanding which exercises to do, and how to do them; most of them preferred exercising at home and exercising alone.

Most participants were unaware of how to activate recovery after stroke and did not know or understand the benefits of exercising for stroke prevention. Results show that the education imparted to the stroke survivors is focused on improving mobility, with lesser emphasis on stroke recovery and secondary prevention.

Drawing from the Reasoned Action Approach, she described how behaviour change happens in three phases:

eliciting relevant beliefs,
changing intention by changing those beliefs, and
changing behaviour by changing intention.

She concluded that the next step is to investigate carers understanding of recovery and rehabilitation, as they play such an important role in motivating and supporting stroke survivors, and let’s face it we could all change our attitude towards exercise and fitness for a better, healthier world.

Dr John Solomon (left) and Dr Amreen Mahmood (right) with Professor Coralie English (Newcastle University, Australia) (centre).

Team members:

Dr. Amreen Mahmood, Assistant Professor, Manipal Academy of Higher Education, Manipal, India.
Dr. John Solomon M, Associate Professor- Senior Scale and Coordinator - Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India.
Dr. Manikandan N, Associate Professor- Senior Scale, Manipal Academy of Higher Education, Manipal, India.
Prof. Coralie English, University of Newcastle, Australia.

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