Physical activity participation in community dwelling stroke survivors: synergy and dissonance between motivation and capability. A qualitative study

Objectives: The evidence supporting benefits of physical activity (PA) on fitness, functioning, health and secondary prevention after stroke is compelling. However, many stroke survivors remain insufficiently active. This study explored survivors' perspectives and experiences of PA participation to develop an explanatory framework that physiotherapists and other health professionals can use to develop person-specific strategies for PA promotion.

Design: Qualitative study using semi-structured in-depth interviews. Data was audio-recorded and transcribed. Analysis followed the Framework Approach.

Setting: Community setting, interviews conducted within participants' homes.

Participants: Community dwelling stroke survivors (n=38) six months or more after the end of their rehabilitation, purposively selected by disability, PA participation and socio-demographic status.

Results: Findings suggest that survivors' beliefs, attitudes, and physical and social context generated synergy or dissonance between motivation (desire to be active) and capability (resources to be active) for PA participation. Dissonance occurred when motivated survivors had limited capability for activity, often leading to frustration. Confidence to achieve goals and determination to overcome barriers, acted as activity catalysts when other influences were synergistic. We illustrate these relationships in a dynamic explanatory model that can be used to support both novel interventions and personal activity plans.

Conclusions: This study suggests a shift is required from purely pragmatic approaches to PA promotion towards conceptual solutions. Understanding how synergy or dissonance between motivation and capability influence individual survivors' behaviour will support physiotherapists and other health professionals in promoting PA. This study provides a model for developing person-centred, tailored interventions that address barriers encountered by stroke survivors.