Barriers to physical activity limit stroke survivors in Singapore

Many stroke survivors in Singapore are willing to engage in physical activities (PAs), but they are usually encumbered by organizational, intrapersonal, and community barriers, reports a study.

“Most of these barriers are beyond their control,” said the researchers. “To give stroke survivors the best chance to engage in regular PA after stroke, it is vital to address these barriers and ensure the same PA opportunities accorded to the healthy population are also made available to stroke survivors.”

A face-to-face survey was conducted with stroke survivors recruited from Singapore National Stroke Association platforms. Patients aged 21 years and above, with a medical diagnosis of stroke, and had a weak arm or leg were eligible to participate.

The researchers used comprehensive Barriers to Physical Activity Questionnaire for People with Mobility Impairments (BPAQ-MI) to identify intrapersonal, interpersonal, organizational, and community barriers to PA faced by stroke survivors in Singapore.

Thirty-eight stroke survivors met the eligibility criteria and completed the survey. More than half of them had moderate or moderately severe disability and required assistance for activities of daily living or walking. [Proc Singap Healthc 2023;doi:10.1177/20101058231184953]

A total of 63 barriers were identified, spanning across intrapersonal, interpersonal, organizational, and community domains. Of these, the most reported barriers were lack of accessible classes or programs at fitness centres (21/38; 55 percent), lack of assistance from a fitness centre staff (19/38; 50 percent), and feelings of tiredness or fatigue (18/38; 47 percent).

Among the top 10 most common barriers, four were organizational, four were intrapersonal, and two were community barriers.

“Collaborative models of care between health and exercise professionals, and training programs to upskill health and exercise professionals are possible solutions to target these barriers,” according to the researchers.

Larger barriers

In addition, the findings suggested that stroke survivors who were younger, female, or more disabled experienced larger barriers.

“These results are interesting as women are known to have poorer recovery outcomes compared to men poststroke, and younger stroke survivors have been identified to have many unique unmet needs in a healthcare system which tends to cater more for the older consumer,” the researchers said. [Circ Res 2022;130:512-528; Lancet Neurol 2008;7:915-926; Disabil Rehabil 2020;42:1697-1704]

“To develop a targeted and personalized PA program that will cater to all stroke survivors, the barriers faced by [this] subgroup of individuals will need to be considered carefully as they will have unique needs that are unlikely to be met by generic exercise programs targeted at milder strokes,” they added.

The study was limited by the small sample size, the use of a translated but untested version of BPAQ-MI in a small number of surveys, and the lack of more in-depth responses, which could have been used to address the barriers or why certain survivors face more obstacles than others.

“Future studies should consider recruiting a larger sample size, testing the psychometric properties of the Mandarin version of BPAQ-MI, and combining the survey with semi-structured interviews or focus groups to further understand the barriers so that they can be addressed within the ecosystem of community living after stroke,” the researchers said.