Background
Methods
Informants
Age, years | 56.5 (36–61) |
Sex, women / men | 6 / 4 |
Time since stroke | |
< 1 year | 2 |
1–3 years | 3 |
8–24 years | 5 |
Living status | |
alone | 6 |
alone with children | 2 |
with partner | 2 |
Working status | |
working part-time | 3 |
on sick leave | 4 |
on disability pension | 3 |
Ambulatory statusa | |
walking without aid | 7 |
walking without aid indoors, motorised wheelchair outdoors | 1 |
walking with aid | 2 |
Activities of daily living | |
independent | 8 |
with home-care services | 2 |
Self-reported physical activityb, hours/week | |
low intensity | 7 (1–15) |
moderate-to-vigorous intensity | 1.8 (0–4.5) |
Data collection
Data analysis
Meaning unit | Condensed text | Code | Subtheme | Main theme |
---|---|---|---|---|
“With exercise I can make the pain go away, or at least reduce it. That’s why I avoid a lot of painkillers.” | Prefer exercise instead of painkillers | Physical activity reduces pain | Physical activity is treatment | Physical activity – medicine for body and mind |
“I tried to ride a bike last autumn but I haven’t tried again now this spring. I don’t think I dare. If something happens unexpectedly, like a noise or someone appearing suddenly, my reaction is very strong.” | I don’t dare to ride a bicycle anymore because something unexpected might happen | Fear of falling | Feelings of insecurity | Physical activity reminds of limitations |
“In the beginning when I couldn’t sit up straight, I thought I’ll never be able to go outside … I’ll be like an old person, just sit [in the wheelchair] and look out the window. That’s how I was in the beginning. But now, I hardly sit at all, I don’t sit all day.” | I was afraid I would be sitting and not be able walk again, but now I hardly sit at all | Avoid wheelchair | Risk factor for impairment and dependence | Sedentary behaviour – risk, rest, and alternative |
Results
Overarching theme | Main themes | Subthemes |
---|---|---|
Physical activity and sedentary behaviour – between commitment and avoidance | Physical activity – medicine for body and mind | Physical activity is treatment |
Strengthened identity and self-image | ||
Exercising gives a sense of context and meaning | ||
Positive emotions and well-being | ||
Physical activity reminds of limitations | Demands and frustration | |
Reminder of disability | ||
Feelings of insecurity | ||
Increased pain and discomfort | ||
Sedentary behaviour – risk, rest, and alternative | Risk factor for impairment and dependence | |
Necessary for recovery | ||
Sedentary activities for body and mind |
Overarching theme: Physical activity and sedentary behaviour – between commitment and avoidance
Main theme 1: Physical activity – medicine for body and mind
“With exercise, something happens, even if you don’t believe it. We will never be like before, that’s the way it is, but we will be much better.” (I6)
Physical activity is treatment
“Physical activity is the only thing that can make me, let’s say, become normal. Return to my normal life. And there are no other ways, no other pills, no such thing.” (I9)
Strengthened identity and self-image
“ I notice that I can do more for myself now. Going to the gym and exercising on my own, that also increases my self-confidence.” (I3)
Exercising gives a sense of context and meaning
“I don’t say “I’m going to exercise now”, I say “I’m going to work” - this is my job. I walk and I cycle, and do this and that and the other. That’s the way it is. We work with our own body – it’s also a job. That’s why we have … those who have sickness benefits or such, it’s also a job they have. You have to work with yourself.” (I6)
Positive emotions and well-being
Some expressed strong emotions of gratitude for what the body can accomplish and be able to perform physical activities after a stroke. Finding forms of activity that highlight one’s resources and make the body feel and function as before gave a feeling of freedom. To be able to continue with the same activities as before the stroke, even though it was with adaptions, was appreciated. Ball games of various kinds, swimming, dance, and rhythmic training were given as examples of activities that were fun.“Physical activity gives me harmony. It makes you happy, you know, the endorphins are bubbling, and it makes you very positive.” (I4)
“I think swimming was the first time that I felt a little normal and could move properly and almost run, stand on one leg and things like that … it was a fantastic feeling!” (I8)
Main theme 2: Physical activity reminds of limitations
“I’m still scared someone is going to bump into me and knock me over.” (I8)
Demands and frustration
Informants talked about a constant struggle, with demands both from themselves and from family members to be more physically active. Not being able or able to live up to these expectations gave a bad conscience.“Everyday life still takes a lot of time. If, for example, I vacuum one day and clean the kitchen, then it is almost a day’s project in addition to cooking and things you do every day. It will be, like, the event of the day.” (I7)
Reminder of disability
It was mentioned that being active requires personal responsibility and discipline, which may be difficult with cognitive dysfunction. Planning, encouragement, and help from other people, as well as adaptation of training and premises were needed. Some expressed that all the logistics related to physical activity simply had become too difficult and complicated. The need for guidance and support to be physically active could persist long after the stroke and limit the choice of activities.“I have been thinking about horse riding again, maybe in the future, maybe tomorrow... But I don’t want the others in the stable to be there because I know everyone watches each other … that's the way it is …" (I4)
Feelings of insecurity
“I would rather exercise at a [physiotherapy] clinic than at a regular gym. I feel safe and there is a physiotherapist who is there and helps all the time. If I start doing something [wrong], she says no, no, no … (laughs) … She has a watchful eye all the time and she knows what we need to do.” (I1)
Increased pain and discomfort
“So, I have pain, but it will be twice as much if I take my stick and walk. I like to walk and go out and do things like that, but I can’t. It's not that I don’t dare … but I know I will get a lot of pain afterwards.” (I6)
Main theme 3: Sedentary behaviour – risk, rest, and alternative
“I have to think about myself, that I must push myself, I know it's not good if I’m lazy and just sit.” (I4)
Risk factor for impairment and dependence
“No, you have to make an effort. And you can’t just sit in front of the TV. It’s easy to get stuck there [ … ] The worst thing you can do is stay in bed and think that help will come to you.” (I1)
Necessary for recovery
“It’s not that I'm so tired that I can’t do anything. But that’s how it is right after … but with that said, I recover quite fast. But it will have an impact on the rest of the day.” (I10)
Sedentary activities for body and mind
“In the beginning when I started here [at the tennis club], I actually started sitting on a chair. So, I sat on a regular chair at the baseline and then the coaches hit the balls so I could reach. Well, I can only say that these guys down here have been great!” (I2)