Between commitment and avoidance - working age stroke survivors' perceptions of physical activity and sedentary behaviour: a qualitative study

It is critical for stroke survivors in working age to develop skills and confidence for long-term self-management of physical activity and exercise training to maintain a healthy lifestyle and decrease the risk of recurrent stroke and other cardiovascular diseases. Still, knowledge is scarce about concerns and experiences of physical activity and sedentary behaviour after stroke in working age, and further qualitative studies are required. The aim of this study was to explore and describe perceptions of physical activity and sedentary behaviour in stroke survivors under 65 years who are living with disability.

A qualitative design with individual semi-structured interviews was selected to generate rich data. Ten informants aged 36-61 years were interviewed 0.5-25 years after their stroke. The interviews were analysed with qualitative content analysis, with an inductive and interpretive approach.

A two-sided contradictory relationship to physical activity and sedentary behaviour was identified. The overarching theme found was "Physical activity and sedentary behaviour - between commitment and avoidance", comprising three main themes; "Physical activity - medicine for body and mind", "Physical activity reminds of limitations", and "Sedentary behaviour - risk, rest, and alternative". The informants perceived physical activity as medicine, important for both physical and mental functioning, but also as a constant reminder of having a body that no longer functions as it used to. These mixed perceptions and feelings influenced the informants' behaviours related to physical activity and sedentary behaviour, and both commitment and avoidance were clear strategies.

Working age stroke survivors expressed a clear positive perception of the importance of physical activity for health. However, physical activity was also described as a strong reminder of limitations which paradoxically could lead to sedentary behaviour. To support a physically active lifestyle post stroke, effective interventions as well as health promotion, counselling and patient education are imperative. These should be delivered by appropriately skilled health care professionals.