Date of Award

Spring 2020

Document Type

Open Access Dissertation

Department

Exercise Science

First Advisor

Stacy Fritz

Abstract

Stroke is the leading cause of disability in the United States (U.S.). Impairments after stroke typically result in reduced physical activity which increases the risk for stroke recurrence and the development or worsening of comorbid health conditions. Physical activity and exercise behaviors can reduce cardiovascular risk factors and improve endurance for survivors of stroke. Despite these known significant benefits, survivors of stroke face barriers to participating in regular physical activity due to limited self-efficacy, safety concerns, environmental restrictions and lack of accessible community programs.

Cardiac Rehabilitation (CR) is a structured exercise and behavior modification program for people with cardiovascular disease that is prevalent in health care systems in the U.S. Participation in CR has been shown to increase functional exercise capacity, lower risk of hospital readmissions, and improve health related quality of life for traditional participants. Despite similar cardiovascular risk factors, stroke is not among the covered diagnoses for CR services.

The purpose of this mixed methods pilot intervention study was to examine the feasibility and participant impact of integrating survivors of stroke into an existing hospital-based CR program in the southeast U.S. Chapter two assessed feasibility through quantitative assessments of recruitment, uptake, retention, adherence, fidelity, acceptability and safety, and a qualitative evaluation of participant perception of the program. Chapter three evaluated participant impact through pilot effectiveness measures for physical function and other health impacts, and through qualitative evaluation of participant perception of outcomes and future exercise plans.

A mixed methods design combined a single group, pre-post, follow-up design, pilot feasibility study with a pragmatic qualitative inquiry. Survivors of stroke were recruited through hospital system providers and the community into a standard 12-week, 36 visit CR program. Fifty-three survivors were referred, 29 started the program and 24 completed the program. Participants were evaluated in effectiveness outcome measures at three timepoints: pre-program, post-program and six-month follow-up. Qualitative interviews occurred at the post-program evaluation. Process variables and feasibility measures were recorded and analyzed throughout the study.

Results suggest CR is feasible for survivors of stroke who were able to meet dosage and intensity goals, and perceived the program as needed regardless of their mobility limitations or previous exercise experience. Participants enjoyed the camaraderie and positive environment and felt safe and attended to by staff. CR had significant impacts on cardiovascular endurance and functional strength, which were maintained at six-month follow-up. Most participants continued to exercise in the follow-up period. Challenges focused primarily on managing referral and uptake of the program. Using an existing structured exercise program, that is widely available in the U.S., feasible for stroke survivors, and supported by qualified licensed professionals, has the potential to improve cardiovascular endurance, health status and quality of life for survivors of stroke.

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