Patient factors influencing participation in aerobic exercise during inpatient and outpatient rehabilitation post stroke: a prospective cohort study
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Background
Aerobic exercise is recommended during stroke rehabilitation to improve cardiorespiratory fitness and support recovery; however, participation rates remain low. While institutional and system-level barriers have been widely examined, less is known about how individual patient factors influence engagement in aerobic exercise during rehabilitation.
Objectives
We aimed to determine whether depressive symptoms, apathy, self□efficacy and outcome expectations for exercise, perceived barriers, or past exercise history were associated with aerobic exercise participation in stroke rehabilitation.
Methods
In this prospective cohort sub□study, adults admitted to in- or out-patient stroke rehabilitation at three urban hospitals completed validated questionnaires assessing depressive symptoms, apathy, exercise self□efficacy, outcome expectations for exercise, perceived barriers to being active, and premorbid exercise history. Participants were separated into two groups for analysis: those who completed aerobic exercise during rehabilitation and those who did not. Equivalence testing and between□group comparisons were performed.
Results
Sixty□two participants were enrolled; 16 participated in aerobic exercise and 46 did not. Groups were not equivalent on any individual□level factors. Compared to non□participants, those who performed aerobic exercise had significantly higher depressive symptom scores (p=0.0025) and lower self□efficacy for exercise (p=0.0087). Non□participants demonstrated significantly higher apathy (p=0.0007). No significant differences were found for outcome expectations, perceived barriers, or exercise history.
Conclusion
Depressive symptoms and lower self□efficacy did not impede aerobic exercise participation during rehabilitation. Increased apathy, however, was associated with non□participation. Findings highlight the need for individually tailored aerobic exercise prescriptions that consider motivational and affective factors to optimize engagement during stroke rehabilitation.
