Exercise in British South Asian Stroke Survivors

“I can do it and I will do it” but do they do it?: A qualitative exploration of exercise in British South Asian stroke survivors

Meriel Norris

Hrudya Philip

Brunel University London

1 May 2023

Presentation Title 2

Plan of talk

• Stroke, exercise and ethnicity – what is the fuss about?

• What we did• What we found• What is this actually suggesting?• So what?


Stroke

• Long term neurological condition

• Closely linked with other cardiovascular problems (risk factors)

• One of the leading causes of acquired disability in the world with risk increasing with age


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Stroke and ethnicity


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What’s exercise got to do with this?


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Stroke and exercise

Increasing agePhysical inactivityChronic diseases

smoking

Stroke

Physical inactivity

Direct effect of stroke

Fitness impairments

Cycle of ‘detraining’ post-stroke

Activity limitations

Participation restriction

Other impairments

From Mead and van Wijck 2013


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Exercise and stroke

• Exercise decreases the risk of stroke and recurrent strokes (Gordon et al 2014)

• Exercise improves physical function post stroke (French et al 2010 +)

• Exercise may have antidepressant qualities post stroke (Saunders et al 2013)

BUT…


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Exercise and South Asians

• South Asians have lower levels of participation in exercise than Caucasian populations

• Those that are involved do less moderate to vigorous exercise (Fischbachet et al 2009, Ghouri et al 2013)

• Several barriers to exercise are noted (Horne et al 2010, 2012, Lawton et al 2006)

• Cost• Weather/environment• Motivation• Education on benefits• Social/religious restrictions

• Language

• Also facilitators

• Anticipated health benefits

• Social support (multiple sources)

• Professional support


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Aim

To explore the complex interaction between stroke and exercise in British South Asian stroke survivors.


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What we did

Methodologically informed by interpretative phenomenology.

Semi-structured interviews with stroke survivors from self-identified South Asian background (n=7), thematically analysed.

Participants

• 4M: 3F

• Mean age 58 years (37-81)

• Range of religions – Hindu, Muslim, Sikh, Christian

• Long time in the UK – mean 40 years

• Varied time post stroke – mean 7 years (0.5-14)


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What we found Theme 1

“Why can’t I do it? I should be able to do it and I will do it.


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Self-belief

Determination with a hope of recovery- goal setting/ achievement

- creating a cycle of achievement

“once I have done it [exercise], I’m so happy inside. Yes! I have done it. I can do it. I can do it. Then it just motivates me more. If I can do this, I’m sure I can do that and just one step stretch myself one step further and further.” Mohit

BUT when meaningful change did not occur

“I want to improve myself and still don’t improve…I thought exercise was very good for me and I can improve myself. I can’t. Now I am stuck where I am. I don’t know what to do.” Seema


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Pre-morbid habits

Returning to a personal narrative

“The goals that I want to achieve right now is I would like to run a marathon. But probably not, you know, but at least I want to get back to myself and a lot more exercise” Mohit

“Before the stroke I used to do a lot of exercise…I was one of the fit fanatics…Now I do exercises, but these are light exercises. Things have changed considerably. Slowly, slowly I want to go to the extent that I used to.” Rahman


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Fear

Concerned with death, falls and impairment/pain

“I was in so much pain [in arm]…I felt really scared…I thought it was going to break.” Mohit

• May decrease with time and experience

• May be quite specific to the condition and myths around causation, but also real restrictions due to impairments


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God

A source of personal strength

“My God gave me the will power and the strength from inside. I have to do it and He will give me everything” Fathima (from participants across the religious groups)


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What we foundTheme 2

Exercise is not just about the individual


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Family

A source of motivation“my kids, my son, my daughter and my partner, my mrs they always say to me that you can do it. Do not say no. you can always do it. So that really motivated me.” Mohit

Absence of that support is critical

“I like to go for swimming. But I don’t think anybody will take me. You know my brother has his own business. My sons are too young. I am scared to go, what if I fall down…I feel helpless. I can’t go by myself”. Rohit

But not for all – fear of family member can be restrictive

“my wife doesn’t allow me to go anywhere on my own, even if I try…She is part of my problem, she is too negative minded.” Johny


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Peer groups

Doing with others encourages and improves confidence- Sharing of knowledge but also emotions

“I like to ask…is this okay or this? She shows me and I show her and it is good…all people together and working out at the same time is good.” Reena

But not for everyone

“I don’t like to talk to people, my nature is like that. I like to be alone. I don’t like group exercise” Johny


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Health professionals

Experts have been here before

Hospital based

“listen to the physiotherapists because they know the best of what to do because they have dealt with so many other patients.” Mohit

But real issues with this contact

“in the hospital, nobody ever told me about the stroke exercise classes or anything like that, nothing”.

But who are health professionals?


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Environmental factors

Distance and fatigue

“I used to go to a gymnasium but that was closed. I like to go where there is disabled people. But then going for exercise, in the train with all the people…pulling and pushing, pulling and pushing. It’s hard.” Rohit

Weather

Accessibility


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So what is this actually suggesting?


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Factors (some) associated with regular physical activity/exercise

Personal• Age

• Educational attainment

• Income

• Health

• Perceptions of success

Behavioural• Goal setting

Environmental• Family

• Social support

• Physician/professional advice

• Transport

• Physical environment

From Kaminsky ed. (ACSM) 2006


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Summary

• Stroke survivors from South Asian background could be classed as a difficult to reach population in relation to exercise

• Exercise is important to this group

• There may be some specific factors that relate to ethnicity

• There are some specific factors that relate to stroke

• There are more factors that are common to all people

• Focussing on hard to reach populations may enhance our understanding of all

Health & Medicine

Exercise in British South Asian Stroke Survivors