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Reavenall, Sarah and Blake, Holly (2010) Determinants of physical activity participation following traumatic brain injury. International Journal of Therapy and Rehabilitation, 17 (7). pp. 360-369. ISSN 1759-779X
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Determinantsofphysicalactivityparticipationfollowingtraumaticbrain
injury
�SarahReavenall1andHollyBlake2
1UniversityHospitalsBirminghamNHSFoundationTrust,BurnsCentre,New
QueenElizabethHospitalBirmingham
2DivisionofNursing,FacultyofMedicineandHealthSciences,Queen’sMedical
Centre,Nottingham,UK
Citation:Reavenall,S.,Blake,H.Determinantsofphysicalactivity
participationfollowingtraumaticbraininjury.InternationalJournalof
TherapyandRehabilitation,2010;17;7:360-367.
�Submitted18November2009,sentbackforrevisions18January2010;accepted
forpublicationfollowingdouble-blindpeerreview19May2010
Abstract
Aims:Theobjectiveofthestudydescribedinthisarticlewastoestablishthe
environmental,social,orpersonaldeterminantsassociatedwithphysicalactivity
participationinpeoplewithtraumaticbraininjury(TBI).
Methods:Amulti-centrecross-sectionalquestionnairesurveyusinga
conveniencesamplewasusedateightcommunitydaycentresforbrain-injured
populations.Theparticipantswere63individualswithtraumaticbraininjury
(51male,12female).Physicalactivityparticipationwasbasedontheproportion
ofparticipantsachievingthelevelofphysicalactivityrecommendedforhealth
(30minsmoderateactivity,mostdaysoftheweek).Standardizedmeasures
wereusedtoassessactivitiesofdailyliving(ExtendedActivitiesofDailyLiving
Scale),self-efficacy(Self-EfficacyforExerciseScale),socialsupport(Social
SupportforExerciseScale)andmood(GeneralHealthQuestionnaire-12).
Findings:Overhalftheparticipantswerenotactiveenoughforhealthbenefit.
Activeparticipantsweremoreindependentinactivitiesofdailyliving(t=-2.21,
P<0.05),hadgreaterself-efficacyforexercise(t=-3.02,P<0.05)andweremore
educated(�2=5.61,P<0.05)thaninactiveparticipants.LogisticRegression
showedself-efficacyforexercisetobetheonlysignificantpredictorofphysical
activityparticipation(�=0.32,OR1.03,P<0.05).
Conclusions:Self-efficacypredictedphysicalactivityparticipation.Effortsto
increaseself-efficacyamongbraininjuredparticipantsmayencourageactivity
participationinthosewhoareableandthiswarrantsfurtherinvestigation.
Keywords:barriers,braininjury,determinants,physicalactivity
��
Introduction
Promotingpopulationphysicalactivityishighonthepublichealthagenda
(DepartmentofHealth(DH),2005a;DH,2009).Currently,only37%ofmenand
25%ofwomenmeettherecommendedphysicalactivitytargetof30minutesof
exerciseatleastfivedaysaweek(DH,2004a;2004b;2004c).Physicalactivity
playsakeyroleindiseaseprevention(Knowleretal,2002;PiperidouandBliss,
2008),improvingqualityoflife(PenedoandDahn,2005;Warburtonetal,2006)
andpreventingprematuredeath(LeeandSkerrett,2001),sincemortalityriskis
threetimesgreaterinsedentarythanregularlyactiveindividuals(Chipperfield,
2008).Promotingactivelifestylesinpeoplewithlong-termcon-ditionsis
particularlyimportantsincetheseindividualsareatincreasedriskofsecondary
diseaseduetodeconditioning(DH,2005b;Blake,2009).
Exerciseinterventionsforbrain-injuredindividualsareontheincrease(Blake
andBatson,2008).Inparticular,community-basedphysicalactivity
interventionsforpeoplewithbraininjurieshavebeenpromotedandinclude
aerobicinterventions(Batemanetal,2001;Jacksonetal,2001;Hassettetal,
2008),aquaticprogrammes(Driveretal,2004;Driveretal,2006),andmindful
exercisesuchasTaiChi/Qigong(BlakeandBatson,2009).Whilethesestudies
suggestpositiveoutcomesofexerciseinthosewithtraumaticbraininjury(TBI),
suchinterventionsareoftenplaguedbyhighattritionrates(‘drop-out’)
(Batemanetal,2001;Jacksonetal,2001;McMillanetal,2002),whichisa
commonprobleminexerciseresearch(Jonesetal,2006).Furtherinvestigation
intothebarrierstoexercisefacedbythosewithTBImayhelptoexplainboth
thisattritionandalsodecisionstoparticipate,whichareimportantinthedesign
ofinterventionsinpractice.
�����Participationisdefinedasinvolvementina‘lifesituation’(WorldHealth
Organization(WHO),2001)andisusedinthiscontexttorefertoengagementin
physicalactivitytotherecommendedlevelforhealthbenefit.Participationin
physicalactivitybypeoplewithdisabilitiesisalreadyknowntobeacomplex,
multifacetedissuecomposedofpersonal,socialandenvironmentalbarriers(van
derPloegetal,2004;Rimmeretal,2004;Rogersetal,2008).Forhealthy
individuals,barriersarediverse,butcommonlyincludelackoftime,feelingtired,
andlackofmotivation(Leeetal,2008).
Possiblebarrierstophysicalactivityamongpeoplewithdisabilitieshavebeen
proposedforarangeofpopulations(Levinsetal,2004;Rimmeretal,2004;
Rogersetal,2008;Vissersetal,2008).However,ithasbeensuggestedthatthere
areadditionalcontextual,physical,socialandpersonalfactorsthataffect
participationinexerciseforpeoplewithneurologicalconditions(Dawes,2009).
Thesemayspecificallyincludeconcernregardingappropriatefacilities,
embarrassmentissueswhenusingcommunityvenues,perceivedlackof
knowledgeoffitnessorofhealthprofessionalsabouttheirneurologicaldisease,
andtheimpactoftheconditiononexerciseprescription(Dawes,2009;Elsworth
etal,2009a;2009b;inpress).
Physicalindependence,socialsupportandpsychologicalfactorssuchasself-
efficacyandmoodhaveallbeenshowntoinfluencephysicalactivity
participationinahealthypopulation(SimonaviceandWiggins,2008;Sharpeet
al,2008)andalsoinsedentarypopulations(Steptoeetal,2000).However,there
remainslittlepublishedevidenceaboutwhyindividualswithTBIspecifically
engageinphysicalactivity,andwhatbarrierstheyfaceinparticipation(Hellweg
andJohannes,2008;BlakeandBatson,2009).ThisisimportantsincetheTBI
populationispredominantlyyoungandmale(Yatesetal,2006)andsomaynot
bedirectlycomparabletootherneurologicalpopulations,suchasstroke,for
whichinformationaboutbarrierstoexerciseismorereadilyavailable.Theaim
ofthisstudywastodeterminetheenvironmental,socialandpersonal
determinantsassociatedwithphysicalactivityparticipationinpeoplewithTBI.
METHODS
Thiswasamulti-centrecross-sectionalquestionnairestudyusingaconvenience
sample.ApprovalwasgrantedbyalocalethicscommitteeinJuly2008.
ParticipantslivinginthecommunitywithTBIwereidentifiedthroughthe
registeredcharity‘Headway’–thenationalbraininjuryassociation–ateight
HeadwaydaycentresacrosstheMidlandsregion.Headwaymanagersidentified
participantswhometthestudyinclusioncriteria.
Participantswereinvitedtotakepartinthestudyiftheywere18yearsorolder,
hadadiagnosisofTBI,werefluentinEnglishlanguageandhadalevelof
cognitiveabilitysuchthattheywereabletocomprehendtheparticipant
informationsheet.Datawerecollectedbyatrainedresearcher,ateachcentre,on
onedesignateddaypercentrebetweenJuly2008andJanuary2009.Individuals
withTBIattendingonthatdaywereprovidedwithaletterofinvitationanda
studyinformationsheet.Theinformationsheetprovideddetailastothepurpose
ofthestudyandthevoluntarynatureofparticipation,andensuredparticipants
thattheirchoicetoparticipateornotwouldhavenoimpactontheircare.
Allthoserecruitedagreedtotakepartandcompletedaquestionnaire.
Completionoftheformwastakenasinformedconsent.Theresearcherwas
availableonrequesttoassistwithquestionnairecompletionforparticipants
withreadingorwritingdifficultiesthatpreventedthemcompletingtheform
themselves.Onlythestudyteamhadaccesstothedata.Namesandcontact
detailsofparticipantswererecordedseparatelytothequestionnaire,using
uniqueidentifiernumbers,inaccordancewiththeDataProtectionAct(1998),to
maintainanonymity.Atotalof207individualswithTBIwereregisteredatthe
centres,and63(30%)werepresentonthedatacollectiondaysandinvitedto
participate.
MEASURES
Demographicdatawerecollected,sinceresearchshowsthatvariablessuchas
age,genderandethnicityinfluencetrendsseennationallyintheuptakeof
physicalactivity(Caspersonetal,2000;Trostetal,2002;Emmonsetal,2006;
Joshietal,2007).Participantswereaskedtoprovidetheirage,gender,ethnic
origin,maritalstatus,levelofeducation(noqualifications/O-levelorGCSE
passesorhigher),lengthoftimesinceinjury,andcauseofinjury.
Basedonaconceptualmodelforphysicalactivityforpeoplewithdisabilities
(vanderPloeg,2004),personal,socialandenvironmentalfactorswereassessed.
Personalandsocialfactorswereassessedusingstandardizedquestionnaire
measuresofphysicalactivityparticipation,activitiesofdailyliving,self-efficacy,
��������socialsupportandmood.Thesix-partStagesofExerciseBehaviourChange
Model(Marcusetal,1992)wasusedtoidentifycurrentself-reportedphysical
activityparticipation.Thismeasureisextensivelyusedasanepidemiological
tool,andhasbeentestedforvalidityusingobjectivemeasuringofexercise
behaviour(Bulleyetal,2008).Originalscoringwas(0–5)frompre-
contemplationstagetomaintenancestage,whichwascollapsedtoabimodal
response(0–1)forno/yesrespectively,referredtointhetextas‘inactive’and
‘active’.Forthepurposeofthisstudy,‘active’wasdeterminedbywhetherornot
participantsreportedthattheyengagedin30minutesofphysicalactivityper
day,foraminimumof5daysaweek(DH,2004).Thosewhodidnotmeetthese
criteriawereclassedas‘inactive’.
The22-itemExtendedActivitiesofDailyLivingScale(EADL)(NouriandLincoln,
1987)wasusedtoassessself-reportedindependenceinactivitiesofdailyliving.
Thescaleisscored(0-0-1-1),indicatingparticipants’levelofindependence.
Higherscoresthereforeshowincreasedindependenceinextendedactivitiesof
dailyliving.Thescalehasbeenusedinotherchronicpopulationsincluding
stroke,arthritisofthehipandcoronaryobstructivepulmonarydisease
(Gladmanetal,1993;Gompertzetal,1994;Okubadejoetal,1997;Harwoodand
Ebrahim,2002).TheEADLanditsfoursubscaleshavedemonstratedhigh
internalconsistency(0.72–0.94)andsatisfactorytest-retestreliability(rs0.81–
0.90)inaneurologicalpopulation(Nicholletal,2002).
The9-itemSelf-EfficacyforExerciseScale(ResnickandJenkins,2000)wasused
asaself-reportmeasuretoassessperceivedself-efficacyorconfidenceto
participateinexercise.Scoringrangedfrom0–10where0=‘notveryconfident’;
10=‘veryconfident’.Totalscoreswereusedindataanalysis.Thescalehasbeen
usedwitholderadults,disabilityandchronicdiseasepopulations(Resnicketal,
2004;HarnirattisaiandJohnson,2005;Gleeson-Kreig,2006).Studieswitholder
adultshaveshownevidenceofinternalconsistency(α=0.89and0.90;0.92)
withevidenceofvaliditybasedonconfirmatoryfactoranalysisandhypothesis
testing(ResnickandJenkins,2000;Resnicketal,2004).λXestimates(allesti-
mates≥0.81)providedfurtherevidenceofvalidity(ResnickandJenkins,2000).
The13-itemSocialSupportandExerciseScale(Sallisetal,1987)wasusedto
measuretheperceivedinfluenceoffamilyandfriendsinphysicalactivity
participation.ALikert-typescalescoringsystemwasused(1‘none’/‘doesnot
apply’;2‘rarely’;3‘afewtimes’;4‘often’;5‘veryoften’)andseparatescores
obtainedforthetwosub-scales,familyandfriends.Higherscoresindicate
greaterperceivedsupport.Inhealthypopulations,test-retestandinternal
consistencyreliabilitieswereacceptable(Sallisetal,1987).Thescalehasbeen
usedpreviouslywithabrain-injuredpopulation(Driver,2005).
TheGeneralHealthQuestionnaire-12item(GoldbergandWilliams,1988)was
usedtoassessparticipantmood.Likert-typescoring(0–3)wasusedandhigher
scoresindicatelowermood.Thescaleiswell-validatedwithrecentstudies
showingreliabilitytobeadequate(α=0.73)withdiscriminationhighestwith
Likertscoringmethod(δ=0.94)(Hankins,2008).Highsensitivityandspecificity
hasbeenshowninotherclinicalpopulations(Jacobetal,1997;Donath,2001).
ThescalehasbeenusedpreviouslyinTBIresearch(Hawleyetal,2003).
Alistofenvironmentalbarrierswasdevelopedfromthepublishedevidenceon
barrierstoexerciseinlong-termconditions.Participantswereaskedtoselect
thebarriersrelevanttothemandweregivenopportunityforfurthercomment.
DatawereanalysedusingSPSSversion15.0.Allvariableswerecheckedfor
normalityusingPP-Plotandnormaldistributionwasobserved.Univariateand
multivariateanalyseswereconductedtodeterminewhichfactorspredicted
participationinphysicalactivity.UnivariateanalysisincludedT-Teststo
comparephysicalactivityparticipationonthecontinuousvariables(age,time
sinceinjury),andchi-squareteststocomparephysicalactivityparticipationon
categoricalvariables(gender,maritalstatus,ethnicorigin,levelofeducation,
causeofinjury).Variablesthatweresignificantintheunivariateanalyses
(ExtendedActivitiesofDailyLivingscore,Self-efficacyforExercisescore,
educatedyes/noandroadtrafficaccidentyes/noasthecauseofinjury)were
thenenteredintoaLogisticRegressionmodel.
RESULTS
Recruitmentandcompletionratesforquestionnaireswas100%(n=63).Age
rangedfrom19–67years(mean43.89years,SD13.42years).Almostonethird
(31.7%)weremarriedorcohabiting,withtheremainderreportingthatthey
weresingleorlivedalone(68.3%).Themajorityofparticipantsweremale.More
thanhalfoftheparticipantsreportedthattheydidnotmeetcurrent
recom���mendationsforphysicalactivity(30mins/mostdaysoftheweek).
Demographicvariableswerecomparedbetweenactiveandinactiveparticipants.
ResultsareshowninTable1.
Scoresforindependenceinextendedactivitiesofdailyliving,self-efficacy,social
supportandmoodwerecomparedbetweenactiveandinactiveparticipants.
ResultsareshowninTable2.
Activeparticipantsreportedsignificantlygreaterindependenceinactivitiesof
dailylivingthanthosewhowereinactive.Self-efficacywassignificantlygreater
inthosewhowereactivecomparedwiththosewhowereinactive.Active
participantsweremorelikelytohaveformaleducationalqualificationsthat
thosewhowereinactive.ThosewhohadsufferedTBIasaresultofaroadtraffic
accidentweremorelikelytobeactivethanthosewhohadsufferedTBIasa
resultofanothercause,suchasviolentattack.Nosignificantdifferencewas
foundbetweenactiveandinactiveparticipantsonotherdemographicvariables,
oronmeasuresofmoodandsocialsupport.
Onlythosevariableswhichshowedsignificantdifferencesinunivariateanalyses
wereenteredintoaforward-WaldLogisticRegressionequation.Theseincluded
ExtendedActivitiesofDailyLivingscore,Self-efficacyforExercisescore,whether
theparticipanthadqualifications(yes/no),androadtrafficaccidentasthecause
ofinjury(yes/no).ResultsarepresentedinTable3.
ResultsfromtheLogisticRegressionanalysisshowedthattheoverallmodelwas
significant,[χ2(4)=15.59,P<0.01]andaccountedfor29.3%ofthetotal
varianceinexerciseparticipation.Self-efficacysignificantlypredictedexercise
participation[χ2=0.32,P<0.05],inthatthosewhoreportedhigherself-efficacy
weremorelikelytoexercisethanthosewhohadlowerself-efficacy.Noother
variablesweresignificantinthemodel.
Participantsidentifiedawiderangeofadditionalbarrierstoparticipatingin
physicalactivityandthemostcommonlyselectedarepresentedinTable4.
Althoughthemostcommonlyreportedbarrierwasapersonalconcern,many
otherbarrierswereenvironmentalconcerns,suchasaccessibilityofservicesand
lackoftransport.Nosignificantdifferenceswerefoundbetweenactiveand
inactiveparticipantsontheseitemsandsotheywerenotincludedinthe
multivariateanalysis.
Themostcommonlyselectedbarrierstoparticipationwerelackofmotivation
andpersonalhealth.Freeresponsesidentifiedfurtherbarrierstophysical
activityandfactorswhichencouragedthemtotakepart.Theseadditional
barriersincludedcognitiveproblems,mostspecificallywithmemory,concern
aboutseizuresorepilepsy,physicalproblemsassociatedwithpainandseasonal
distresses,suchaschildrenusingphysicalactivityfacilitiesduringtheschool
holidayperiods.Additionalencouragingfactorstoparticipationinphysical
activityincludedenjoymentofphysicalactivities,exercisegainedthroughcaring
forpets,andencouragementprovidedbydaycentresinprovidingservices
specificallyforthem.
DISCUSSION
Morethanhalftheparticipantsreportedthattheywerenotactiveenoughfor
healthbenefit,inthattheydidnotengagein30minutesofmoderateactivityon
mostdaysoftheweek(DH,2004a).Activeparticipantsweremoreindependent
inactivitiesofdailyliving,hadgreaterself-efficacyforexerciseandmorelikely
tobeeducatedthanthosewhowereinactive.
Theaimofthisstudywastoidentifythekeypersonal,socialandenvironmental
determinantsassociatedwithphysicalactivityparticipationfollowingtraumatic
braininjury.Themainfindingwasthathighself-efficacysignificantlypredicted
physicalactivityparticipation.Althoughfindingsshouldbeinterpretedwith
cautionduetostudylimitations,previousworkissupportedwhichidentifies
self-efficacyasanimportantfactorinphysicalactivityparticipationinhealthy
populations(Sternfeldetal,1999;Wallaceetal,2000;Sharpeetal,2008;
SimonaviceandWiggins,2008),forindividualswithTBIandinthosewithother
long-termconditionsordisabilities(Steptoeetal,2000;Rimmeretal,2008;
Williamsetal,2008).
Forindividualswithhighself-efficacythishaspositiveimplications,asother
researchhasshownthatthosewhoratetheirconfidencehigherperceivefewer
barrierstophysicalactivityparticipation,andaremorelikelytomaintaintheir
physicalactivitylevelsovertime(SimonovaceandWiggins,2008;Williamsetal,
2008).Forthosewithlowself-efficacy,itmaybethatinterventionstoimprove
confidencetobeactivemayhelptoincreasetheirphysicalactivitylevels.Indeed,
pilotworkhassuggestedthatmindfulexerciseinterventionsuchasTai
Chi/Qigongmayitselfleadtoimprovementsinpsychologicaloutcomes(Blake
andBatson,2009)althoughthisrequiresfurtherinvestigation.
Despiteevidencesuggestingthatsocialsupportexertsasignificanteffecton
physicalactivityparticipation(Helleretal,2002;Levinsetal,2004),thiswasnot
supportedinthisstudy.Inthisinstance,socialsupportfromfriendsandfamily
didnotappeartoinfluencephysicalactivityinthebraininjuredindividual,
althoughpositiveviewswereexpressedtowardsdaycentrestaffinproviding
thephysicalactivityinterventionandsupportingparticipation.
Genderandethnicityhavebeenassociatedwithexerciseparticipationinother
populations(Trostetal,2002;Emmonsetal,2006),butthesampleherewas
predominantlywhitemalemakingmeaningfulgenderandethnicitycomparisons
difficulttoachieve.Giventhemale:femaleratiointheTBIpopulation,gender
comparisonsrequirelargersamplesizesandtotheauthors’knowledgethereis
noexistingdataonethnicityprofileandtheinfluenceofdifferentethnicgroups
onexerciseparticipationinTBI.
Participantsfrequentlyidentifiedlackofmotivation,theirpersonalhealthand
tirednessasimportantbarrierstophysicalactivity.Whilemotivationalissues
areevidentalsoinhealthypopulations,concernsrelatingtopersonalhealthmay
potentiallybeassociatedwithlackofknowledgeaboutthehealthbenefitsofan
activelifestyle.Thesefactorsmayalsoberelatedtofearoftheunknown,failure
andinjury(Rimmeretal,2004;Rogersetal,2008)allofwhichmayaffectthe
person’sconfidencetobephysicallyactive(Sternfeldetal,1999).
Encouragement,tailorededucationandsupportfromhealthcareprofessionals
regardingsafetyandappropriatenessofphysicalactivitiescouldhelpin
addressingsuchbarriersdirectly,andthisinturnmayincreaseconfidencetobe
moreactiveforthosewhoarephysicallyable.
Otherimportantissuesraisedincludedavailabilityofservices,transportandthe
socialaspectsofphysicalactivity,andthisinformationisrelevanttoservice
providerswhocaninvestinappropriateservicesandgroupphysicalactivity,or
provideinformationonaccessingexistingfacilities.
LIMITATIONS
Thisstudyhasanumberoflimitations.OnlyindividualswithTBIwereincluded,
althoughthefindingsmayalsoberelevanttoindividualswithothertypesof
acquiredbraininjuryandotherneurologicalpopulations,suchasstroke.The
researchersonlyaccessedindividualswhowereregisteredwiththedaycentres,
andsothebarriersanddeterminantstophysicalactivityforthosewhowerenot
inattendanceatthedaycentresonthespecifiedvisitdaysisunknown.Baseline
dataonthephysicalandcognitiveabilityofparticipantsinoursamplewasnot
collectedandthereforeitwasnotpossibletodetermineindividualcapacityfor
physicalactivity.
Futurestudiesshouldincludeassessmentofphysicalfunctionbyuseof,for
example,6-MinuteWalkTest(6MWT),FunctionalIndependenceMeasure-
Locomotor(FIM-L),or10-MeterWalkTest(10MWT).Assessmentofcognitive
functionshouldbeundertakenonaglobalmeasureofcognitivefunctionsuchas
theMini-MentalStateExamination(Folsteinetal,1975)orMontrealCognitive
Assessment(Nasreddineetal,2005).
Thefindingsofthisstudywerebasedsolelyonself-reportquestionnaire
measures,whichreliedonindividual’sabilitytodefinetheircurrentlevelof
physicalactivitycorrectly.Nevertheless,thepresenceoftheresearcheratthe
timeofcompletionmeantthatallinstructionsweredeliveredinthesameway,
bythesameresearcher,andanyqueriesweredealtwithatthetime.Including
objectivemeasuresofparticipationinphysicalactivitiesmayhavestrengthened
thefindingsandthisisanareaforfurtherdevelopment.
Thequestionnairemeasuresincludedhadestablishedreliabilityandvalidity
and,wherepossible,thiswasevidencedinchronicandneurologicalpopulations,
althoughthemeasureshadnotbeenvalidatedforTBIspecifically.Nevertheless,
wherepossible,measureswereincludedthathadbeenusedinTBIpopulations
previously.FuturetestingofthescalesusedshouldbecarriedoutamongtheTBI
populationspecificallyforawideruseoftheinstruments.Avalidandreliable
measureofparticipationinphysicalactivitiesspecifictothebraininjured
populationislacking.Participationinthisinstancewasbasedonadichotomous
measure,whichwassufficientforthepurposeofthisstudy.However,future
researchmayconsidertheuseofacontinuousmeasureofphysicalactivityto
gatherinformationonintensityofphysicalactivityparticipation.
Giventimelimitations,datacollectionspannedseveralmonths(July2008-
January2009)andthereforeitispossiblethattheremayhavebeendifferences
inactivitylevelswithseasonalchange,sincephysicalactivityparticipationis
generallyhigherinthesummer(Plasquietal,2004).
Duetothelimitationsofthestudydesignthesefindingsshouldbeinterpreted
cautiously.However,theremaybepracticeimplicationsforTBIrehabilitation.It
seemsplausiblethatinterventionstoimproveself-efficacyinTBImayinfluence
participationinphysicalactivitiesforthosewhoareable.Previousinterventions
designedforincreasingself-efficacyhavepromotedphysicalactivityusing
behaviouralchanges(Kingetal,1995),whichhasbeenreasonablyeffective
sincepsychosocialfactorsaremoreeasilymodifiablecomparedwithmost
demographicfactors(Sternfeldetal,1999).Whilethisstudyestimatesthe
proportionofindividualswithTBIparticipatinginphysicalactivity,further
researchmightincludeinvestigationintointensityofphysicalactivityforthose
whoareabletoparticipate,andpotentialdifferencesinbarriersbetween
individualswhovaryintheircapacityforparticipationinphysicalactivities
(affectedbycognitivefunctionandmobility).
CONCLUSION
MorethanhalfofindividualswithTBIattendingcommunitydaycentresinthis
studywerenotactiveenoughforhealthbenefit,andmaythereforebeatriskof
deconditioningandsecondarydisease.Despitestudylimitations,self-efficacy
emergedasthestrongestpredictorofparticipationinphysicalactivitiesforthis
population.Interventionstoimproveself-efficacymayencourageindividuals
withTBItoengageinphysicalactivities.
Educatingbraininjuredindividualsaboutthebenefitsofphysicalactivitymay
increasetheirmotivationtobemoreactive,alleviatetheirconcernsregarding
theirownphysicalhealthandhighlighttheformsofactivitythatmaybesuitable
andanylong-termbenefitsofparticipation,andthiswarrantsfurther
investigation.Informingserviceprovidersaboutthebarriersanddeterminants
specifictoTBImayassistinthedevelopmentofcommunityphysicalactivity
interventions.Thisway,rehabilitationprofessionalssuchasphysiotherapists
andcommunitysupportworkersmayencourageparticipantswhohavethe
potentialtobephysicallyactive,whileprovidingasafeenvironmenttoexercise
tomaintainhighself-efficacy.
Conflictofinterest:none
Sourceoffunding:Thisstudywascompletedaspartofadissertationfora
MastersinNursingSciencedegree(S.Reavenall).
Acknowledgements:TheauthorswouldliketothankHeadwayandall
participantsfortheirinvolvementinthestudy,andDrTonyArthurforadviceon
statisticalanalysis.
�KEYPOINTS
• �Therecommendedphysicalactivitytargetis30minutesofexerciseat
leastfivedaysaweek.
• Overhalftheparticipantsinthisstudywerenotactiveenoughforhealth
benefit.
• Self-efficacy(‘confidence’)forexercisepredictsphysicalactivity
participationinindividualswithtraumaticbraininjury.
• Interventionstoimproveself-efficacymayinfluencephysicalactivity
levelsinthosewhoareableandthisneedstobetestedinalarge-scale
study.
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