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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
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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).
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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),
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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).
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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
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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.
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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
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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).
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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.
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Scoresforindependenceinextendedactivitiesofdailyliving,self-efficacy,social
supportandmoodwerecomparedbetweenactiveandinactiveparticipants.
ResultsareshowninTable2.
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Activeparticipantsreportedsignificantlygreaterindependenceinactivitiesof
dailylivingthanthosewhowereinactive.Self-efficacywassignificantlygreater
inthosewhowereactivecomparedwiththosewhowereinactive.Active
participantsweremorelikelytohaveformaleducationalqualificationsthat
thosewhowereinactive.ThosewhohadsufferedTBIasaresultofaroadtraffic
accidentweremorelikelytobeactivethanthosewhohadsufferedTBIasa
resultofanothercause,suchasviolentattack.Nosignificantdifferencewas
foundbetweenactiveandinactiveparticipantsonotherdemographicvariables,
oronmeasuresofmoodandsocialsupport.
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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.
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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.
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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.
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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.
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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,
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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
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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.
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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.
References
BatemanA,CulpanF,PickeringA,PowellJ,ScottO,GreenwoodR(2001)The
effectofaerobictrainingonrehabilitationoutcomesafterrecentseverebrain
injury:Arandomizedcontrolledevaluation.ArchPhysMedRehabil82(2):174–
82
![Page 21: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/21.jpg)
BlakeH(2009)Physicalactivityandlong-termconditions.In:BlakeH(ed.)
PhysicalActivityinRehabilitationandRecovery.NovaSciencePublishersInc,
NewYork,USA
BlakeH,BatsonM(2009)Exerciseinterventioninbraininjury:apilot
randomizedstudyofTaiChiQigong.ClinRehabil23(7):589–98
BlakeH,BatsonM(2008)Exerciseinterventioninacquiredbraininjury
rehabilitation.InternationalJournalofTherapyandRehabilitation15(4):180–5
BulleyC,DonaghyM,PayneA,MutrieN(2008)Stagesofexercisebehaviour
change:Apilotstudyofmeasurementvalidity.InternationalJournalofHealth
PromotionandEducation46(1):4–10
CaspersonCJ,PereiraMA,CurranKM(2000)Changesinphysicalactivity
patternsintheUnitedStates,bysexandcross-sectionalage.MedSciSports
Exerc32(9):1601–9
ChipperfieldJG(2008)EverydayPhysicalActivityasaPredictorofLate-Life
Mortality.Gerontologist48(3):349–57
DawesH(2009)Exercisepromotionandrehabilitationofneurological
conditions.In:BlakeH(ed.)PhysicalActivityinRehabilitationandRecovery.
NovaSciencePublishersInc,NewYork,USA
![Page 22: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/22.jpg)
DepartmentofHealth(2004a)Atleastfiveaweek.Evidenceontheimpactof
physicalactivityanditsrelationshiptohealth.DepartmentofHealth,Health
ImprovementandPrevention,UK
DepartmentofHealth(2004b)ChoosingHealth.HMSO,London.Online.
http://tinyurl.com/2ajw4pg(accessed21June2010)
DepartmentofHealth(2004c)HealthSurveyforEngland2003.TheStationery
Office,London.Online.http://tinyurl.com/65sjpp(accessed21June2010)
DepartmentofHealth(2005a)Choosingactivity:aphysicalactivityactionplan.
DepartmentofHealth,London.Online.http://tinyurl.com/2dbtkd(accessed21
June2010)
DepartmentofHealth(2005b)TheNationalServiceFrameworkforlong-term
conditions.HMSO,London.Online.http://tinyurl.com/2rcjfa(accessed21June
2010)
DepartmentofHealth(2009)BeActive,BeHealthy:Aplanforgettingthenation
moving.DepartmentofHealth,London.Online.http://tinyurl.com/dd6596
(accessed21June2010)
DonathS(2001)Thevalidityofthe12-itemGeneralHealthQuestionnairein
Australia:acomparisonbetweenthreescoringmethods.AustNZJPsychiatry
35(2):231–5
![Page 23: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/23.jpg)
DriverS,O’ConnorJ,LoxC,ReesK(2004)Evaluationofanaquaticsprogramme
onfitnessparametersofindividualswithabraininjury.BrainInj18(9):847–69
DriverS(2005)Socialsupportandthephysicalactivitybehavioursofpeople
withabraininjury.BrainInj19(3):1067–75
DriverS,ReesK,O’ConnerJ,LoxC(2006)Aquatics,health-promotingself-care
behavioursandadultswithbraininjuries.BrainInj20(2):133–41
ElsworthC,DawesH,SackleyCetal(2009a)Astudyofperceivedfacilitatorsto
physicalactivityinneurologicalconditions.InternationalJournalofTherapyand
Rehabilitation16(1):17–24
ElsworthC,PatelS,MeekCetal(2009b)AphaseIIrandomizedcontrolledtrial
ofalong-termindividualfitnessenablementinterventionforpeoplewith
multiplescle-rosis.ClinicalRehabilitationConferenceProceedings23:472
ElsworthC,DawesH,SackleyCetal(2010)Perceivedfacilitatorstophysical
activityinindividualswithprogressiveneurologicalconditions;afocusgroup
andquestionnairestudy.JournalofSportSciences(inpress)
EmmonsKM,BarbeauEM,GutheilC,StrykerJE,StoddardAM(2006)Social
influences,socialcontext,andhealthbehaviorsamongworking-class,multi-
ethnicadults.HealthEducBehav34(2):315–34
![Page 24: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/24.jpg)
FolsteinMF,FolsteinFE,McHughPR(1975)“Mini-mentalstate”.Apractical
methodforgradingthecognitivestateofpatientsfortheclinician.JPsychiatric
Res12(3):189–98
GladmanJFR,LincolnNB,AdamsSA(1993)UseoftheextendedADLscalewith
strokepatients.AgeAgeing22(6):419–24
Gleeson-KreigJM(2006)Self-monitoringofphysicalactivity:effectsonself-
efficacyandbehaviorinpeoplewithtype2diabetes.DiabetesEduc32(1):69–77
GoldbergD,WilliamsP(1988)AUsersGuidetotheGeneralHealth
Questionnaire.NFER-Nelson,Windsor
GompertzP,PoundP,EbrahimS(1994)Validityoftheextendedactivitiesof
dailylivingscale.ClinRehabil8(4):275–80
HankinsM(2008)Thereliabilityofthetwelve-itemgeneralhealthquestionnaire
(GHQ-12)underrealisticassumptions.BMCPublicHealth8:345
HarnirattisaiT,JohnsonRA(2005)Effectivenessofabehavioralchange
interventioninThaieldersafterkneereplacement.NursRes54(2):97–107
![Page 25: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/25.jpg)
HarwoodRH,EbrahimS(2002)Thevalidity,reliabilityandresponsivenessof
theNottinghamExtendedActivitiesofDailyLivingscaleinpatientsundergoing
totalhipreplacement.DisabilRehabil24(7):371–7
HassettL,MoseleyAM,TateR,HarmerAR(2008)Fitnesstrainingfor
cardiorespitoryconditioningaftertraumaticbraininjury.CochraneDatabase
SystRev2:CD006123
HawleyCA,WardAB,MagnayAR,LongJ(2003)Parentalstressandburden
followingtraumaticbraininjuryamongchildrenandadolescents.BrainInj
12(1):1–23
����HellerT,HsiehK,RimmerJ(2002)Barriersandsup-portsforexercise
participationamongadultswithDownSyndrome.JGerontolSocWork38(1):
161–78
HellwegS,JohannesS(2008)Physiotherapyaftertraumaticbraininjury:a
systematicreviewoftheliterature.BrainInj22(5):365–73
JacksonD,Turner-StokesL,CulpanJetal(2001)Canbrain-injuredpatients
participateinanaerobicexer-ciseprogrammeduringearlyinpatient
rehabilitation?ClinRehabil15(5):535–44
![Page 26: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/26.jpg)
JacobKS,BrugraD,MannAH(1997)TheValidationofthe12-itemGeneral
HealthQuestionnaireamongethnicIndianwomenlivingintheUnitedKingdom.
PsycholMed27(5):1215–7
JonesKD,AdamsD,Winters-StoneK,BurckhardtCS(2006)Acomprehensive
reviewof46exercisetreat-mentstudiesinfibromyalgia(1988-2005).Health
QualLifeOutcomes4:67–73
JoshiP,IslamS,PaisPetal(2007)Riskfactorsforearlymyocardialinfarctionin
SouthAsianscomparedwithindividualsinothercountries.JAMA297(3):286–
94
KingAC,HaskellWL,YoungDR,OkaRK,StefanickML(1995)Longtermeffects
ofvaryingintensitiesandfor-matsofphysicalactivityonparticipationrates,
fitnessandlipoproteinsinmenandwomenaged50,60,65years.Circulation
91(10):2596–604
KnowlerWC,Barrett-ConnorE,FowlerSEetal(2002)Reductioninthe
incidenceoftype2diabeteswithlifestyleinterventionormetformin.NEnglJ
Med345(6):393–403
LeeS,BattM,MortimerD,Blake,BoothY(2008)Q-activeFinalReport.
NottinghamUniversityHospitalsNHSTrust.ExecutiveSummary.Online.
http://tinyurl.com/23nocko(accessed21June2010)
![Page 27: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/27.jpg)
LeeI,SkerrettPJ(2001)Physicalactivityandall-causemortality:whatisthe
dose-responserelation?MedSciSportsExerc33(6):459–71
LevinsSM,RedenbachDM,DyckI(2004)Individualandsocietalinfluenceson
participationinphysicalactivityfollowingspinalcordinjury:aqualitativestudy.
PhysTher84(6):496–509
McMillanT,RobertsonIH,BrockD,ChorltonL(2002)Briefmindfulnesstraining
forattentionalproblemsaftertraumaticbraininjury:Arandomisedcontrol
treatmenttrial.NeuropsycholRehabil12(2):117–25
MarcusBH,SelbyVC,NiauraRS,RossiJS(1992)Self-efficacyandthestagesof
exercisebehaviorchange.ResQExercSport63(1):60–6
NasreddineZS,PhillipsNA,BedirianVetal(2005)TheMontrealCognitive
Assessment,MoCA:abriefscreeningtoolformildcognitiveimpairment.JAm
GeriatrSoc53(4):695–9
NichollCR,LincolnNB,PlayfordED(2002)Thereliabilityandvalidityofthe
NottinghamExtendedActivitiesofDailyLivingScaleinpatientswithmultiple
sclerosis.MultScler8(5):372–6
NouriF,LincolnN(1987)Anextendedactivitiesofdailylivingscaleforstroke
patients.ClinRehabil1(4):301–5
![Page 28: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/28.jpg)
OkubadejoAA,O’SheaL,JonesPW,WedzichaJA(1997)Homeassessmentof
activitiesofdailylivinginpatientswithseverechronicobstructivepulmonary
diseaseonlong-termoxygentherapy.EurRespJ10(7):1572–5
PenedoFJ,DahnJR(2005)Exerciseandwell-being:areviewofmentaland
physicalhealthbenefitsasso-ciatedwithphysicalactivity.CurrOpinPsychiatry
18(2):189–93
PiperidouE,BlissJ(2008)Anexplorationofexercisetrainingeffectsincoronary
heartdisease.BrJCommunityNurs13(6):271–7
PlasquiG,WesterterpKR(2004)Seasonalvariationintotalenergyexpenditure
andphysicalactivityinDutchyoungadults.ObesRes12(4):688–94
ResnickB,JenkinsL(2000)TestingtheReliabilityandValidityoftheSelf-
EfficacyforExerciseScale.NursRes49(3):154–9
ResnickBD,LuisiA,VogelP,JunaleepaP(2004)Reliabilityandvalidityofthe
self-efficacyforexerciseandoutcomeexpectationsforexercisescaleswith
minor-ityolderadults.JNursMeas12(3):235–47
RimmerJH,WangE,SmithD(2008)Barriersassociatedwithexerciseand
communityaccessforindividualswithstroke.JRehabilResDev45(2):315–22
![Page 29: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/29.jpg)
RimmerJH,RileyB,WangE,RauworthA,JurkowskiJ(2004)PhysicalActivity
ParticipationAmongPersonswithDisabilities:BarriersandFacilitators.AmJ
PrevMed26(5):419–25
RogersLQ,CourneyaKS,RobbinsKTetal(2008)PhysicalActivityCorrelates
andBarriersinHeadandNeckCancerPatients.SupportCareCancer16(1):19–
27
SallisJF,GrossmanRM,PinskiRB,PattersonTL,NaderPR(1987)The
developmentofscalestomeasuresocialsupportfordietandexercisebehaviors.
PrevMed16(6):825–36
SharpePA,GrannerML,HuttoBE,WilcoxS,PeckL,AddyCL(2008)Correlatesof
physicalactivityamongAfricanAmericanandwhitewomen.AmJHealthBehav
32(6):701–13
SimonaviceEM,WigginsMS(2008)Exercisebarriers,self-efficacyandstagesof
change.PerceptMotSkills107(3):946–50
SteptoeA,RinkE,PhilM,KerryS(2000)PsychosocialPsychosocialpredictorsof
changesinphysicalactivityinoverweightsedentaryadultsfollowingcounseling
inprimarycare.PrevMed31(2Pt1):183–94
SternfeldB,AinsworthBE,QuesenberryCP(1999)Physicalactivitypatternsina
diversepopulationofwomen.PrevMed28(3):313–23
![Page 30: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/30.jpg)
TrostSG,PateRR,SallisJFetal(2002)Ageandgenderdifferencesinobjectively
measuredphysicalactivityinyouth.MedSciSportsExerc34(2):350–5
vanderPloegHP,vanderBeekAJ,vanderWoudeLHV,vanMechelenW(2004)
Physicalactivityforpeo-plewithadisability:aconceptualmodel.SportsMed
34(10):639–49
VissersM,vandenBerg-EmonsR,SluisT,BergenM,StamH,BussmannH(2008)
Barrierstoandfacilitatorsofeverydayphysicalactivityinpersonswithaspinal
cordinjuryafterdischargefromtherehabilitationcentre.JRehabilMed40(6):
461–7
WallaceLS,BuckworthJ,KirbyTE,ShermanWM(2000)Characteristicsof
exercisebehavioramongcollegestu-dents:applicationofsocialcognitivetheory
topredictingstageofchange.PrevMed31(5):494–505
WarburtonDER,NicolCW,BredinSSD(2006)Healthbenefitsofphysical
activity:theevi-dence.CanadianMedicalAssociationJournal174(6):801–9
WilliamsDM,LewisBA,DunsigerSetal(2008)Comparingpsychosocial
predictorsofphysicalactiv-ityadoptionandmaintenance.AnnBehavMed
36(2):186–94
WorldHealthOrganization(2001)InternationalClassificationofFunctioning,
DisabilityandHealth.WorldHealthOrganization,Geneva
![Page 31: 2010 Reavenall and Blake Determinants of physical activity ...eprints.nottingham.ac.uk/38999/1/2010 Reavenall and Blake... · Determinants of physical activity participation following](https://reader031.vdocuments.mx/reader031/viewer/2022030807/5b1582c47f8b9a1a398cd1a8/html5/thumbnails/31.jpg)
YatesPJ,WilliamsWH,HarrisA,RoundA,JenkinsR(2006)Anepidemiological
studyofheadinju-riesinaUKpopulationattendinganemer-gencypopulation.
JNeurolNeurosurgPsychiatry77(5):699–701