Exercise barriers contributing to reduced physical activity in chronic stroke survivors in a multi-ethnic population: a cross-sectional study in Suriname

Objectives: Despite all the recommendations physical activity (PA) and participation in structured PA programs remains low among the stroke survivors. Compared to high-income societies, these patients face unequal socio-economic challenges in countries with low-and middle- income and in multi-ethnic populations. We therefore aimed to explore factors associated with reduced PA levels in chronic stroke patients living in a middle-income country with a multi-ethnic population, Suriname. Furthermore, we explored possible barriers that may prevent participation in exercise programs. Methods: We recruited participants from the general population and the Academic Hospital, and used energy expenditure (EE) and step count, measured with the GARMIN Forerunner 225 for seven consecutive days to evaluate PA. With the Barriers to Physical Activity and Disability (BPAD) questionnaire we identified exercise barriers and obtained demographic and socio-economic characteristics. We used regression analyses to assess associations with reduced PA levels, and descriptive analyses to assess exercise barriers based on socio-economic diversity. Results: The mean age of the 44 participants was 58.2 +/- 10.0 years and 21 were men. The median EE and steps were 24.2 (min-max: 16.1-53.7) Cal/kg/day and 3165.5 (min-max: 1093.0-9727.00) steps/day, respectively. Reduced PA levels were not related to demographic or socio-economic variables. Overall, patient-reported environmental exercise barriers were (1) "cost of the program" (45%) followed by (2) "lack of transportation" (34%). Personal barriers were (1) "feeling that an exercise instructor is incapable to set up an exercise program to meet their needs" (88%) and (2) "not willing to spend money" (40%). Different personal exercise barriers between ethnic groups were reported, but environmental barriers were the same. Conclusions: Reduced PA levels in chronic stroke survivors were not explained by demographic or socio-economic variables. The participants reported several exercise barriers. In addition to the most common occurring barriers, future research should also evaluate feasibility and (cost-) effectiveness of tailored PA programs.