Presentation by Meriel Norris for the ESRC Seminar Series on Ageing and Physical Activity - "Physical activity among hard to reach groups: Issues for research, policy and practice" http://seminars.ecehh.org

1. “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

2. Brunel University London
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?
17 November 2015
Presentation Title 2

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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 17 November 2015
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What’s exercise got to do with this? 17 November 2015
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Stroke and exercise 17 November 2015
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Increasing age
Physical inactivity
Chronic 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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13. Brunel University London
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 found
Theme 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? 17 November 2015
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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
17 November 2015
22From 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
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