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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