Barriers and facilitators to physical activity engagement among chronic brain injury survivors: A qualitative exploration

BACKGROUND: Survivors of chronic brain injury (CBI) experience ongoing cognitive, emotional, and physical difficulties that negatively affect their health and quality of life. Physical activity (PA) is an important non-pharmacological treatment that simultaneously promotes recovery and well-being. However, CBI survivors face persistent barriers that inhibit their engagement in PA following completion of a rehabilitation program. PURPOSE: Adopting an integrated socioecological and physical literacy lens, this study explored the lived experiences of CBI survivors to elucidate the multi-level factors influencing their PA engagement. METHODS: Upon eligibility screening, individuals with a moderate or severe brain injury who met the study inclusion criteria participated in the study. Participants completed PA and demographic questionnaires and participated in a semi-structured interview informed by a phenomenological approach. Recruitment was completed once thematic saturation was achieved. RESULTS: A total of 10 individuals (6 females, 4 males) participated in the study. Thematic analysis revealed barriers and facilitators to PA engagement associated with the socioecological and physical literacy domains. We identified the intrapersonal and interpersonal socioecological domains and the knowledge and motivation physical literacy domains to be particularly salient to participants' PA experiences. Sub-themes pertaining to environmental influences included insurance, the COVID-19 pandemic, accessibility, environment, PA programs, work and school, personal support network, and professional care. Intrapersonal factors influencing PA included participants' needs, abilities, relearning, appreciation for PA, energy, fear, and mind-set. CONCLUSIONS: The study results illuminate the unique barriers and facilitators survivors of CBIs experience, informing the design of rehabilitation programs tailored to their individualized needs. As a next step, we propose that virtual exercise programming might be a promising avenue through which to increase access, enhance facilitators, and mitigate barriers to PA for this special population.