Associations of environmental and personal factors, participation and health-related quality of life with physical activity and sedentary behavior in people with subarachnoid hemorrhage: a cross-sectional accelerometer-based study

Purpose: To explore associations of environmental and personal factors, participation, and health-related quality of life (HR-QoL) with physical behavior (PB) after subarachnoid hemorrhage (SAH). Materials and Methods: PB, expressed in duration and distribution of physical activity (PA; walking, running, cycling) and sedentary behavior (SB; lying/sitting) and PA intensity was assessed with the Activ8 accelerometer during 7 days. Environmental and personal factors (social influence, health-condition, illness-perception, self-efficacy, fatigue, mood, kinesiophobia, cognition, coping, sleep), participation and HR-QoL, were assessed with validated questionnaires. Correlation analyses were conducted. Results: In total 39 SAH survivors participated on average 9.6 months post-SAH onset, mean age was 53.2 years (SD = 13.2) and 59% were women. Moderate correlations were found (r = 0.300-0.500, p < 0.05): worse illness-perception, cognition, fatigue, social support, participation, and HR-QoL were associated with worse PA outcomes. Additionally, higher age, unemployment, smoking, longer hospital stay, aneurysmal-SAH, and discharge to outpatient rehabilitation were associated with worse PA outcomes. Worse cognition, participation, smoking, more severe SAH and longer hospital stay were associated with worse SB outcomes. Conclusions: Targeting illness perception, cognition, fatigue, and social support, might improve PB post-SAH, which may improve participation and HR-QoL. In smokers (former/current), unemployed, older or more severely affected individuals, improving PB might be more challenging.Implications for rehabilitation Both environmental and personal factors were associated with poorer physical behavior (PB) after subarachnoid hemorrhage (SAH). Poorer PB was associated with worse participation and HR-QoL in SAH survivors. Targeting social support, illness perception, fatigue and cognition may improve PB after SAH. Improving PB in SAH survivors who smoke or have been smoking, are unemployed, older, or more severely affected, might be challenging.