Sustained physical activity and health following rehabilitation: unravelling the role of perceived fatigue and activity pacing behaviour

This thesis aimed to investigate the role of fatigue and activity pacing on sustained physical activity and health among people with physical disabilities and/or chronic diseases following discharge from rehabilitation, and especially in stroke survivors. This thesis took a diagnosis-overarching and disease-specific (stroke) approach to investigate this aim. Moreover, this aim was investigated by using divers methodologies, including quantitative study designs (cohort studies and cross-sectional studies), a narrative literature review and qualitative study designs (a semi-structured interview study and a focus group study).

High levels of perceived fatigue are associated with low levels of physical activity and low levels of HR-QoL in people with physical disabilities and/or chronic diseases following discharge from rehabilitation, and especially in stroke survivors. Advice on activity pacing seems to have the potential to manage fatigue and to increase physical activity and HR-QoL in this target population in rehabilitation practice and in follow-up care. The findings of this thesis will help guide improvement of fatigue guidance (e.g., advice on activity pacing) in rehabilitation programmes and follow-up care. Especially in stroke survivors, the advice on activity pacing should be person-centred through considering the acceptance of the disease, the capability, opportunity and motivation to change physical activity behaviour, and the distinct notions of perceived fatigue (mental and physical fatigue). Besides, information on post-stroke fatigue should be provided to stroke survivors well before discharge. Also, follow-up support after rehabilitation by a stroke coach should be implemented nationwide, since survivors and professionals expressed a need for it.