Motivation, Daily Physical Activity Participation, and Depression Post-Stroke

Self-management is an important concept in stroke rehabilitation and has received increased recognition for its effectiveness in preventing stroke recurrence and post-stroke depression. Among different self-management strategies, staying physically active is purported to be most helpful by patients in their day-to-day management of depression. However, stroke survivors are largely sedentary and only 17% meet the recommended level of physical activity. Motivation is a strong, frequently reported, but far less studied facilitator for post-stroke physical activity participation. The purpose of this dissertation was to gather needed information to develop a mobile motivation-based self-management intervention to enhance daily physical activity participation and psychological health in stroke survivors. This dissertation leveraged mHealth technologies by employing innovative multimodal ambulatory monitoring to understand the motivational processes underpinning daily physical activity participation and their impact on depressive symptomatology in real-world environments. Multimodal ambulatory monitoring integrates the rigor of accelerometry to monitor free-living physical activity and the merit of ecological momentary assessment to capture motivation and depressive symptomatology that vary quickly in response to the changing contexts in everyday life. The aims of this dissertation were threefold: (1) review theory-based self-management interventions for people with stroke and other neurological disorders; (2) determine the validity, acceptability, and feasibility of multimodal ambulatory monitoring in stroke survivors; (3) uncover the dynamic motivational processes underpinning daily physical activity participation and depressive symptomatology in stroke survivors