Exploring the Significance of Physical Activity to Enhance Quality of Life Among Hemiplegic Elderly: A Novel Approach Using Mixed-Methods Grounded Theory (MM-GT)

Background Elderly stroke survivors commonly live a sedentary life with some degree of mobility disability despite their independent functional ability in performing activities of daily living (ADL) and ambulation. The perception and meanings given to physical activity (PA) play a significant role in promoting active aging for better quality of life (QoL). This study aims to explore the QoL-related meanings of PA given by hemiplegic older adults living in Thailand's rural community to construct an explorative theoretical model. Methods A mixed-methods grounded theory (MM-GT) exploratory embedded research design was used with case-by-case purposive theoretical sampling for qualitative data collection and grounded analysis from community-dwelling elderlies who were hemiplegic stroke survivors. Quantifying the PA level of respondents was embedded using Global Physical Activity Questionnaires (GPAQ), whereas World Health Organization Quality of Life-Brief (WHOQOL-BREF) and Stroke Impact Scale (SIS) were used for measuring functional impacts and QoL. Results The constructive theoretical model displayed three hierarchical meaningful PA categories. Firstly, initial PA refers to activities that positively drive to more independent living and negatively drive to avoid burdening the family. Secondly, identity PA refers to what they do regarding the accountabilities of prior family roles instead of living a sedentary and empty life. Thirdly, optimizing PA is defined as what PAs do to maintain and balance their meaningful existence within the wider community. The more meaningful PA was the more possibility to turn into action and contribute to the QoL of elderly hemiplegic stroke survivors. The MM-GT exploratory embedded research design with the lens of the Theory of Everything (TOE) helped to disclose the multidimensional QoL-related meanings of the PA behaviors of older people with mobility disability. Meanwhile, the Social Cognitive Learning Theory (SCLT) enhanced its learning property and explanatory power. Conclusions These findings have significant implications for geriatrics, rehabilitation, and public health areas, providing insights into the role of meaningful PA in improving the QoL of elderly stroke survivors and using it as a strategy for promoting active aging and improving QoL within their living community. The gender distribution of respondents and the particular semi-urban context of this study limited its generalizability.