Patient perceptions of physical activity after patent foramen ovale (PFO)-associated stroke and transcatheter closure: A qualitative study

Background: The presence of a patent foramen ovale (PFO) in the heart is a risk factor for stroke due to the potential for paradoxical embolism. Given the implication of the heart in PFO-associated stroke and transcatheter closure, there may be unique factors that prevent patients from returning to physical activity. Purpose: To elicit patient perceptions of physical activity after PFO-associated stroke and transcatheter closure. Method: A purposive sample of 48 individuals who had a PFO-associated stroke participated in this study. Data were collected using semi-structured interviews and data were analyzed using Braun and Clarke’s thematic analysis methodology. NVivo software was used to manage data, code, and generate themes. Results: Participants were on average 47.7 years of age (SD = 8.2). All participants were diagnosed with ischemic stroke or transient ischemic attack and 44 participants received transcatheter PFO closure. The main themes (and sub themes) related to perceptions of physical activity after stroke and closure were: (1) psychological barriers (fear and anxiety, and closure device apprehension); (2) variability in fitness performance (subjective fitness improvement and decline in physical activity compared to before their stroke); and (3) variability in physical recovery (lingering fatigue/neuro-fatigue, residual physical symptoms, and cardiac irregularities after closure). Conclusion: PFO-associated stroke survivors reported several significant and unique barriers (e.g., cardiac irregularities) to engaging in physical activity after PFO-associated stroke and closure. Some participants also reported improved fitness after their closure procedure. These findings highlight the need for further research to better support patient recovery and reduce uncertainty surrounding return-to-activity recommendations.