The course of physical functioning in the first two years after stroke depends on peoples’ individual movement behavior patterns

Abstract

Background and purpose: Deterioration of physical functioning after stroke in the long term is regarded as a major problem. Currently, the relationship between 'peoples' movement behavior patterns (the composition of sedentary behavior and physical activity during waking hours) directly after stroke and the development of physical functioning over time is unknown. Therefore, the objectives of this study were to investigate 1) the course of physical functioning within the first two years after returning home after stroke and 2) the association between physical functioning and baseline movement behavior patterns. Method: In the longitudinal RISE cohort study, 200 persons with a first-ever stroke discharged to the home-setting were included. 'Participants' physical functioning was assessed within three weeks, at six months, and one and two years after discharge using the Stroke Impact Scale (SIS) 3.0 subscale physical and the five-meter walk test (5MWT). Three distinct movement behavior patterns were identified in a previous study at baseline and were used in the current study: 1. 'sedentary 'exercisers' (sufficiently active and 64% of waking hours sedentary), 2. 'sedentary 'movers' (inactive and sedentary 63% of waking hours sedentary), and 3. 'sedentary 'prolongers' (inactive and >78% of waking hours sedentary accumulated in long prolonged bouts). The association between movement behavior patterns and the course of physical functioning was determined using longitudinal generalized estimating equations analyses. Results: Overall participants' physical functioning increased between discharge and six months and declined from six months up to two years. Physical functioning remained stable during the first two years after stroke in 'sedentary 'exercisers'. Physical functioning improved during the first six months after discharge in 'sedentary 'movers' and 'sedentary 'prolongers' and deteriorated in the following six months. Only physical functioning (SIS) of 'sedentary 'prolongers' further declined from one up to two years. A similar pattern was observed in the 5MWT. Conclusion: Movement behavior patterns identified directly after returning home in people with stroke are associated with and are predictive of the course of physical functioning. Highly sedentary and inactive people with stroke have unfavorable outcomes over time than individuals with higher amounts of physical activity.

Identifying Unique Subgroups of Individuals With Stroke Using Heart Rate and Steps to Characterize Physical Activity

“…In addition to variability within our sample, the combined heart rate and step count metrics were key variables in distinguishing the 3 subgroups identified by k‐means clustering. Previous work has identified distinct subgroups with respect to sedentary behavior and moderate to vigorous activity patterns in individuals after stroke 11 ; however, that work did not use heart rate data. Thus, it is particularly noteworthy that the proportion of time spent in the low steps and high heart rate state was significantly different between the subgroups identified here.…”

“…The Deconditioned and Sedentary groups show a much larger difference when compared with one another in the combined metric relative to the differences in more conventional metrics such as steps per day and sedentary time. 11 The difference on the combined metric is of particular interest because it indicates that different interventions might be needed for individuals in these 2 subgroups. Specifically, the Sedentary group might benefit from behavioral modifications to increase activity, 31 , 32 whereas the Deconditioned group might benefit from both behavioral modifications to increase activity and cardiovascular conditioning.…”

“…The subgrouping work done previously in stroke has used only step count‐based metrics of PA, whether these counts are derived from proprietary (as provided by commercially available personal wearables) or raw count‐based (as derived from raw accelerometry data) metrics. 11 Although many metrics can be derived from minute‐level stepping data, determination of the intensity of PA with stepping data is particularly challenging in patient groups that have heterogeneous walking speeds and gait mechanics. Variability in these gait parameters makes it difficult to set minute‐level thresholds that accurately define intensity.…”

The whole day matters after stroke: Study protocol for a randomized controlled trial investigating the effect of a ‘sit less, move more, sleep better’ program early after stroke

“…For instance, dedicating more time to physical activity necessitates reducing time spent sleeping or engaging in sedentary behaviour, or both. Gaining insight into these relationships is crucial for targeted care, as they are predictors of recovery and health outcomes [13,14]. Employing a whole-day approach that maximizes stepping time and repetitions, frequently interrupts sedentary behaviour, and optimizes sleep may be beneficial.…”

The World Stroke Academy: A World Stroke Organization global pathway to improve knowledge in stroke care

“… 2 , 11 , 12 There is lack of educational provision on the topic of life after stroke as well as lack of government attention to long-term support for stroke survivors despite what we know about their needs. We need to take actions to ensure stroke survivors are getting the best possible recovery (optimization of recovery) to achieve the best possible outcome, to build on scientific evidence, 13 to reduce the overall social costs 14 , 15 by introducing innovative strategies (e.g. public reporting of outcomes, use of validated risk prognostic scores, and implementing mobile stroke units and telestroke to deliver high-quality stroke care in underserved areas) 16 – 18 and preventing substantial hardship (reducing costs for governments to care for stroke survivors), and to create a community for Allied Health Professionals working with stroke survivors and caregivers.…”