Prevalence of five lifestyle risk factors among U.S. adults with and without stroke

Factors associated with health behaviours among stroke survivors: A mixed-methods study using COM-B model

AIMS

To identify factors associated with health behaviours among stroke survivors, through a multi-centre study.

DESIGN

A sequential mixed methods design.

METHODS

In the quantitative research phase, a total of 350 participants were recruited through multi-stage sampling from December 2022 to June 2023. General information questionnaires, The Stroke Prevention Knowledge Questionnaire (SPKQ), Short Form Health Belief Model Scale (SF-HBMS), Health Promoting Lifestyle Profile (HPLPII), and the WHOQOL-BREF (World Health Organization Quality of Life Questionnaire, Brief Version) were distributed across five tertiary hospitals in Henan province, China. For the qualitative research component, semi-structured interviews were conducted to explore the barriers and facilitators of health behaviour. This study adheres to the GRAMMS guidelines.

RESULTS

A total of 315 participants (90.0%) completed the survey. Identified barriers to health behaviour included residing in rural areas, higher scores on the Charlson Comorbidity Index (CCI) and mRS, as well as lower scores on SPKQ, SF-HBMS and WHOQOL-BREF. Twenty-four individuals participated in qualitative interviews. Twenty-eight themes were identified and categorised by frequency, covering areas such as knowledge, skills, intentions, social influences, social/professional role and identity, environmental context and resources, beliefs about capabilities, beliefs about consequences and behavioural regulation. Both quantitative and qualitative data suggested that health behaviour among stroke survivors is at a moderate level, and the identified barrier factors can be mapped into the COM-B model (Capability, Opportunity, Motivation and Behaviour).

CONCLUSION

The study indicates that key barriers to health behaviour among stroke survivors align with the COM-B model. These identified factors should be carefully considered in the planning of future systematic interventions aimed at improving health behaviours among stroke survivors.

PATIENT OR PUBLIC CONTRIBUTION

Patients were invited to completed questionnaires in the study and semi-structured interviews. The investigators provided explanation of this study' content, purpose and addressed issues during the data collection.

Reducing risk behaviours after stroke: An overview of reviews interrogating primary study data using the Theoretical Domains Framework

BACKGROUND

Lifestyle changes, in addition to preventive medications, optimise stroke secondary prevention. Evidence from systematic reviews support behaviour-change interventions post-stroke to address lifestyle-related risk. However, understanding of the theory-driven mediators that affect behaviour-change post-stroke is lacking.

METHODS

Electronic databases MEDLINE, Embase, Epistemonikos and Cochrane Library of Systematic Reviews were searched to March 2023 for systematic reviews addressing behaviour-change after stroke. Primary studies from identified systematic reviews were interrogated for evidence supporting theoretically-grounded interventions. Data were synthesized in new meta-analyses examining behaviour-change domains of the Theoretical Domains Framework (TDF) and secondary prevention outcomes.

RESULTS

From 71 identified SRs, 246 primary studies were screened. Only 19 trials (N = 2530 participants) were identified that employed theoretically-grounded interventions and measured associated mediators for behaviour-change. Identified mediators mapped to 5 of 14 possible TDF domains. Trial follow-up ranged between 1-12 months and no studies addressed primary outcomes of recurrent stroke or cardiovascular mortality and/or morbidity. Lifestyle interventions targeting mediators mapped to the TDF Knowledge domain may improve the likelihood of medication adherence (OR 6.08 [2.79, 13.26], I2 = 0%); physical activity participation (OR 2.97 [1.73, 5.12], I2 = 0%) and smoking cessation (OR 10.37 [3.22, 33.39], I2 = 20%) post-stroke, supported by low certainty evidence; Lifestyle interventions targeting mediators mapping to both TDF domains of Knowledge and Beliefs about Consequences may improve medication adherence post-stroke (SMD 0.36 [0.07, 0.64], I2 = 13%, very low certainty evidence); Lifestyle interventions targeting mediators mapped to Beliefs about Capabilities and Emotions domains may modulate low mood post-stroke (SMD -0.70 [-1.28, -0.12], I2 = 81%, low certainty evidence).

CONCLUSION

Limited theory-based research and use of behaviour-change mediators exists within stroke secondary prevention trials. Knowledge, Beliefs about Consequences, and Emotions are the domains which positively influence risk-reducing behaviours post-stroke. Behaviour-change interventions should include these evidence-based constructs known to be effective. Future trials should address cardiovascular outcomes and ensure adequate follow-up time.

Healthy lifestyle behaviors among teachers working in public primary schools and affecting factors

Healthy lifestyle behaviors have been recognized as a key strategy to achieve a policy of health for all. The aim of this study was to determine the levels of health promotion lifestyle behavior among teachers working in public primary schools. The present study also investigated the effects of selected socio-demographic characteristics on these behaviors. The research was designed using the survey model, one of the quantitative research methods. The sample of the research consisted of public primary school teachers (n = 372). Research data were collected using the Health-Promotion Lifestyle Profile-II (HPLP-II) scale. As a result of the research, it was put forward that there were statistically significant differences in levels of health promotion lifestyle behaviors based on taking courses on health promotion, and following programs and articles about healthy living (p < 0.05). It was revealed that primary teachers' taking courses on health promotion, and following programs and articles affected their healthy lifestyle behaviors. Public primary school teachers' health promotion lifestyle behaviors were found to be moderate. It was found that the primary teachers obtained the highest mean score for the spiritual growth subscale of the health promotion lifestyle behaviors scale; however, the primary school teachers had the lowest mean score for the physical activity subscale, which indicates that they need support in improving their healthy lifestyle. Male teachers had higher mean scores in the physical activity subscale, whereas females had higher mean scores in all other subscales. Training programs to protect and improve the health of teachers should be organized.

Performance of Dietary Behaviors in Chronic Community-Dwelling Stroke Survivors: A Mixed-Methods Study

In order to gain a better understanding of post-stroke dietary behaviors (e.g., selecting, accessing, and preparing healthy foods) among chronic, community-dwelling stroke survivors, we conducted a mixed-methods study consisting of a quantitative online survey (n = 63) and follow-up focus groups with a subset of participants (n = 7). Perceived performance, assistance required, adaptive equipment and compensatory strategies used, and sources of education and training were examined. Results demonstrated (1) diminished post-stroke performance for most dietary behaviors (e.g., grocery shopping, meal preparation), (2) an increased desire to eat healthily to prevent recurrent stroke, (3) variable use of adaptive equipment and compensatory strategies, and (4) limited healthcare-based dietary behavior education and training. These results suggest that stroke survivors could benefit from increased dietary behavior intervention to improve dietary behavior performance. Findings can be used to guide clinical intervention and design future research studies.

Health risk factors in Australian Stroke Survivors: A latent class analysis

ISSUES ADDRESSED

To (i) determine the prevalence of health risk factors (physical activity, diet, alcohol, smoking, blood pressure medication use and mental health) in community-dwelling stroke survivors; and (ii) examine how these health risk factors cluster, and identify associations with physical functioning, independent living, or sociodemographic factors.

METHODS

A secondary analysis of data obtained during a national randomised controlled trial. Participants had experienced stroke and completed a baseline telephone survey on demographic and stroke characteristics, health risk factors, physical functioning and independence in activities of daily living. A latent class analysis was performed to determine health risk profiles. Univariate logistic regressions were performed to identify if participant characteristics were associated with resulting classes.

RESULTS

Data analysed from 399 participants. Two classes of health risk factors were identified: Low Mood, Food & Moves Risk (16% of participants) and Alcohol Use Risk (84% of participants). The Low Mood, Food & Moves Risk group had poorer diet quality, lower physical activity levels and higher levels of depression and anxiety. Lower levels of independence and physical functioning were predictor variables for this group. In contrast, the Alcohol Use Risk group had better physical activity and diet scores, significantly lower probability of depression and anxiety, but a higher probability of risky drinking.

CONCLUSIONS

We identified two distinct health risk factor groups in our population. SO WHAT?: Future interventions may benefit from targeting the specific needs and requirements of people who have experienced stroke based on their distinct risk group. Alcohol consumption in poststroke populations requires further attention.

Differences in health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors aged ≥65 years in the USA

OBJECTIVES

To examine differences in health characteristics and health behaviors between rural and non-rural stroke survivors in the USA.

METHODS

Data were extracted from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) to compare prevalences of health characteristics (i.e., diabetes, disability, poor health, high cholesterol, hypertension, no health care coverage, weight status) and health behaviors (i.e., fruit consumption, vegetable consumption, physical inactivity, high alcohol consumption, smoking) among community-dwelling stroke survivors, stratified by rural status (i.e., rural vs. non-rural). Logistic regression was used to calculate odds ratios (ORs) for health characteristics and health behaviors to examine the association of rural status with each variable of interest (reference group=non-rural).

RESULTS

Data from 14,599 respondents (rural: n = 5,039; non-rural: n = 9,560) were available for analysis. The majority of respondents were female (61.4%), non-Hispanic white (83.2%), previously married (56.1%), had at least some college education (55.2%), and had an annual household income ≥USD $25,000 (56.9%). Prevalences of disability, poor health, weekly aerobic exercise, and smoking were higher among rural respondents compared to non-rural respondents. Logistic regression showed increased odds (odds ratio range: 1.1-1.2) for these variables among rural respondents; however, odds ratios were attenuated after controlling for sociodemographic and health characteristics.

CONCLUSIONS

We did not find evidence of differences in the investigated health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors in the USA. Additional research is needed to confirm these findings and to identify alternative sociodemographic and health factors that may differ between rural and non-rural community-dwelling stroke survivors.

Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry

Background

The incidence of acute ischemic stroke caused by large vessel occlusion is relatively infrequent in the young adult population. We sought to evaluate their clinical outcomes after endovascular treatment (EVT) and stroke etiology compared with older patients.

Methods

We examined data from the ANGEL-ACT registry, a nationwide study in China focusing on EVT for acute ischemic stroke. We compared two age groups: <50 years old and ≥50 years old. Our analysis focused on outcome measures such as the 90-day modified Rankin Scale (mRS) score, mortality, and symptomatic intracranial hemorrhage (sICH). We adjusted for confounding variables.

Results

We included 1,691 patients, and 216 patients (13%) were <50 years old. Young patients had lower median National Institutes of Health Stroke Scale (NIHSS) scores (14 vs. 17, P < 0.001) and fewer cardiovascular comorbidities than older patients. Underlying intracranial atherosclerosis disease (ICAD) was higher in young patients (39.4 vs. 28.7%, P = 0.001). Clinical outcome was less favorable in older compared to younger patients (mRS shift: 0.76 [95% confidence interval (CI), 0.58-0.99]); functional independence [mRS score 0-2] 61% vs. 39% (adjusted odds ratio (OR), 0.7 [95% CI, 0.51-0.97]). Mortality and sICH did not differ between groups. Onset to puncture time (OTP) was longer in young patients (357 min vs. 294 min, P = 0.001).

Conclusion

An estimated 13% of patients who underwent endovascular thrombectomy for acute ischemic stroke were <50 years old. Symptomatic underlying ICAD was more prevalent in the younger patient population. Despite a prehospital delay, younger patients exhibited more favorable outcomes than their older counterparts.

Association between Living Conditions and the Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults

Objective In recent decades, living conditions have changed drastically. However, there are few data regarding the interaction between living conditions and the risk of ischemic stroke (IS) in young adults. The present study explored the association between living conditions or marital status and the risk factors, etiology, and outcome of IS in young adults. Methods We prospectively enrolled patients with incident IS who were 20-49 years old from 37 clinical stroke centers. We collected the demographic data, living conditions, marital status, vascular risk factors, disease etiology, treatment, and outcomes at discharge. A comparison group was established using the official statistics of Japan. We categorized patients into the two groups based on living conditions: solitary group and cohabiting group. Clinical characteristics were then compared between living conditions. Results In total, 303 patients were enrolled (224 men; median age at the onset: 44 years old). Significant factors associated with the incidence of IS were as follows: solitary status, body mass index >30 kg/m2, current smoking, heavy alcohol consumption, hypertension, diabetes mellitus, and dyslipidemia. Furthermore, in the solitary group, the proportions of men, unmarried individuals, and current smokers were significantly higher than in the cohabiting group. In addition, poor outcomes (modified Rankin Scale ≥4) of IS were more common in the solitary group than in the cohabiting group. Conclusion Our study showed that not only conventional vascular risk factors but also living conditions, especially living alone while unmarried, were independent risk factors for IS in young adults.

Interventions for Behaviour Change and Self-Management of Risk in Stroke Secondary Prevention: An Overview of Reviews

INTRODUCTION

Optimised secondary prevention strategies that include lifestyle change are recommended after stroke. While multiple systematic reviews (SRs) address behaviour change interventions, intervention definitions, and associated outcomes differ between reviews. This overview of reviews addresses the pressing need to synthesise high-level evidence for lifestyle-based behavioural and/or self-management interventions to reduce risk in stroke secondary prevention in a structured, consistent way.

METHODS

Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were applied to meta-analyses, demonstrating statistically significant effect sizes to establish the certainty of existing evidence. Electronic databases MEDLINE, Embase, Epistemonikos, and the Cochrane Library of Systematic Reviews were systematically searched, current to March 2023.

RESULTS

Fifteen SRs were identified following screening, with moderate overlap of primary studies demonstrated (5.84% degree of corrected covered area). Interventions identified could be broadly categorised as multimodal; behavioural change; self-management; psychological talk therapies, albeit with overlap between some theoretical domains. Seventy-two meta-analyses addressing twenty-one preventive outcomes of interest were reported. Best-evidence synthesis identifies that for primary outcomes of mortality and future cardiovascular events post-stroke, moderate certainty GRADE evidence supports multimodal interventions to reduce cardiac events, with no available evidence for outcomes of mortality (all-cause or cardiovascular) or recurrent stroke events. For secondary outcomes addressing risk-reducing behaviours, best-evidence synthesis identifies moderate certainty GRADE evidence for multimodal lifestyle-based interventions to increase physical activity participation, and low certainty GRADE evidence for behavioural change interventions to improve healthy eating post-stroke. Similarly, low certainty GRADE evidence supports self-management interventions to improve preventive medication adherence. For mood self-management post-stroke, moderate GRADE evidence supports psychological therapies for remission and/or reduction of depression and low/very low certainty GRADE evidence for reduction of psychological distress and anxiety. Best-evidence for outcomes addressing proxy physiological measures identified low GRADE evidence supporting multimodal interventions to improve blood pressure, waist circumference, and LDL cholesterol.

CONCLUSION

Effective strategies to redress risk-related health behaviours are required in stroke survivors to complement current pharmacological secondary prevention. Inclusion of multimodal interventions and psychological talk therapies in evidence-based stroke secondary prevention programmes is warranted given the moderate GRADE of evidence that supports their role in risk reduction. Given the overlap in primary studies across reviews, often with overlapping theoretical domains between broad intervention categories, further research is required to identify optimal intervention behavioural change theories and techniques employed in behavioural/self-management interventions.

Behaviour Change to Promote Diabetes Outcomes: Getting More From What We Have Through Dissemination and Scalability

The potential benefits of advanced medical treatments (pharmacotherapies) and technologies (diagnostics, devices and apps) are unrealized due to lack of sustained behaviour change in individuals living with type 2 diabetes. The lack of scale-up of effective health behaviour change interventions limits health improvement. Identification of mediators of behaviour change (adherence, self-efficacy, intrinsic motivation) can address this limitation by shifting the focus of behaviour change from input (which behaviour change strategy to choose) to output (what can the person adhere to and sustain). Technology and accessing the workplace environment to promote change offer scalable opportunities for facilitating health behaviour change in populations.

Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke

INTRODUCTION

Survivors of stroke have an elevated risk of recurrent stroke. Prompt intervention to support healthy lifestyle modification following an initial stroke is crucial for effective secondary prevention of stroke. However, many patients do not receive adequate postdischarge support for secondary prevention, particularly if not referred to inpatient rehabilitation. Living Well After Stroke is a health promotion programme based on the health action process approach (HAPA), which is designed to support this underserviced group to improve and self-manage secondary prevention behavioural performance (eg, diet, exercise, medication-adherence) by equipping participants with a toolkit of theory-based and evidence-based behaviour change strategies and techniques that are transferable to different behavioural contexts.

METHODS AND ANALYSIS

The target sample is 118 adults living in Queensland, Australia, with stroke or transient ischaemic attack not referred to inpatient rehabilitation. Adopting a prospective single-arm trial design, the intervention comprises five behaviour change sessions over an 8-week period. Participants will receive a mix of individual-based and group-based assessments and interventions, based on the HAPA theoretical framework, delivered via telehealth or in-person (eg, public library). Measures of primary (ie, goal behaviours 1 and 2) and secondary outcomes (intention, outcome expectancy, risk perception, self-efficacy, planning, action control, subjective well-being) will be taken at 2 weeks, 4 weeks, 8 weeks and 16 weeks. The primary outcomes of the trial will be behavioural performance and transferability of behaviour change skills at 16 weeks.

ETHICS AND DISSEMINATION

The study has received ethical approval from the Griffith University Human Research Ethics Committee (Ref no: 2022/308). Informed consent is obtained via telephone prior to data collection. Findings will be presented in the form of peer-reviewed journal articles, industry reports and conference presentations, and will be used to inform the continued development and refinement of the programme for testing in a future fully powered trial.

Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke

Increased physical activity is required in patients with stroke that are hospitalized in the rehabilitation unit. This study investigated the association between the daily number of steps and walking independence in order to determine the cutoff value of daily number of steps that can predict walking independence in hospitalized patients with sub-acute stroke. This cross-sectional observational study included 85 stroke patients admitted to the rehabilitation unit. The average daily number of steps was measured using Fitbit One for 4 days starting at 30 days after stroke onset. 6-min walk test, and Fugl-Meyer assessment of the lower extremities were measured The category of walking independence was classified using the Functional Ambulation Category (FAC). The subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was conducted to investigate the association of daily number of steps with walking independence and a receiver operating characteristic curve was used to identify the cutoff value of daily number of steps for predicting walking independence. The daily number of steps (per 1000 steps) was independently associated with walking independence (odds ratio (OR); 2.53, 95% confidence interval (CI); 1.40–5.73, p = 0.009). The cutoff value of daily number of steps for predicting independent walking was 4286 steps (area under the curve = 0.914, sensitivity of 0.731, and specificity of 0.949). The daily number of steps was associated with independent walking in hospitalized patients with sub-acute stroke. The daily number of steps may be a useful target in rehabilitation for patients with sub-acute stroke.

The power of a healthy lifestyle for cancer prevention: the example of colorectal cancer

OBJECTIVE

We aimed to directly compare the estimated effects of adherence to a healthy lifestyle with those of risk predisposition according to known genetic variants affecting colorectal cancer (CRC) risk, to support effective risk communication for cancer prevention.

METHODS

A healthy lifestyle score (HLS) was derived from 5 lifestyle factors: smoking, alcohol consumption, diet, physical activity, and body adiposity. The association of lifestyle and polygenic risk score (PRS) (based on 140 CRC-associated risk loci) with CRC risk was assessed with multiple logistic regression and compared through the genetic risk equivalent (GRE), a novel approach providing an estimate of the effects of adherence to a healthy lifestyle in terms of percentile differences in PRS.

RESULTS

A higher HLS was associated with lower CRC risk (4,844 cases, 3,964 controls). Those adhering to all 5 healthy lifestyle factors had a 62% (95% CI 54%-68%) lower CRC risk than those adhering to ≤ 2 healthy lifestyle factors. The estimated effect of adherence to all 5 compared with ≤ 2 healthy lifestyle factors was as strong as the effect of having a 79 percentile (GRE 79, 95% CI 61-97) lower PRS. The association between a healthy lifestyle and CRC risk was independent of PRS level but was particularly pronounced among those with a family history of CRC in ≥ 1 first-degree relative (P-interaction = 0.0013).

CONCLUSIONS

A healthy lifestyle was strongly inversely associated with CRC risk. The large GRE indicated that CRC risk determined by polygenic risk may be offset to a substantial extent by adherence to a healthy lifestyle.

Evidence Surrounding Dietary Behavior Interventions in Community-Dwelling Stroke Survivors: A Scoping Review

Objective: To identify and summarize studies that have implemented dietary behavior interventions and reported dietary outcomes in community-dwelling adult stroke survivors. Design: Scoping Review; Setting: Not applicable. Participants: Studies eligible for review included peer-reviewed studies describing both a dietary intervention and a dietary outcome among community-dwelling stroke survivors published between January 2000 and June 2022. Results: We identified 14 articles that included both a dietary behavior intervention and a dietary outcome. All studies (5 pilot randomized controlled trials (RCTs), 6 non-pilot RCTs, 3 cohort studies) delivered multimodal health behavior interventions that included a dietary component. Interventions were delivered weekly to every other month and lasted for 1–24 months. Most studies did not use standardized assessments to assess dietary outcomes; however, 8 studies reported improvement in dietary outcomes. Conclusions: This review provides support for the efficacy of dietary behavior interventions in stroke survivors. Variability in intervention format and assessment measures across studies impedes the ability to conduct meta-analyses of outcomes to inform research knowledge and clinical practice. Additional research is needed to determine mechanisms-of-action for dietary behavior change in stroke survivors.

Clinical Characteristics and Risk Factors of First-Ever Stroke in Young Adults: A Multicenter, Prospective Cohort Study

Stroke in young adults has catastrophic consequences and has increased in prevalence, contrary to the trends of most other diseases. This study aimed to determine the major characteristics and risk factors for stroke in younger adults compared with older adults. From the Korean Stroke Cohort for Functioning and Rehabilitation, 10,584 patients with first-ever stroke between August 2012 and March 2015 were enrolled retrospectively and divided into younger (age ≤ 45) and older groups (age > 45). The clinical characteristics and risk factors of stroke were compared between the younger and older groups. The younger group comprised 915 patients (8.6%). The proportion of hemorrhage strokes in the younger group (42.3%) was significantly higher than in the older group (20.0%) (p < 0.001). Obesity, current smoking, and heavy alcohol consumption were significantly more common risk factors in the younger group than in the older group for all stroke types, whereas hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and coronary heart disease were significantly more frequent in the older group (both p < 0.001). The major risk factors in the younger group may be lifestyle-related. Therefore, increasing awareness of lifestyle-related risk factors may be necessary to prevent stroke in young adults.

Impact of Cardiovascular Diseases on Ischemic Stroke Outcomes

Stroke induces complex pathological cascades in the affected brain area, leading to brain injury and functional disability. To fight against cerebral ischemia/reperfusion-induced neuronal death, numerous neuroprotective strategies and reagents have been studied. However, translation of these neuroprotective drugs to clinical trials has been unsuccessful. To date, the tissue plasminogen activator is still the only FDA-approved drug for treating ischemic stroke. Thus, it is obligatory to identify and validate additional therapeutic strategies for stroke. A stroke rarely occurs without any other pathophysiological condition; but instead, it often has multi-morbidity conditions, one of which is cardiac disease. Indeed, up to half of the stroke cases are associated with cardiac and large artery diseases. As an adequate blood supply is essential for the brain to maintain its normal function, any pathophysiological alterations in the heart are frequently implicated in stroke outcomes. In this review, we summarize some of the cardiovascular factors that influence stroke outcomes and propose that considering these factors in designing stroke therapies should enhance success in clinical trials. We also highlight the recent advances regarding the potential effect of protein aggregates in a peripheral organ, such as in the heart, on ischemic stroke-caused brain injury and functional recovery. Including these and other comorbidity factors in the future therapeutic strategy designs should facilitate translational success toward developing effective combinational therapies for the disorder.

[The effective post-stroke adaptation behavior model requires a family support system]

PURPOSE

This study aimed to explain the effective post-stroke adaptation behavior based on the Roy's adaptation model (RAM) through the patient experiences when undergoing the adaptation process after stroke.

METHODS

This study was qualitative used a phenomenological approach. The participants were patients undergoing post-stroke recovery at home with the following inclusion criteria: post-discharge from the hospital 2-3 months, and in stable medical condition. The data were collected through in-depth interviews. The data analysis was performed through content analysis. We used Lincoln and Guba's criteria to establish the trustworthiness of the study.

RESULTS

Three thematic categories structured the meaning of the stroke survivor's experience: (1) Problems after stroke; (2) Adaptive coping strategies and (3) Effective adaptation response.

CONCLUSION

A thematic analysis integrated with Roy's adaptation model generated an effective post-stroke adaptation model. We recommend the development of a family empowerment intervention framework to improve the adaptation behavior of stroke survivors.

Health Behavior Change Following Stroke: Recommendations for Adapting the Diabetes Prevention Program-Group Lifestyle Balance Program

Objective. History of stroke increases risk for recurrent stroke, which is a significant issue faced by survivors. The Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB) program is an effective lifestyle modification intervention for ameliorating cardiovascular risk factors but has not been adapted to account for common stroke-related deficits. The purpose of this study was to determine appropriate adaptations to the DPP-GLB for adults with stroke. Design and Methods. In this phenomenological qualitative study, a total of 15 community-dwelling adults with stroke and 10 care-partners participated in 4 focus groups to review DPP-GLB curriculum materials and provide recommendations for adaptation. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes. Results. Three themes were identified. First, physical, cognitive, sensory, and psychosocial stroke-related deficits could affect DPP-GLB participation. Second, existing DPP-GLB characteristics could facilitate participation by adults with stroke. Third, stroke-specific adaptations were recommended, including modified session content and format, adapted physical activity and dietary recommendations, and inclusion of care-partners. Conclusion. Current DPP-GLB content and structure may be insufficient to meet the unique needs of adults with stroke. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for preliminary efficacy for reducing recurrent stroke risk.

Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event

OBJECTIVES

Socioeconomic status (SES) and lifestyle have impact on recovery after ischaemic stroke (IS) and on risk of recurrent ischaemic stroke (RIS) in elderly patients. With regard to currently available limited data on young people, we aimed to assess SES and parameters of lifestyle and evaluate their relationship to stroke recovery and risk of RIS in young patients.

METHODS

We analysed consecutive young IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischaemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). Data were acquired from structured a self-evaluating multiple-choice questionnaire. Clinical outcome was assessed using the Modified Rankin Scale (MRS) after 3 months with score 0-1 for excellent outcome.

RESULTS

Data were obtained from 297 (163 males, mean age 39.6 ± 7.8 years) young patients. Patients with MRS 0-1 (237, 79.8%) did not differ in SES except university education (21.1 vs. 3.3%; p = 0.001), less smoked (16.5 vs. 58.3%; p < 0.001), more of them did regular sport activities (79.1 vs. 51.6%; p = 0.02) and passed regular preventive medical checks (45.6 vs. 24.2%; p = 0.01). Twelve (4%) patients suffered from RIS during a follow-up with median of 25 months. They did not differ in SES but had higher body mass index (31.6 vs. 26.7; p = 0.007), reported less regular sport activities (16.7 vs. 73.0%; p < 0.001) and less regular medical checks (8.3 vs. 40.0%; p = 0.001).

CONCLUSION

In young patients, SES had no relationship to clinical outcome after IS and to risk of RIS except education level. Some parameters of health lifestyle were presented more in patients with excellent outcome and without RIS during the follow-up.

Association of obesity and diabetes with physical activity and fruit and vegetable consumption in stroke survivors

BACKGROUND

Engaging in unhealthy behaviours [poor diet, insufficient physical activity (PA)] increases risk for recurrent stroke and can be compounded by obesity and diabetes, but the association of obesity and diabetes with poor diet and insufficient PA in stroke survivors is unknown.

OBJECTIVE

The purpose of this study was to compare prevalences of low fruit and vegetable consumption (low FV consumption, <1 fruit and <1 vegetable daily) and low physical activity (low PA, <150 minutes of weekly moderate-intensity PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, both conditions).

METHODS

Cross-sectional data from 32 876 non-institutionalized, US stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AORs) of the investigated unhealthy behaviours (adjusted for sex, age, race, income, education and marital status) and 95% confidence intervals (CIs) were calculated.

RESULTS

Prevalences of low FV consumption and low PA exceeded 50% across all obesity-diabetes categories. Compared with respondents with neither obesity nor diabetes, AORs for low PA were increased for respondents with both obesity and diabetes (2.02, 95% CI: 1.72-2.37) and respondents with obesity only (1.31, 1.13-1.53); AORs for low FV consumption did not differ across obesity-diabetes categories.

CONCLUSIONS

Results indicated a joint effect of obesity and diabetes with low PA among stroke survivors. Regardless of obesity-diabetes status, however, prevalence of low FV consumption and low PA exceeded 50%. Targeted interventions that modify these unhealthy behaviours among stroke survivors should be explored.

The effective post-stroke adaptation behavior model requires a family support system

PURPOSE

This study aimed to explain the effective post-stroke adaptation behavior based on the Roy's adaptation model (RAM) through the patient experiences when undergoing the adaptation process after stroke.

METHODS

This study was qualitative used a phenomenological approach. The participants were patients undergoing post-stroke recovery at home with the following inclusion criteria: post-discharge from the hospital 2-3 months, and in stable medical condition. The data were collected through in-depth interviews. The data analysis was performed through content analysis. We used Lincoln and Guba's criteria to establish the trustworthiness of the study.

RESULTS

Three thematic categories structured the meaning of the stroke survivor's experience: (1) Problems after stroke; (2) Adaptive coping strategies and (3) Effective adaptation response.

CONCLUSION

A thematic analysis integrated with Roy's adaptation model generated an effective post-stroke adaptation model. We recommend the development of a family empowerment intervention framework to improve the adaptation behavior of stroke survivors.

Influences of Daily Life Habits on Risk Factors of Stroke Based on Decision Tree and Correlation Matrix

Purpose

To explore the influences of smoking, alcohol consumption, drinking tea, diet, sleep, and exercise on the risk of stroke and relationships among the factors, present corresponding knowledge-based rules, and provide a scientific basis for assessment and intervention of risk factors of stroke.

Methods

The decision tree C4.5 algorithm was optimized and utilized to establish a model for stroke risk assessment; then, the main risk factors of stroke (including hypertension, dyslipidemia, diabetes, atrial fibrillation, body mass index (BMI), history of stroke, family history of stroke, and transient ischemic attack (TIA)) and daily habits (e.g., smoking, alcohol consumption, drinking tea, diet, sleep, and exercise) were analyzed; corresponding knowledge-based rules were finally presented. Establish a correlation matrix of stroke risk factors and analyze the relationship between stroke risk factors.

Results

The accuracy of the established model for stroke risk assessment was 87.53%, and the kappa coefficient was 0.8344, which was superior to that of the random forest and Logistic algorithm. Additionally, 37 knowledge-based rules that can be used for prevention of risk factors of stroke were derived and verified. According to in-depth analysis of risk factors of stroke, the values of smoking, exercise, sleep, drinking tea, alcohol consumption, and diet were 6.00, 7.00, 8.67, 9.33, 10.00, 10.60, and 10.75, respectively, indicating that their influence on risk factors of stroke was reduced in turn; on the one hand, smoking and exercise were strongly associated with other risk factors of stroke; on the other hand, sleep, drinking tea, alcohol consumption, and diet were not firmly associated with other risk factors of stroke, and they were relatively tightly associated with smoking and exercise.

Conclusions

Establishment of a model for stroke risk assessment, analysis of factors influencing risk factors of stroke, analysis of relationships among those factors, and derivation of knowledge-based rules are helpful for prevention and treatment of stroke.

Association of Perceived Built Environment Attributes with Objectively Measured Physical Activity in Community-Dwelling Ambulatory Patients with Stroke

There is little evidence on how perceptions of the built environment may influence physical activity among post-stroke patients. This study aimed to explore the associations between perceived built environment attributes and objectively measured physical activity outcomes in community-dwelling ambulatory patients with stroke. This cross-sectional study recruited patients who could walk outside without assistance. We assessed both objectively measured physical activity outcomes such as number of steps and duration of moderate-to-vigorous physical activity (MVPA) with an accelerometer and the patients’ perceived surrounding built environment with the International Physical Activity Questionnaire Environmental Module. Sixty-one patients (67.0 years old) were included. The multiple linear regression analysis showed significant associations of the presence of sidewalks (β = 0.274, p = 0.016) and access to recreational facilities (β = 0.284, p = 0.010) with the number of steps taken (adjusted R² = 0.33). In contrast, no significant associations were found between perceived built environment attributes and MVPA. These findings may help to suggest an approach to promote appropriate physical activity in patients with stroke depending on their surrounding built environment.

Lifestyle Risk Behaviors Among Stroke Survivors With and Without Diabetes

OBJECTIVE

History of stroke and diabetes increases risk for cardiometabolic disease, which can be mitigated through lifestyle management. To evaluate lifestyle risk behaviors among stroke survivors, we compared the prevalence of three lifestyle risk behaviors-physical inactivity, consuming one or less fruit and one or less vegetable daily, and overweight/obesity-between stroke survivors with and without diabetes.

DESIGN

Data from the 2013 and 2015 Behavioral Risk Factor Surveillance System were examined. Weighted and age-adjusted prevalence estimates as well as crude and adjusted odds ratios (adjusted for sociodemographic characteristics) were calculated to compare lifestyle risk behaviors between US stroke survivors with and without diabetes.

RESULTS

Prevalence and adjusted odds ratios for lifestyle risk behaviors were higher in respondents with diabetes compared with those without diabetes for consuming one or less fruit and one or less vegetable daily (58.8% vs. 53.7%, adjusted odds ratio = 1.14), physical inactivity (65.7% vs. 54.6%, adjusted odds ratio = 1.41), and overweight/obesity (87.2% vs. 63.1%, adjusted odds ratio = 2.42).

CONCLUSIONS

Prevalence of select lifestyle risk behaviors exceeds 50% in adults with stroke but is higher in adults with diabetes compared with adults without diabetes. Effective interventions, community programs, and healthcare policy are needed to promote lifestyle management in adults with stroke, particularly among those with diabetes.

Examining daily physical activity in community-dwelling adults with stroke using social cognitive theory: an exploratory, qualitative study

Purpose: A better understanding of psychosocial factors underlying daily physical activity (i.e. physical activity performed throughout the day) in stroke survivors could be used to develop interventions to promote post-stroke physical activity, particularly in individuals for whom exercise is difficult.Methods: In-depth qualitative interviews were conducted with 15 ambulatory, community-dwelling stroke survivors. Interview transcripts were analyzed using directed content analysis, guided by Social Cognitive Theory, to investigate outcomes expectations, self-efficacy, self-regulation, and social-support for daily physical activity.Results: Participants reported that physical and mental health, and independence and recovery, were important outcomes expectations. Self-efficacy was enhanced through mental perceptions and mastery experiences. Planning, problem-solving, reviewing performance, and establishing routines that require physical activity were important self-regulation strategies. Social support provided praise and encouragement and physical assistance, but was also a barrier when friends and family were overprotective.Conclusions: Participants reported that the investigated Social Cognitive Theory constructs were important psychosocial factors for daily physical activity. Future research and clinical investigations should empirically test the use of strategies to modify these factors for promoting daily physical activity in community-dwelling adults with stroke.Implications for rehabilitationInterventions to increase physical activity after stroke are needed.Outcomes expectations, self-efficacy, self-regulation, and social support were reported by participants as important psychosocial factors underlying daily physical activity.These psychosocial factors should be explored with individual patients and clients to determine which are most deficient, and where amenable to change, targeted for intervention to promote daily physical activity.