1
|
Ibeneme SC, Mah J, Omeje C, Fortwengel G, Nwosu AO, Irem FO, Ibeneme GC, Myezwa H, Nweke M. Effectiveness of pedometer-based walking programmes in improving some modifiable risk factors of stroke among community-dwelling older adults: a systematic review, theoretical synthesis and meta-analysis. BMC Geriatr 2024; 24:516. [PMID: 38872081 DOI: 10.1186/s12877-024-05069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Pedometer-based walking programs hold promise as a health promotion strategy for stroke prevention in community-dwelling older adults, particularly when targeted at physical activity-related modifiable risk factors. The question arises: What is the effectiveness of pedometer-based walking program interventions in improving modifiable stroke risk factors among community-dwelling older adults? METHOD Eight databases were searched up to December 2nd, 2023, following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol. Inclusion criteria focused on randomized controlled trials (RCTS) involving community-dwelling older adults and reported in English. Two independent reviewers utilized Physiotherapy Evidence Database (PEDro) tool to extract data, assess eligibility, evaluate study quality, and identify potential bias. Standardized mean difference (SMD) was employed as summary statistics for primary -physical activity level -and secondary outcomes related to cardiovascular function (blood pressure) and metabolic syndrome, including obesity (measured by body mass index and waist circumference), fasting blood sugar, glycated hemoglobin, high-density lipoprotein cholesterol (HDL-C), and triglycerides. A random-effects model was used to generate summary estimates of effects. RESULTS The review analyzed eight studies involving 1546 participants aged 60-85 years, with 1348 successfully completing the studies. Across these studies, pedometer-based walking programs were implemented 2-3 times per week, with sessions lasting 40-60 minutes, over a duration of 4-26 weeks. The risk of bias varied from high to moderate. Our narrative synthesis revealed positive trends in HDL-C levels, fasting blood sugar, and glycated hemoglobin, suggesting improved glycemic control and long-term blood sugar management. However, the impact on triglycerides was only marginal. Primary meta-analysis demonstrated significantly improved physical activity behavior (SMD=0.44,95%CI:0.26, 0.61,p=<0.00001;I2=0%;4 studies; 532 participants) and systolic blood pressure (SMD=-0.34,95%CI:-0.59,-0.09;p=<0.008;I2=65%,2 studies;249 participants), unlike diastolic blood pressure (SMD=0.13,95%CI:-0.13,-0.38,p=0.33; I2=91%; 2 studies; 237 participants). Interventions based on social cognitive, self-efficacy, and self-efficiency theory(ies), and social cognitive theory applied in an ecological framework, were linked to successful physical activity behavior outcomes. CONCLUSION Pedometer-based walking programs, utilizing interpersonal health behavior theory/ecological framework, enhance physical activity behavior and have antihypertensive effects in community-dwelling older adults. While they do not significantly affect diastolic blood pressure, these programs potentially serve as a primary stroke prevention strategy aligning with global health goals. TRIAL REGISTRATION Registration Number: INPLASY202230118.
Collapse
Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria.
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa.
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria.
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Juliet Mah
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Enugu, Nigeria
| | - Chidimma Omeje
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Gerhard Fortwengel
- Faculty III, Hochschule Hannover University of Applied Sciences & Arts, 30159, Hannover, Lower Saxony, Germany
| | - Akachukwu Omumuagwula Nwosu
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Frank Onyemaechi Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Enugu, Nigeria
| | - Georgian Chiaka Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Health Sciences, Ebonyi State University, Ebonyi State, Abakaliki, Nigeria
- Department of Nursing Science, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies,University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Martins Nweke
- Department of Physiotherapy, Faculty of Health Sciences & Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Department of physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
2
|
Payne C, Gesch J, Smits E, Brakenridge C, Johnston V, Gardiner PA, Comans T, Bell R, Gane E. Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury. BRAIN IMPAIR 2024; 25:IB23095. [PMID: 38810091 DOI: 10.1071/ib23095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
Background Physical activity has health benefits for adults with acquired brain injury, but it is a challenge to increase physical activity during inpatient rehabilitation. The objectives of this pilot study were to determine whether a physiotherapy-supervised inpatient walking program was feasible and able to improve physical activity and sedentary behaviour in the short and medium term. Methods Adults with acquired brain injury receiving inpatient rehabilitation undertook twice-weekly supervised walks plus behavioural therapy for 4 weeks. Feasibility was measured via recruitment, participation and drop out rates, adverse events and intervention delivery costs. Physical activity and sedentary behaviour were measured with an activPAL. Assessments were conducted at baseline, post-intervention and 3-6 months post-intervention. Results The program was safe to deliver (no adverse events), recruitment rate was 55% (16/29) and the participation rate for eligible individuals was high (14/19, 74%). However, the program had a high drop out rate (7/16, 44%) and physical activity and sedentary behaviour did not significantly change during the 4-week intervention. Costs were AU$427.71/participant. Physical activity and sedentary behaviour did improve 3-6 months after the intervention (vs baseline, on average: +3913 steps per day, 95% CI: 671, 7156). Conclusion This pilot study demonstrated a supervised physiotherapy walking program is safe and feasible to recruit in an inpatient setting. However, drop out during the study was high and behaviour change did not occur. More work is required to boost physical activity during sub-acute rehabilitation for acquired brain injury.
Collapse
Affiliation(s)
- Caitlyn Payne
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Janelle Gesch
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Esther Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Charlotte Brakenridge
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia; and School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Health Research, University of Southern Queensland, Darling Heights, Qld, Australia
| | - Paul A Gardiner
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Ryan Bell
- Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Elise Gane
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Functioning and Health Research, Metro South Health, Brisbane, Qld, Australia
| |
Collapse
|
3
|
Fini NA, Simpson D, Moore SA, Mahendran N, Eng JJ, Borschmann K, Moulaee Conradsson D, Chastin S, Churilov L, English C. How should we measure physical activity after stroke? An international consensus. Int J Stroke 2023; 18:1132-1142. [PMID: 37300499 PMCID: PMC10614172 DOI: 10.1177/17474930231184108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Physical activity is important for secondary stroke prevention. Currently, there is inconsistency of outcomes and tools used to measure physical activity following stroke. AIM To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity. METHODS Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney's Value-Focused Thinking Methodology. Survey 1 identified physical activity tools, outcomes, and measurement considerations which were ranked in Survey 2. Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3, participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations. RESULTS Twenty-five stroke survivors, 5 carers, 18 researchers, and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included the ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort, and ability to detect changes. Consensus recommendations included using the Actigraph, Actical, and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations. CONCLUSIONS These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge, and resources. Comprehensive measurement requires the use of devices and questionnaires.
Collapse
Affiliation(s)
- Natalie A Fini
- Physiotherapy Department, School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
| | - Dawn Simpson
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Sarah A Moore
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
- Stroke Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Niruthikha Mahendran
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- Physiotherapy Division, School of health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Janice J Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Karen Borschmann
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- St Vincent’s Hospital, Melbourne, VIC, Australia
| | - David Moulaee Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Women’s Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Sebastien Chastin
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Leonid Churilov
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Coralie English
- Centre for Research Excellence in Stroke Rehabilitation and Recovery, Florey Institute of Neuroscience, The University of Melbourne, Parkville, VIC, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia
- Heart and Stroke Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
4
|
Brandenbarg P, Hoekstra F, Barakou I, Seves BL, Hettinga FJ, Hoekstra T, van der Woude LHV, Dekker R, Krops LA. Measurement properties of device-based physical activity instruments in ambulatory adults with physical disabilities and/or chronic diseases: a scoping review. BMC Sports Sci Med Rehabil 2023; 15:115. [PMID: 37735403 PMCID: PMC10512652 DOI: 10.1186/s13102-023-00717-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND People with physical disabilities and/or chronic diseases tend to have an inactive lifestyle. Monitoring physical activity levels is important to provide insight on how much and what types of activities people with physical disabilities and/or chronic diseases engage in. This information can be used as input for interventions to promote a physically active lifestyle. Therefore, valid and reliable physical activity measurement instruments are needed. This scoping review aims 1) to provide a critical mapping of the existing literature and 2) directions for future research on measurement properties of device-based instruments assessing physical activity behavior in ambulant adults with physical disabilities and/or chronic diseases. METHODS Four databases (MEDLINE, CINAHL, Web of Science, Embase) were systematically searched from 2015 to April 16th 2023 for articles investigating measurement properties of device-based instruments assessing physical activity in ambulatory adults with physical disabilities and/or chronic diseases. For the majority, screening and selection of eligible studies were done in duplicate. Extracted data were publication data, study data, study population, device, studied measurement properties and study outcome. Data were synthesized per device. RESULTS One hundred three of 21566 Studies were included. 55 Consumer-grade and 23 research-grade devices were studied on measurement properties, using 14 different physical activity outcomes, in 23 different physical disabilities and/or chronic diseases. ActiGraph (n = 28) and Fitbit (n = 39) devices were most frequently studied. Steps (n = 68) was the most common used physical activity outcome. 97 studies determined validity, 11 studies reliability and 6 studies responsiveness. CONCLUSION This scoping review shows a large variability in research on measurement properties of device-based instruments in ambulatory adults with physical disabilities and/or chronic diseases. The variability highlights a need for standardization of and consensus on research in this field. The review provides directions for future research.
Collapse
Affiliation(s)
- Pim Brandenbarg
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Femke Hoekstra
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Ioulia Barakou
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Bregje L Seves
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Florentina J Hettinga
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, NE1 8ST, UK
| | - Trynke Hoekstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, 1081 BT, The Netherlands
| | - Lucas H V van der Woude
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Leonie A Krops
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| |
Collapse
|
5
|
Lau SCL, Tabor Connor L, Baum CM. Motivation, Physical Activity, and Affect in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Approach. Ann Behav Med 2023; 57:334-343. [PMID: 36732938 DOI: 10.1093/abm/kaac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Motivation is a frequently reported but far less studied driver for post-stroke physical activity participation. Motivation and physical activity may be important contributors to the prevention management and alleviation of affective symptoms among stroke survivors. PURPOSE To investigate the real-time associations between motivation, physical activity, and affect in the daily lives of community-dwelling stroke survivors using ecological momentary assessment (EMA) and accelerometry. METHODS Forty community-dwelling stroke survivors wore an accelerometer on the thigh and completed EMA surveys assessing motivation (autonomous motivation, controlled motivation) and affect (negative affect, positive affect) eight times daily for 7 days. Multivariate regression analysis and multilevel modeling investigated the associations between motivation, physical activity, and affect. RESULTS Greater autonomous motivation for physical activity was associated with less sedentary behavior (β = -0.40, p = .049) and more moderate-to-vigorous physical activity (β = 0.45, p = .020) participation in daily life. Greater autonomous motivation was momentarily associated with less depressed affect (β = -0.05, p < .001) and greater positive affect (β = 0.13, p < .001). Moreover, greater controlled motivation was momentarily associated with greater depressed affect (β = 0.06, p < .001). More intense physical activity was momentarily associated with greater positive affect (β = 0.13, p = .016). No moderating effect of motivation on the association between physical activity and affect was found. CONCLUSIONS Motivation and physical activity are momentarily associated with affect among stroke survivors. Assessing and fostering autonomous motivation may be beneficial for promoting physical activity and managing positive and depressed affect as stroke survivors return to the community.
Collapse
Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| |
Collapse
|
6
|
Chung J, Brakey HR, Reeder B, Myers O, Demiris G. Community-dwelling older adults' acceptance of smartwatches for health and location tracking. Int J Older People Nurs 2023; 18:e12490. [PMID: 35818900 PMCID: PMC10078487 DOI: 10.1111/opn.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite rapid growth in the popularity of smartwatches, evidence lacks regarding older adults' acceptance of smartwatches. Since most wearable sensors are not designed specifically for older adults, there is a need to examine wearability and usability challenges of wearable sensing devices faced by older adults to facilitate the use of objective measurements of health and mobility. OBJECTIVES We aimed to examine older adults' perceptions of GPS-enabled smartwatches and to identify potential barriers and facilitators of smartwatch and sensor data use. METHODS As part of a larger feasibility study, we conducted a mixed-methods study that included a descriptive content analysis of interviews and a brief usability survey with 30 participants aged 60 years and older after they had used a smartwatch for 3 days. RESULTS Most participants perceived wearable activity trackers including smartwatches and sensor-based data as useful for tracking health, finding activity patterns and promoting healthy behaviours. Privacy was of little concern, leading to willingness to share activity and location data with others. Participants identified barriers to usability as clumsy design, lack of aesthetic appeal, and difficulty reading the display and using the GPS tracking function. In contrast, identified facilitators of adoption included a big display, high-tech look, self-awareness and possible behaviour change. CONCLUSIONS Smartwatches have the potential of personalised detection of health deterioration and disability prevention, based on analysis of older adults' activities in free-living environments. The usefulness of this technology for older adults can be significantly increased by addressing usability issues and providing instructions on challenging features. IMPLICATIONS FOR PRACTICE To support sustained self-monitoring behaviours through wearable sensor devices in older adults, it is critical to examine how they perceive those devices and identify factors affecting technology acceptance that can maximise adoption.
Collapse
Affiliation(s)
- Jane Chung
- Virginia Commonwealth University School of Nursing, Richmond, Virginia, USA
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Blaine Reeder
- University of Missouri School of Nursing, Columbia, Missouri, USA.,University of Missouri Institute for Data Science & Informatics, Columbia, Missouri, USA
| | - Orrin Myers
- Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - George Demiris
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Lau SCL, Connor LT, King AA, Baum CM. Multimodal Ambulatory Monitoring of Daily Activity and Health-Related Symptoms in Community-Dwelling Survivors of Stroke: Feasibility, Acceptability, and Validity. Arch Phys Med Rehabil 2022; 103:1992-2000. [PMID: 35780826 PMCID: PMC10338086 DOI: 10.1016/j.apmr.2022.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the feasibility, acceptability, and validity of multimodal ambulatory monitoring, which combines accelerometry with ecological momentary assessment (EMA), to assess daily activity and health-related symptoms among survivors of stroke. DESIGN Prospective cohort study involving 7 days of ambulatory monitoring; participants completed 8 daily EMA surveys about daily activity and symptoms (mood, cognitive complaints, fatigue, pain) while wearing an accelerometer. Participants also completed retrospective assessments and an acceptability questionnaire. SETTING Community. PARTICIPANTS Forty survivors of stroke (N=40). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Feasibility was determined using attrition rate and compliance. Acceptability was reported using the acceptability questionnaire. Convergent and discriminant validity were determined by the correlations between ambulatory monitoring and retrospective self-reports. Criterion validity was determined by the concordance between accelerometer-measured and EMA-reported daily activity. RESULTS All participants completed the study (attrition rate=0%). EMA and accelerometer compliance were 93.6 % and 99.7%, respectively. Participants rated their experience with multimodal ambulatory monitoring positively. They were highly satisfied (mean, 4.8/5) and confident (mean, 4.7/5) in using ambulatory monitoring and preferred it over traditional retrospective assessments (mean, 4.7/5). Multimodal ambulatory monitoring estimates correlated with retrospective self-reports of the same and opposing constructs in the predicted directions (r=-0.66 to 0.72, P<.05). More intense accelerometer-measured physical activity was observed when participants reported doing more physically demanding activities and vice versa. CONCLUSIONS Findings support the feasibility, acceptability, and validity of multimodal ambulatory monitoring in survivors of mild stroke. Multimodal ambulatory monitoring has potential to provide a more complete understanding of survivors' daily activity in the context of everyday life.
Collapse
Affiliation(s)
- Stephen C L Lau
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO.
| | - Lisa Tabor Connor
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO; Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Allison A King
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO; Department of Medicine, Washington University School of Medicine, St Louis, MO; Department of Pediatrics, Washington University School of Medicine, St Louis, MO; Department of Surgery, Washington University School of Medicine, St Louis, MO; Department of Education, Washington University School of Medicine, St Louis, MO
| | - Carolyn M Baum
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO; Department of Neurology, Washington University School of Medicine, St Louis, MO; Brown School of Social Work, Washington University in St Louis, St Louis, MO
| |
Collapse
|
8
|
Validity of the activPAL monitor to measure stepping activity and activity intensity: A systematic review. Gait Posture 2022; 97:165-173. [PMID: 35964334 DOI: 10.1016/j.gaitpost.2022.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/24/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accumulating step counts and engaging in moderate-to-vigorous intensity physical activity is positively associated with numerous health benefits. The activPAL is a thigh-worn monitor that is frequently used to measure physical activity. RESEARCH QUESTION Can the activPAL accurately measure stepping activity and identify physical activity intensity? METHODS We systematically reviewed validation studies examining the accuracy of activPAL physical activity outcomes relative to a criterion measure in adults (>18 years). Citations were not restricted to language or date of publication. Sources were searched up to May 16, 2021 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. The study was pre-registered in Prospero (ID# CRD42021248240). Study quality was determined using a modified Hagströmer Bowles checklist. RESULTS Thirty-nine studies (20 laboratory arms, 17 semi-structured arms, 11 uncontrolled protocol arms; 1272 total participants) met the inclusion criteria. Most studies demonstrated a high validity of the activPAL to measure steps across laboratory (12/15 arms), semi-structured (10/13 arms) and uncontrolled conditions (5/7 arms). Studies that demonstrated low validity were generally conducted in unhealthy populations, included slower walking speeds, and/or short walking distances. Few studies indicated that the activPAL accurately measured physical activity intensity across laboratory (0/6 arms), semi-structured (0/5 arms) and uncontrolled conditions (2/5 arms). Using the default settings, the activPAL overestimates light-intensity activity but underestimates moderate-to-vigorous intensity activity. The overall study quality was 11.5 ± 2.0 out of 19. CONCLUSION Despite heterogeneous methodological and statistical approaches, the included studies generally provide supporting evidence that the activPAL can accurately detect stepping activity but not physical activity intensity. Strategies that use alternative data processing methods have been developed to better characterize physical activity intensity, but all methods still underestimate vigorous-intensity activity.
Collapse
|
9
|
Cabot M, Daviet JC, Duclos N, Bernikier D, Salle JY, Compagnat M. First systematic review and meta-analysis of the validity and test retest reliability of physical activity monitors for estimating energy expenditure during walking in individuals with stroke. Arch Phys Med Rehabil 2022; 103:2245-2255. [DOI: 10.1016/j.apmr.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
|
10
|
Brauer SG, Kuys SS, Paratz J, Ada L. IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: a randomised trial. Int J Stroke 2022; 17:1137-1144. [DOI: 10.1177/17474930221078121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: To determine if treadmill training embedded in self-management education commencing during stroke inpatient rehabilitation results in more physical activity than usual gait training. Method: A prospective, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis involving 119 stroke survivors undergoing rehabilitation who were able to walk independently was undertaken. The experimental group undertook treadmill training (40-60% heart rate reserve) and self-management education for 30 minutes, three times a week for 8 weeks and the control group undertook the same amount of usual gait training. Outcomes were measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). The primary outcome was physical activity measured as steps/day using an activity monitor. Secondary outcomes were walking ability, cardiorespiratory fitness, cardiovascular risk, depression, self-efficacy, perception of physical activity, participation, and quality of life. Results: After 8 weeks, the experimental group took 1436 more steps/day (95% CI 229 to 2643) than the control group. By 6 months, they took 871 more steps/day (95% CI -385 to 2129) than the control group. There was no difference between groups in any other outcome. Conclusions: In individuals undergoing rehabilitation after stroke, 8 weeks of treadmill training embedded in self-management resulted in more physical activity than usual gait training and this was largely maintained at 6 months, despite little effect on walking or cardiorespiratory fitness, suggesting the self-management was responsible. Trial Registration: ACTRN12613000744752. Data Access: Data are available from the corresponding author.
Collapse
Affiliation(s)
- Sandra G Brauer
- The University of Queensland, Division of Physiotherapy, Brisbane, Australia
| | - Suzanne S Kuys
- Australian Catholic University, School of Physiotherapy, Faculty of Health Sciences, Banyo, Australia
| | - Jenny Paratz
- Griffith University Faculty of Health, School of Health Sciences and Social Work, Gold Coast, Australia
| | - Louise Ada
- The University of Sydney Faculty of Medicine and Health, Sydney, Australia
| |
Collapse
|
11
|
Concurrent Validity of the Garmin Vivofit®4 to Accurately Record Step Count in Older Adults in Challenging Environments. J Aging Phys Act 2022; 30:833-841. [PMID: 34996032 DOI: 10.1123/japa.2021-0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/23/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
There is little evidence of the concurrent validity of commercially available wrist-worn long battery life activity monitors to measure steps in older adults at slow speeds and with real-world challenges. Forty adults aged over 60 years performed a treadmill protocol at four speeds, a 50-m indoor circuit, and a 200-m outdoor circuit with environmental challenges while wearing a Garmin Vivofit®4, the activPAL3™, and a chest-worn camera angled at the feet. The Garmin Vivofit®4 showed high intraclass correlation coefficients2,1 (.98-.99) and low absolute percentage error rates (<2%) at the fastest treadmill speeds and the outdoor circuit. Step counts were underestimated at the slowest treadmill speed and the indoor circuit. The Garmin Vivofit®4 is accurate for older adults at higher walking speeds and during outdoor walking. However, it underestimates steps at slow speeds and when walking indoors with postural transitions.
Collapse
|
12
|
Brauer SG, Kuys SS, Paratz JD, Ada L. High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study. Pilot Feasibility Stud 2021; 7:215. [PMID: 34876235 PMCID: PMC8650326 DOI: 10.1186/s40814-021-00941-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. METHOD A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). RESULTS Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. CONCLUSIONS A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. TRIAL REGISTRATION This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).
Collapse
Affiliation(s)
- Sandra G Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Jennifer D Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| |
Collapse
|
13
|
Chung J, Boyle J, Wheeler DC. Relationship Between Life-Space Mobility and Health Characteristics in Older Adults Using Global Positioning System Watches. J Appl Gerontol 2021; 41:1186-1195. [PMID: 34719296 DOI: 10.1177/07334648211054834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine the feasibility of using global positioning system (GPS) watches to examine relationships between GPS-based life-space mobility (LSM) metrics and self-report LSM and health measures (physical, psychological, and cognitive function) among older adults. Thirty participants wore a Fitbit Surge for 3 days. Eight spatial and temporal LSM measures were derived from GPS data. About 90% of in-home movement speeds were zero, indicating the sedentary lifestyle, but they made some active out-of-home trips as the total distance traveled and size of movement area indicated. There was a significant difference in total distance traveled and 95th percentile of movement speed between mild cognitive and intact cognition groups. GPS-based higher proportion of out-of-home time was significantly associated with greater functional fitness. Greater GPS use hours were significantly associated with higher cognition. These findings suggest the potential of GPS watches to continuously monitor changes in functional health to inform prevention efforts.
Collapse
Affiliation(s)
- Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Joseph Boyle
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - David C Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
14
|
Chung J, Boyle J, Pretzer-Aboff I, Knoefel J, Young HM, Wheeler DC. Using a GPS Watch to Characterize Life-Space Mobility in Dementia: A Dyadic Case Study. J Gerontol Nurs 2021; 47:15-22. [PMID: 34590977 PMCID: PMC10054372 DOI: 10.3928/00989134-20210908-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Persons with dementia (PWD) often experience difficulty navigating their environments and performing out-of-home activities. Life-space mobility (LSM) is an effective way of assessing functional levels and independence. We present a dyadic case study to explore the feasibility of using a global positioning system (GPS) watch to measure LSM of a Latino PWD. Methods included travel diary, LSM questionnaire, and qualitative interviews in addition to the GPS-based mobility characterization. GPS data indicated that the PWD made outdoor trips regularly and was active socially, with day-to-day variations. Caregiver and PWD interviews revealed contextual information about mobility patterns captured by other methods. The dyad had positive perceptions of the GPS watch for tracking health and activities. This study demonstrated a use for wearable location tracking technology to support accurate LSM assessment in dementia that can inform nursing practice, policy, and research to promote well-being and delay functional deterioration in PWD. [Journal of Gerontological Nursing, 47(10), 15-22.].
Collapse
|
15
|
Dobiasch M, Stafylidis S, Baca A. Effects of different feedback variants on pacing adherence in a field based running test. INT J PERF ANAL SPOR 2021. [DOI: 10.1080/24748668.2021.1968662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Martin Dobiasch
- Centre for Sport Science and University Sports, Department for Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
| | - Savvas Stafylidis
- Centre for Sport Science and University Sports, Department for Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Centre for Sport Science and University Sports, Department for Biomechanics, Kinesiology and Computer Science in Sport, University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
|
17
|
Outdoor Walking Test With a Global Positioning System Device as an Additional Tool for Functional Assessment of Older Women. J Aging Phys Act 2020; 29:620-625. [PMID: 33333488 DOI: 10.1123/japa.2020-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/18/2022]
Abstract
The primary aim was to assess the test-retest reliability of an outdoor walking test with a global positioning system device in older women in a community setting. In addition, correlations between the suggested test and various tests recommended to evaluate muscle strength, walking speed, and self-perceived health status in older adults were studied. The study included 40 women aged 68 (SD = 5) years. The primary outcomes were total walked distance and mean walking speed. The secondary outcomes were lower-body strength, heart rate, speed in a 4-m walk test, and self-perceived health status. The intraclass correlation coefficients calculated for the total walked distance, mean walking speed, and mean heart rate were .94, .92, and .37, respectively. Thus, the suggested outdoor walking test with the application of a global positioning system device may be considered a reliable test tool, which can be recommended for the evaluation of walking ability among older women in a community setting.
Collapse
|
18
|
Fuller D, Colwell E, Low J, Orychock K, Tobin MA, Simango B, Buote R, Van Heerden D, Luan H, Cullen K, Slade L, Taylor NGA. Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e18694. [PMID: 32897239 PMCID: PMC7509623 DOI: 10.2196/18694] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022] Open
Abstract
Background Consumer-wearable activity trackers are small electronic devices that record fitness and health-related measures. Objective The purpose of this systematic review was to examine the validity and reliability of commercial wearables in measuring step count, heart rate, and energy expenditure. Methods We identified devices to be included in the review. Database searches were conducted in PubMed, Embase, and SPORTDiscus, and only articles published in the English language up to May 2019 were considered. Studies were excluded if they did not identify the device used and if they did not examine the validity or reliability of the device. Studies involving the general population and all special populations were included. We operationalized validity as criterion validity (as compared with other measures) and construct validity (degree to which the device is measuring what it claims). Reliability measures focused on intradevice and interdevice reliability. Results We included 158 publications examining nine different commercial wearable device brands. Fitbit was by far the most studied brand. In laboratory-based settings, Fitbit, Apple Watch, and Samsung appeared to measure steps accurately. Heart rate measurement was more variable, with Apple Watch and Garmin being the most accurate and Fitbit tending toward underestimation. For energy expenditure, no brand was accurate. We also examined validity between devices within a specific brand. Conclusions Commercial wearable devices are accurate for measuring steps and heart rate in laboratory-based settings, but this varies by the manufacturer and device type. Devices are constantly being upgraded and redesigned to new models, suggesting the need for more current reviews and research.
Collapse
Affiliation(s)
- Daniel Fuller
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada.,Department of Computer Science, Memorial University, St. John's, NL, Canada.,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Emily Colwell
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Jonathan Low
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Kassia Orychock
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | | | - Bo Simango
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada
| | - Richard Buote
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | | | - Hui Luan
- Department of Geography, University of Oregon, Eugene, OR, United States
| | - Kimberley Cullen
- School of Human Kinetics and Recreation, Memorial University, St. John's, NL, Canada.,Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Logan Slade
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Nathan G A Taylor
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
19
|
Validity of the Walked Distance Estimated by Wearable Devices in Stroke Individuals. SENSORS 2019; 19:s19112497. [PMID: 31159246 PMCID: PMC6604102 DOI: 10.3390/s19112497] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/05/2022]
Abstract
Background: Health professionals need valid devices to assess a stroke individual’s ability to walk. The aim was to evaluate the validity of the estimation of the walked distance by wearable devices and the impact of the sensor’s position in stroke individuals. Methods: Post-stroke patients able to walk without human assistance were equipped with several wearable devices: pedometers, Actigraph, and Sensewear Armband placed according to the manufacturers' recommendations. Participants walked for 6 min at a comfortable speed wearing all sensors at the same time. We analyzed the validity of sensor-estimated distances according to their position using Bland–Altman analysis, root-mean-square error, and coefficient of correlation. Results: In total, 35 individuals were included (mean age = 65 ± 15 years). The best estimations were given by the Actigraph worn on the unaffected ankle (mean bias (MB) = 22.6 ± 32.4 m; p = 0.37) and by the pedometer worn on the unaffected hip (MB = 20.5 ± 24.6 m; p = 0.46). The other sensors and positions provided large estimation errors over 95 m (p < 0.05). Conclusion: This study led to a recommendation of a pedometer worn on the unaffected hip or an Actigraph worn on the unaffected ankle to get a valid estimation of the distance walked by stroke individuals.
Collapse
|
20
|
Mahendran N, Kuys SS, Brauer SG. Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke? Disabil Rehabil 2019; 42:763-769. [PMID: 30724628 DOI: 10.1080/09638288.2018.1508513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To determine which impairments, activity limitations and personal factors at hospital discharge poststroke predict volume, frequency, and intensity of walking activity 1, 3, and 6 months later.Materials and Methods: Prospective longitudinal observational study. Thirty-six people with stroke (71 SD 14 years, 69% male) were recruited at hospital discharge and predictors including fatigue, mood, executive function, walking speed, walking endurance, age, prestroke activity, self-efficacy, and perceived stroke recovery and health were collected. At 1, 3, and 6 months follow-up, participants wore an ActivPAL™ accelerometer to collect measures of walking activity.Results: At 1 month, walking endurance predicted all walking activity (R2 > 0.29, p < 0.01). At 3 months, walking endurance and prestroke activity predicted activity volume and intensity (R2 = 0.46-0.61, p < 0.001), and prestroke activity predicted activity frequency (R2 = 0.31, p = 0.004). At 6 months, age-predicted activity volume and frequency (R2 = 0.34-0.35, p < 0.003), while prestroke activity, discharge walking endurance, and executive function together predicted activity intensity (R2 = 0.79, p < 0.001).Conclusion: Walking endurance contributes to walking activity outcomes across the first 6 months following hospital discharge poststroke. After 1 month of discharge, factors other than poststroke changes also contribute to activity outcomes, and should be considered when targeting poststroke physical activity.Implications for rehabilitationWalking endurance should be addressed during stroke rehabilitation as higher scores are linked to more walking activity in the first month after discharge.Prestroke factors such as low prestroke activity levels and older age predict reduced walking activity after stroke, so approaches to address barriers these factors may pose are needed in people with stroke.Physical activity interventions should be tailored to the individual, their environment, and context, and take into consideration prestroke factors.
Collapse
Affiliation(s)
- Niruthikha Mahendran
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Suzanne S Kuys
- Discipline of Physiotherapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| |
Collapse
|
21
|
Thilarajah S, Mentiplay BF, Bower KJ, Tan D, Pua YH, Williams G, Koh G, Clark RA. Factors Associated With Post-Stroke Physical Activity: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:1876-1889. [DOI: 10.1016/j.apmr.2017.09.117] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/06/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022]
|
22
|
Brauer SG, Kuys SS, Paratz JD, Ada L. Improving physical activity after stroke via treadmill training and self management (IMPACT): a protocol for a randomised controlled trial. BMC Neurol 2018; 18:13. [PMID: 29382298 PMCID: PMC5791375 DOI: 10.1186/s12883-018-1015-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The level of physical activity undertaken by stroke survivors living in the community is generally low. The main objectives of the IMPACT trial are to determine, in individuals undergoing rehabilitation after stroke, if 8 weeks of high-intensity treadmill training embedded in self-management education (i) results in more physical activity than usual physiotherapy gait training and (ii) is more effective at increasing walking ability, cardiorespiratory fitness, self-efficacy, perception of physical activity, participation, and health-related quality of life as well as decreasing cardiovascular risk, and depression, at 8 and 26 weeks. METHODS A prospective, two-arm, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis, will be conducted. 128 stroke survivors undergoing rehabilitation who are able to walk independently will be recruited and randomly allocated to either the experimental or control group, who will both undergo gait training for 30 min, three times a week for 8 weeks under the supervision of a physiotherapist. Outcomes will be measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). This study has obtained ethical approval from the relevant Human Research Ethics Committees. DISCUSSION Improving stroke survivors' walking ability and cardiorespiratory fitness is likely to increase their levels of physical activity. Furthermore, if education in self-management results in sustained high levels of physical activity, this should result in improved participation and quality of life. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000744752 ) on 4th July, 2013.
Collapse
Affiliation(s)
- Sandra G. Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Suzanne S. Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD Australia
| | - Jennifer D. Paratz
- School of Allied Health Sciences, Griffith University, Southport, QLD Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
| |
Collapse
|
23
|
Preston E, Dean CM, Ada L, Stanton R, Brauer S, Kuys S, Waddington G. Promoting physical activity after stroke via self-management: a feasibility study. Top Stroke Rehabil 2017; 24:353-360. [PMID: 28335690 DOI: 10.1080/10749357.2017.1304876] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Many people with mild disability after stroke are physically inactive despite the risk of recurrent stroke. A self-management program may be one strategy to increase physical activity in stroke survivors. OBJECTIVES To investigate the feasibility of a self-management program, and determine whether self-management can increase daily physical activity levels and self-efficacy for exercise, decrease cardiovascular risk, and improve walking ability, participation, and quality of life in people with mild disability after stroke. METHOD A Phase I, single-group, pre-post intervention study was carried out with twenty stroke survivors who had mild disability and were discharged directly home from acute stroke units. A self-management program was delivered via five home-based sessions over 3 months, incorporating: education, goal setting, barrier identification, self-monitoring, and feedback. Feasibility of the intervention was determined by examining adherence, duration, usefulness, and safety. Clinical outcomes were amount of physical activity (duration of moderate physical activity in min/day and counts of physical activity in steps/day), self-efficacy, cardiovascular risk, walking ability, participation, and quality of life. RESULTS The intervention was feasible with 96% of sessions being delivered, each taking less than an hour (41 min, SD 12). Participants perceived the self-management program to be useful and there were few adverse events. At 3 months, participants completed 27 min/day (95% CI 4-49) more moderate physical activity than at baseline and 16 min/day (95% CI -10 to 42) at 6 months. CONCLUSION Self-management appears to be feasible and has the potential to increase physical activity in people with mild disability after stroke. A Phase II randomized trial is warranted.
Collapse
Affiliation(s)
- Elisabeth Preston
- a Discipline of Physiotherapy , University of Canberra , Canberra , Australia
| | - Catherine M Dean
- b Discipline of Physiotherapy , Macquarie University , Sydney , Australia
| | - Louise Ada
- c Discipline of Physiotherapy , The University of Sydney , Sydney , Australia
| | - Rosalyn Stanton
- c Discipline of Physiotherapy , The University of Sydney , Sydney , Australia
| | - Sandy Brauer
- d Discipline of Physiotherapy , University of Queensland , Brisbane , Australia
| | - Suzanne Kuys
- e School of Physiotherapy , Australian Catholic University , Brisbane , Australia
| | - Gordon Waddington
- a Discipline of Physiotherapy , University of Canberra , Canberra , Australia
| |
Collapse
|
24
|
Mahendran N, Kuys SS, Brauer SG. Accelerometer and Global Positioning System Measurement of Recovery of Community Ambulation Across the First 6 Months After Stroke: An Exploratory Prospective Study. Arch Phys Med Rehabil 2016; 97:1465-1472. [DOI: 10.1016/j.apmr.2016.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/11/2016] [Accepted: 04/22/2016] [Indexed: 01/07/2023]
|
25
|
Mahendran N, Kuys SS, Brauer SG. Recovery of ambulation activity across the first six months post-stroke. Gait Posture 2016; 49:271-276. [PMID: 27474947 DOI: 10.1016/j.gaitpost.2016.06.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 02/02/2023]
Abstract
Stroke survivors commonly adopt sedentary activity behaviours by the chronic phase of recovery. However, the change in activity behaviours from the subacute to chronic phase of stroke is variable. This study explored the recovery of ambulation activity (volume and bouts) at one, three and six months after hospital discharge post-stroke. A total of 42 stroke survivors were recruited at hospital discharge and followed up one, three and six months later. At follow-up, ambulation activity was measured over four days using the ActivPAL™ accelerometer. Measures included volume of activity and frequency and intensity of ambulation activity bouts per day. Linear mixed effects modelling was used to determine changes over time. There was wide variation in activity. Total step counts across all time points were below required levels for health benefits (mean 4592 SD 3411). Most activity was spread across short bouts. While most number of bouts was of low intensity, most time was spent in moderate intensity ambulation across all time points. Daily step count and time spent walking and sitting/lying increased from one month to three and six months. The number of and time spent in short and medium duration bouts increased from one to six months. Time in long duration bouts increased at three months only. Time spent in moderate intensity ambulation increased over time. No change was observed for any other measures. In future, it would be valuable to identify strategies to increase engagement in activity behaviours to improve health outcomes after stroke.
Collapse
Affiliation(s)
- Niruthikha Mahendran
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| |
Collapse
|