Levels and patterns of physical activity in stroke survivors with different ambulation status living in low-income areas of Cape Town, South Africa

Stroke survivors with limited walking ability have unique barriers and facilitators to physical activity

PURPOSE

Stroke is a leading cause of morbidity and mortality in Canada. Approximately 73% of stroke survivors experience limited walking ability, requiring a gait aid or assistance. Physical activity is important for secondary stroke prevention, in addition to its benefits for physical and mental health. Little is known about the barriers and facilitators to physical activity in stroke survivors with limited walking ability.

METHODS

This qualitative study used inductive thematic analysis of structured interviews to explore the barriers and facilitators to physical activity in stroke survivors with limited walking ability.

RESULTS

Perceived barriers to physical activity included scarcity of services, societal views, changes in ability, and inclement weather. Perceived facilitators included the desired benefits of physical activity, multidisciplinary rehabilitation services, durable medical equipment, encouragement, positive mindset, and self-efficacy.

CONCLUSIONS

Improving access to rehabilitation services in the chronic phase of stroke and increasing the availability of structured exercise programmes are important strategies to address barriers to physical activity in this population. Supporting self-efficacy, addressing disability stigma, and policy changes are also needed to facilitate participation.

Perceived social support on objective measured sedentary behavior of stroke patients: the mediating role of exercise self-efficacy

Introduction

As stroke patients may have impaired motor function, there may have increased sedentary behavior. Factors associated with sedentary behavior need to be explored to develop targeted interventions. Although studies explore the effects of exercise self-efficacy and perceived social support on sedentary behavior, the relationship is not clear. The aim of this study was to explore the mediating effect of exercise self-efficacy on perceived social support and objective measured sedentary behavior in stroke patients.

Methods

The random sampling method was adopted to select 275 stroke patients from the neurology department of a third-grade hospital of Henan Province from June 2023 to March 2024 in a cross-sectional descriptive study. A general data questionnaire, exercise self-efficacy scale, perceived social support scale, and ActiGraph GT3X accelerometer were used to investigate. The structural equation model was used to analyze the mediating effect of exercise self-efficacy between perceived social support and sedentary behavior.

Results

The mean sedentary behavior time in stroke patients in this study was (479.65 ± 112.65) min, the mean score of perceived social support was (47.53 ± 17.16), and the mean score of exercise self-efficacy was (24.19 ± 6.25). The correlation analysis revealed that, the sedentary behavior of stroke patients was negatively correlated with exercise self-efficacy and perceived social support. The results of the mediation analysis showed that exercise self-efficacy played a partial mediating role between perceived social support and sedentary behavior.

Conclusion

Perceived social support and exercise self-efficacy were influential factors in sedentary behavior. Moreover, the impact of perceived social support on sedentary behavior was partially mediated by exercise self-efficacy. Therefore, to decrease the sedentary behavior, it is crucial to improve the level of perceived social support in stroke patients. Patients with less perceived social support can improve their exercise self-efficacy and thus perceive more social support.

Movement Reminders to Encourage Arm Use During Daily Life in Stroke Patients

Stroke is a leading cause of long-term disability, such as loss of upper limb function. Active arm movement and frequent practice are essential to regain such function. Wearable sensors that trigger individualized movement reminders can promote awareness of the affected limb during periods of inactivity. This study investigated the immediate effect of vibrotactile reminders based on activity counts on affected arm use, the evolution of the effect throughout a 6-week intervention at home, and whether the time of the day influences the response to the reminder. Thirteen participants who experienced a unilateral ischemic stroke were included in the analysis. Activity counts were found to increase significantly after receiving a reminder. The immediate effect of receiving a reminder was maintained throughout the day as well as during the study duration of 6 weeks. In conclusion, wearable activity trackers with a feature to trigger individualized vibrotactile reminders could be a promising rehabilitation tool to increase arm activity of the affected side in stroke patients in their home environment.

A scoping review on recent trends in wearable sensors to analyze gait in people with stroke: From sensor placement to validation against gold-standard equipment

The purpose of the review is to evaluate wearable sensor placement, their impact and validation of wearable sensors on analyzing gait, primarily the postural instability in people with stroke. Databases, namely PubMed, Cochrane, SpringerLink, and IEEE Xplore were searched to identify related articles published since January 2005. The authors have selected the articles by considering patient characteristics, intervention details, and outcome measurements by following the priorly set inclusion and exclusion criteria. From a total of 1077 articles, 142 were included in this study and classified into functional fields, namely postural stability (PS) assessments, physical activity monitoring (PA), gait pattern classification (GPC), and foot drop correction (FDC). The review covers the types of wearable sensors, their placement, and their performance in terms of reliability and validity. When employing a single wearable sensor, the pelvis and foot were the most used locations for detecting gait asymmetry and kinetic parameters, respectively. Multiple Inertial Measurement Units placed at different body parts were effectively used to estimate postural stability and gait pattern. This review article has compared results of placement of sensors at different locations helping researchers and clinicians to identify the best possible placement for sensors to measure specific kinematic and kinetic parameters in persons with stroke.

Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review

A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.

Establishing Accelerometer Cut-Points to Classify Walking Speed in People Post Stroke

While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waist- and ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41−0.8 m/s, 0.81−1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively. Across all speed categories, cut-point classification accuracy was good-to-excellent for the ankle-worn AG accelerometer and fair-to-excellent for the waist-worn AG accelerometer, except for between 0.81 and 1.2 m/s. These cut-points can be used for investigating the link between walking and health outcomes in people post stroke.

Physical activity level of post-stroke individuals that use the Brazilian public health system

Abstract Introduction: According to studies from developed countries, post-stroke individuals commonly have a low level of physical activity. Considering the benefits of maintaining a good level of physical activity in these subjects, it is important to provide specific and complete information, based on the assessment of all dimensions of physical activity, which supports interventions. Objective: To compare the physical activity levels between individuals with stroke and matched healthy individuals that use the public health system in Brazil considering the different dimensions of physical activity. Methods: Individuals with stroke (n = 11) and matched healthy individuals (n = 11) were assessed. Physical activity levels, considering all dimensions -duration (> 3 MET), frequency (number of steps) and intensity (mean total energy expenditure per day) - were assessed using SenseWear® monitor for seven days. Descriptive statistics and between-groups comparisons were performed (α = 0.05). Results: The physical activity levels were significantly lower in individuals with stroke when compared to matched healthy individuals, considering all dimensions. The between-group differences in activity duration, frequency, and intensity were 74 minutes/day, 5,274 steps/day, and 2,134kJ/day, respectively. Conclusion: Individuals with stroke users of the Brazilian public health system have lower physical activity levels in different dimensions of physical activity than matched healthy individuals. The assessment of the physical activity level of post-stroke individuals is important for decision making in public health programs.

Validity of the International Physical Activity Questionnaire Long Form for Assessing Physical Activity and Sedentary Behavior in Subjects with Chronic Stroke

Validation studies of questionnaires used to assess physical activity (PA) and sedentary behavior (SB) in stroke survivors are scarce. This cross-sectional study aimed to examine the validity of the International Physical Activity Questionnaire long-form (IPAQ-LF) in community living adults with post-stroke sequelae (≥6 months) and preserved ambulation. Participants’ functional mobility, lower limb strength, ambulatory level, stroke severity, and disability were assessed. An accelerometer (ActiGraph GT3X+) was worn for ≥7 consecutive days. Subsequently, the IPAQ-LF was interview-administered. Fifty-six participants (58.1 ± 11.1 years, 66.1% male) were included. A strong correlation between the two methods was found for total PA time (ρ = 0.55, p < 0.001). According to the Bland-Altman analyses, over-reporting moderate-to-vigorous PA and under-reporting total PA in the IPAQ-LF were found in those participants with higher PA levels. Both methods measured sedentary time similarly, though random error was observed between them. Moderate-strong correlations were found between the IPAQ-LF and physical function (ρ = 0.29–0.60, p < 0.05). In conclusion, in people with chronic stroke, the IPAQ-LF presented acceptable levels of validity for estimating total PA time in those who are insufficiently active. Therefore, it could be a useful tool to screen for inactive individuals with chronic stroke who can benefit from PA interventions addressed to implement healthier lifestyles.

Association of Barriers, Fear of Falling and Fatigue with Objectively Measured Physical Activity and Sedentary Behavior in Chronic Stroke

Understanding the fostering factors of physical activity (PA) and sedentary behavior (SB) in post-stroke chronic survivors is critical to address preventive and health interventions. This cross-sectional study aimed to analyze the association of barriers to PA, fear of falling and severity of fatigue encountered by stroke chronic survivors with device-measured PA and SB. Ambulatory community-dwelling post-stroke subjects (≥six months from stroke onset) were evaluated and answered the Barriers to Physical Activity after Stroke Scale (BAPAS), Short Falls Efficacy Scale-International (Short FES-I) and Fatigue Severity Scale (FSS). SB and PA were measured with an Actigraph GT3X+ accelerometer for ≥seven consecutive days. Stepwise multiple linear regression analysis was employed to identify factors associated with PA and SB. Fifty-seven participants (58.2 ± 11.1 years, 37 men) met the accelerometer wear–time criteria (three days, ≥eight h/day). The physical BAPAS score explained 28.7% of the variance of the prolonged sedentary time (β = 0.547; p < 0.001). Additionally, the walking speed (β = 0.452) together with physical BAPAS (β = −0.319) explained 37.9% of the moderate-to-vigorous PA time (p < 0.001). In chronic post-stroke survivors, not only the walking speed but, also, the perceived physical barriers to PA are accounted for the SB and PA. Interventions to reverse SB and to involve subjects post-stroke in higher levels of PA should consider these factors.