Classifying physical activity research following stroke using the behavioral epidemiologic framework

Results of a 12-Month Randomized Controlled Trial Testing the Efficacy of the Diabetes Prevention Program Group Lifestyle Balance (DPP-GLB) for People Post Stroke (GLB-CVA)

BACKGROUND

Experience of stroke is associated with an increased risk for diabetes and metabolic syndrome, yet few interventions exist that have been tailored to the population's unique needs.

PURPOSE

To examine adherence and efficacy of the Diabetes Prevention Program Group Lifestyle Balance program (DPP-GLB) modified for individuals post stroke (GLB-CVA) using a randomized controlled trial.

METHODS

Adults (18-85 years of age), >12 months post stroke, and body mass index ≥25 kg/m2 were included in this study. Sixty-five individuals were assigned to either the GLB-CVA intervention or a 6-month wait-list control. Participants completed the 12-month GLB-CVA intervention, with attendance and assessment of weight, anthropometric, biomarker, functional, and patient reported outcome data collected at baseline, 3, 6, and 12 months.

RESULTS

High attendance (90%) and dietary and activity tracking (71%) suggest high adherence to the 12-month GLB-CVA. Six-month randomized controlled trial data indicate significant weight loss (p = .005) in the GLB-CVA group (7.4 ± 13.6 lbs, 3.65%) compared with the wait-list control (0.1 ± 10.1 lbs, 0%), and improvements in arm circumference (p = .04), high-density lipoprotein (HDL) cholesterol (p = .028), 8-year diabetes risk (p = .011), and pain interference (p < .001). Combined 12-month data showed participants lost 10.1 ± 16.8 lbs (4.88%) and improved waist circumference (p = .001), HbA1c (3.6%), diastolic blood pressure (p < .001), pain (p = .001), social participation (p = .025), and eating practices (p = .01) and habits (p < .001).

CONCLUSIONS

Engagement in the GLB-CVA can result in weight loss and improved health for individuals who are overweight or obese following stroke. Future efforts should examine effectiveness in real-world settings and focus on knowledge translation efforts.

Sedentary Behavioral Studies of Young and Middle-Aged Adults with Hypertension in the Framework of Behavioral Epidemiology: A Scoping Review

(1) Background: As times change, the detection rate of hypertension is increasing in the young and middle-aged population due to prevalent sedentary behaviors. The purpose of this study was to conduct a scoping review to identify and summarize the research on sedentary behavior in this population by separating it into five stages: the relationship between sedentary behavior and health; measurement modalities; influencing factors; interventions; and translational research in young and middle-aged adults with hypertension. (2) Methods: Using a scoping review research approach, the PubMed, Web of Science Core Collection, and MEDLINE databases were used to search for the literature on this subject from the date of the database's creation to 14 June 2022, and the behavioral epidemiology framework was used to classify the retrieved articles. (3) Results: A total of eight articles were included. Among them, there were six articles on the relationship between behavior and health, which includes blood pressure, insulin resistance, and the cardiovascular system; one article on the study of measurement methods, which was used for clinical decision making through decision trees; one article on influencing factors, which was divided into intrinsic and extrinsic factors; and no articles on intervention program development or the translation of intervention programs to further practice in this population. (4) Conclusions: Sedentary behavioral studies of young and middle-aged adults with hypertension are scarce and are generally carried out in the early stages of the condition. In the future, in-depth studies can be conducted on the dose-response relationship between sedentary behavior and health in this population; the development of easier and targeted measurement tools; the exploration of more influencing factors; and the effectiveness and translation of intervention programs.

A narrative review of biopsychosocial factors which impact overweight and obesity for individuals with acquired brain injury

Primary Objective: To discuss the biopsychosocial factors that affect being overweight or obese after acquired brain injury (ABI)Research Design: Narrative reviewMethods and Procedures: Based on the biopsychosocial model, we discuss the unique injury-specific factors that can affect bring overweight or obese among individuals with ABI including: (1) biological, (2) psychological and (3) social/ecological factors.Main Outcomes and Results: Injury-specific factors that impact being overweight or obese following ABI include endocrine dysfunction, pain, bowel and bladder incontinence, balance problems and motor impairment, medications, sleep quality and fatigue, alcohol and tobacco use, psychological disorders and symptoms, cognitive changes, social support, isolation, participation, transportation, independence, and knowledge. These factors may also compound general factors impacting weight management, making it difficult for individuals with ABI to maintain a healthy lifestyle.Conclusions: It is important to recognize the biopsychosocial factors that impact weight-loss and lifestyle change after ABI so that interventions can be tailored to meet individuals' unique needs. Empirical research is needed to better understand how biopsychosocial factors interact and impact overweight/ obesity after ABI.

The perceived benefits of community-based group exercise sessions for survivors of stroke

Background/aims

Post-stroke physical disability, cognitive impairment and emotional trauma can adversely affect the wellbeing of people who have survived stroke. Active participation in group exercise programmes has been advocated as an intervention to potentially enhance wellbeing. This study adopted a qualitative approach to explore the experiences of survivors of stroke who were participating in ongoing community-based group exercise sessions and their impact on subjective wellbeing.

Methods

Interviews were conducted with 12 participants from four community-based group exercise sessions. Of these, 6 were survivors of stroke (44–60 years) and the remaining 6 participants comprised caregivers, group coordinators and/or instructors, who were closely involved with sessions attended by the stroke survivors.

Results

Thematic analysis revealed that participation in community-based group exercise sessions offered survivors opportunities for building confidence; enhancing motivation; improving physical ability of affected limbs; enhancing interpersonal relationships; and providing support and knowledge. Participants all agreed that these physical and psychosocial benefits contributed to improved wellbeing and this supported previous research on the benefits of group work.

Conclusions

Participants explained how community-based group exercise sessions had facilitated their recovery journey and hence it is recommended that such programmes are made available, accessible and affordable to survivors of stroke.

Weight Loss After Stroke Through an Intensive Lifestyle Intervention (Group Lifestyle Balance-Cerebrovascular Accident): Protocol for a Randomized Controlled Trial

BACKGROUND

Weight gain can be a consequence of stroke, or cerebrovascular accident (CVA), because of impaired mobility, behavioral and emotional disorders, and sensory losses. Weight gain increases the patient's risk of recurrent stroke and chronic diseases, such as diabetes, metabolic syndrome, and pulmonary and heart disease. Approaches to weight loss in this population are lacking, although necessary because of the unique physiological and cognitive needs of persons after a stroke. Evidence shows that intensive behavioral therapy interventions that address both physical activity and diet offer the greatest potential for weight loss. The Group Lifestyle Balance (GLB) intervention is a 12-month, evidence-based weight loss program that has been used extensively with the general population; this program was modified to meet the needs of people who have had a stroke (GLB-CVA).

OBJECTIVE

This randomized controlled trial (RCT) aims to examine the efficacy of the GLB-CVA on weight and secondary outcomes, compared with that of a waitlist control group.

METHODS

This RCT will enroll and randomize 64 patients over an 18-month period.

RESULTS

Currently, 51 people are waitlisted, with 23 out of 51 screened and 16 out of 23 eligible.

CONCLUSIONS

It is anticipated that the findings from this RCT will contribute to the evidence base regarding weight loss strategies for people living with stroke.

CLINICAL TRIAL

ClinicalTrials.gov NCT03873467; https://clinicaltrials.gov/ct2/show/NCT03873467.

Impaired decision-making and time perception in individuals with stroke: Behavioral and neural correlates

Several studies have demonstrated that stroke subjects present impairment of functions related to decision-making and timing, involving the information processing in the neural circuits of the cerebellum in association with the prefrontal cortex. This review is aimed to identify the gaps, and demonstrate a better understanding of decision-making and timing functions in the patients with stroke. Electronic literature database was searched and the findings of relevant studies were used to explore the mechanisms of decision-making and timing in patients with stroke, as well as the circuit connections in timing mediated by prefrontal cortex and cerebellum. A literature review was conducted with 65 studies that synthesized findings on decision-making and time perception in individuals with stroke. Types of neurobiological modalities in this study included: Relationships among decision-making, time perception, related cognitive aspects (such as discrimination tasks, verbal estimation, bisection tasks, time production and motor reproduction), and motor control. We demonstrate that the timing processes are important for the performance in cognitive tasks and that the cerebellum and prefrontal cortex are involved in decision-making and time perception. In the context, the decision-making is impaired in stroke patients has a great impact on executive functions, and this seems to be important in determining neurobiological aspects relevant to the time interval interpretation.

Physical Activity Research in Intellectual Disability: A Scoping Review Using the Behavioral Epidemiological Framework

Through a scoping review, the current state of physical activity research in people with intellectual disability was examined. A search of publications between 2000 and 2014 retrieved 362 articles that met inclusion criteria. Eligible studies were coded according to the Behavioral Epidemiological Framework. Of the articles identified, 48% examined associations between physical activity and health outcomes, 9% developed or tested methodology to measure physical activity, 34% examined factors that influence physical activity, 8% evaluated interventions to change physical activity, and 1% examined the dissemination of physical activity/health promotion programming. The categories with lower proportions of studies represent the need for greater population-specific research in physical activity measurement, interventional designs, and translational programs.

Stakeholder evaluation of an online program to promote physical activity and workplace safety for individuals with disability

Individuals with disabilities face increasing health and employment disparities, including increased risk of morbidity and mortality and decreased earnings, occupational roles, and greater risk of injury at work. Thus, there is a need to improve workplace safety and health promotion efforts for people with disability. The purpose of this study was to obtain stakeholder feedback about an online program, Be Active, Work Safe, which was developed to increase the physical activity and workplace safety practices of individuals with disability. Eight stakeholders (content experts and individuals with disability) evaluated the 8-week online program and provided feedback on accessibility, usability, and content using quantitative and qualitative approaches. Stakeholders suggested changes to the organization, layout and accessibility, and content. This included making a stronger connection between the physical activity and workplace safety components of the program, broadening content to apply to individuals in different vocational fields, and reducing the number of participant assessments. Engaging stakeholders in the development of health promotion programs is critical to ensure the unique issues of the population are addressed and facilitate engagement in the program. Feedback provided by stakeholders improved the program and provided insight on barriers for adoption of the program.

Application of Intervention Mapping to the Development of a Complex Physical Therapist Intervention

BACKGROUND

Physical therapist interventions, such as those designed to change physical activity behavior, are often complex and multifaceted. In order to facilitate rigorous evaluation and implementation of these complex interventions into clinical practice, the development process must be comprehensive, systematic, and transparent, with a sound theoretical basis. Intervention Mapping is designed to guide an iterative and problem-focused approach to the development of complex interventions.

PURPOSE

The purpose of this case report is to demonstrate the application of an Intervention Mapping approach to the development of a complex physical therapist intervention, a remote self-management program aimed at increasing physical activity after acquired brain injury.

CASE DESCRIPTION

Intervention Mapping consists of 6 steps to guide the development of complex interventions: (1) needs assessment; (2) identification of outcomes, performance objectives, and change objectives; (3) selection of theory-based intervention methods and practical applications; (4) organization of methods and applications into an intervention program; (5) creation of an implementation plan; and (6) generation of an evaluation plan. The rationale and detailed description of this process are presented using an example of the development of a novel and complex physical therapist intervention, myMoves-a program designed to help individuals with an acquired brain injury to change their physical activity behavior.

CONCLUSION

The Intervention Mapping framework may be useful in the development of complex physical therapist interventions, ensuring the development is comprehensive, systematic, and thorough, with a sound theoretical basis. This process facilitates translation into clinical practice and allows for greater confidence and transparency when the program efficacy is investigated.

Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework

Motor and nonmotor symptoms associated with Parkinson disease place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means of improving health and reducing the risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and Parkinson disease to describe the current evolution and inform knowledge gaps in this area. Research placed in phase 1 establishes links between physical activity and health-related outcomes; phase 2 develops approaches to quantify physical activity behavior; phase 3 identifies factors associated with implementation of physical activity behaviors; phase 4 assesses the effectiveness of interventions to promote activity; and phase 5 disseminates evidence-based recommendations. Peer-reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 287 potential articles. After further review, we excluded 109 articles, leaving 178 included articles. Of these, 75.84% were categorized into phase 1 (n = 135), 10.11% in phase 2 (n = 18), 9.55% into phase 3 (n = 17), 3.37% into phase 4 (n = 6), and 1.12% into phase 5 (n = 2). By applying the behavioral framework to the physical activity literature for people with Parkinson disease, we suggest this area of research is nascent with more than 75% of the literature in phase 1.

LEVEL OF EVIDENCE

III.

Correlations between the sequelae of stroke and physical activity in Korean adult stroke patients

[Purpose] The present study investigated a wide range of stroke patients living in South Korea using the Korean Community Health Survey raw data to determine the correlation between stroke and physical activity. [Subjects and Methods] This study used raw data from the 2012 Korean Community Health Survey. The total number of participants was 228,921; of the 4,475 stroke patients who had been diagnosed by a medical doctor or an oriental medical doctor, the data for 4,460 patients, excluding 15 whose amount of physical activity was unclear, were used in the analysis. [Results] The amount of physical activity performed by patients who had sequelae was significantly lower than that performed by patients who no longer had sequelae. Similarly, for the type of sequelae, palsy in the arms and legs, facial palsy, communication disability, swallowing or eating disability, and visual disability were associated with lower physical activity. Furthermore, as the number of sequelae increased, patients performed significantly less physical activity. [Conclusion] The findings suggest that when decisions on national policies and budgets are made, methods for increasing the physical activity of patients with a history of stroke should be considered.

A systematic review of the efficacy of self-management programs for increasing physical activity in community-dwelling adults with acquired brain injury (ABI)

BACKGROUND

Individuals living with acquired brain injury, typically caused by stroke or trauma, are far less likely to achieve recommended levels of physical activity for optimal health and well-being. With a growing number of people living with chronic disease and disability globally, self-management programs are seen as integral to the management of these conditions and the prevention of secondary health conditions. However, to date, there has been no systematic review of the literature examining the efficacy of self-management programs specifically on physical activity in individuals with acquired brain injury, whether delivered face-to-face or remotely. Therefore, the purpose of this review is to evaluate the efficacy of self-management programs in increasing physical activity levels in adults living in the community following acquired brain injury. The efficacy of remote versus face-to-face delivery was also examined.

METHODS

A systematic review of the literature was conducted. Electronic databases were searched. Two independent reviewers screened all studies for eligibility, assessed risk of bias, and extracted relevant data.

RESULTS

Five studies met the inclusion criteria for this review. Studies were widely heterogeneous with respect to program content and delivery characteristics and outcomes, although all programs utilized behavioral change principles. Four of the five studies examined interventions in which physical activity was a component of a multifaceted intervention, where the depth to which physical activity specific content was covered, and the extent to which skills were taught and practiced, could not be clearly established. Three studies showed favorable physical activity outcomes following self-management interventions for stroke; however, risk of bias was high, and overall efficacy remains unclear. Although not used in isolation from face-to-face delivery, remote delivery via telephone was the predominant form of delivery in two studies with support for its inclusion in self-management programs for individuals following stroke.

CONCLUSIONS

The efficacy of self-management programs in increasing physical activity levels in community-dwelling adults following acquired brain injury (ABI) is still unknown. Research into the efficacy of self-management programs specifically aimed at improving physical activity in adults living in the community following acquired brain injury is needed. The efficacy of remote delivery methods also warrants further investigation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42013006748.