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Bansal K, Fox EJ, Clark D, Fulk G, Rose DK. Speed- and Endurance-Based Classifications of Community Ambulation Post-Stroke Revisited: The Importance of Location in Walking Performance Measurement. Neurorehabil Neural Repair 2024; 38:582-594. [PMID: 38813947 DOI: 10.1177/15459683241257521] [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] [Indexed: 05/31/2024]
Abstract
BACKGROUND Gait speed or 6-minute walk test are frequently used to project community ambulation abilities post-stroke by categorizing individuals as household ambulators, limited, or unlimited community ambulators. However, whether improved clinically-assessed gait outcomes truly translate into enhanced real-world community ambulation remains uncertain. OBJECTIVE This cross-sectional study aimed to examine differences in home and community ambulation between established categories of speed- and endurance-based classification systems of community ambulation post-stroke and compare these with healthy controls. METHODS Sixty stroke survivors and 18 healthy controls participated. Stroke survivors were categorized into low-speed, medium-speed, or high-speed groups based on speed-based classifications and into low-endurance, medium-endurance, or high-endurance groups based on the endurance-based classification. Home and community steps/day were quantified using Global Positioning System and accelerometer devices over 7 days. RESULTS The low-speed groups exhibited fewer home and community steps/day than their medium- and high-speed counterparts (P < .05). The low-endurance group took fewer community steps/day than the high-endurance group (P < .05). Despite vast differences in clinical measures of gait speed and endurance, the medium-speed/endurance groups did not differ in their home and community steps/day from the high-speed/endurance groups, respectively. Stroke survivors took 48% fewer home steps/day and 77% fewer community steps/day than healthy controls. CONCLUSIONS Clinical classification systems may only distinguish home ambulators from community ambulators, but not between levels of community ambulation, especially beyond certain thresholds of gait speed and endurance. Clinicians should use caution when predicting community ambulation status through clinical measures, due to the limited translation of these classification systems into the real world.
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Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Mount Union, Alliance, OH, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Brooks Rehabilitation Clinical Research Center, Jacksonville, FL, USA
| | - David Clark
- Brain Rehabilitation Research Center, Malcolm Randall VAMC, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - George Fulk
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Brooks Rehabilitation Clinical Research Center, Jacksonville, FL, USA
- Brain Rehabilitation Research Center, Malcolm Randall VAMC, Gainesville, FL, USA
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Nakano W, Kobayashi S, Maezawa T, Kohno Y. Longitudinal changes in physical activity accumulation patterns during 1-year follow-up in stroke survivors. Disabil Rehabil 2023; 45:4094-4100. [PMID: 36408857 DOI: 10.1080/09638288.2022.2146216] [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: 04/21/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Few studies have reported changes in the accumulation patterns of physical activity over a year after stroke. This study characterized the longitudinal changes in physical activity levels and their accumulation patterns for a 1-year follow-up period in stroke survivors. MATERIALS AND METHODS In this single-center, prospective, longitudinal observational study, 47 stroke survivors were assessed at rehabilitation discharge and at 6 and 12 months post-discharge. Physical activity was evaluated, and measures included the number of steps, walking duration, total number of bouts per day, and intensity (light, moderate-to-vigorous) and spread (short, medium, and long bouts). RESULTS There were no significant main or interaction effects of time on any physical activity variables. Light physical activity accounted for 90% of all walking bouts and 70% of walking duration. Regarding moderate-to-vigorous physical activity (MVPA), 85% of walking bouts and 35% of walking duration were accumulated in short and medium bouts. The number of long-bout MVPA was three per day. CONCLUSIONS Physical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period. Accumulating light physical activity and intermittent MVPA is important for maintaining physical activity levels in stroke survivors. These findings will promote a better understanding of disability and rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPhysical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period.The accumulation of moderate-to-vigorous physical activity in long bouts might be challenging for stroke survivors.Accumulating light physical activity and intermittent moderate-to-vigorous physical activity may be acceptable for stroke survivors.
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Affiliation(s)
- Wataru Nakano
- Department of Physical Therapy, Tokoha University, Shizuoka, Japan
| | - Satomi Kobayashi
- Department of Physical Therapy, Tsukuba International University, Tsuchiura, Japan
| | - Takayuki Maezawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-Gun, Japan
| | - Yutaka Kohno
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Inashiki-Gun, Japan
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Ashizawa R, Honda H, Kameyama Y, Yoshimoto Y. Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial. Int J Behav Med 2023:10.1007/s12529-023-10202-0. [PMID: 37587353 DOI: 10.1007/s12529-023-10202-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke. METHODS This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention). RESULTS Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found. CONCLUSION Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.
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Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, 3453 Mikatahara-Cho, Kita-Ku, Hamamatsu-Shi, Shizuoka, 433-8558, Japan.
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hanadaira Care Center, Hamamatsu, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan
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Steinbeisser K, Schwarzkopf L, Schwettmann L, Laxy M, Grill E, Rester C, Peters A, Seidl H. Association of physical activity with utilization of long-term care in community-dwelling older adults in Germany: results from the population-based KORA-Age observational study. Int J Behav Nutr Phys Act 2022; 19:102. [PMID: 35941614 PMCID: PMC9358813 DOI: 10.1186/s12966-022-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Physical activity (PA) is a proven strategy to prevent chronic diseases and reduce falls. Furthermore, it improves or at least maintains performance of activities of daily living, and thus fosters an independent lifestyle in older adults. However, evidence on the association of PA with relevant subgroups, such as older adults with utilization of long-term care (LTC), is sparse. This knowledge would be essential for establishing effective, need-based strategies to minimize the burden on healthcare systems due to the increasing need for LTC in old age. Methods Data originate from the 2011/12 (t1) baseline assessment and 2016 (t2) follow-up of the population-based Cooperative Health Research in the Region of Augsburg (KORA-)Age study in southern Germany. In 4812 observations of individuals ≥65 years, the association between various types of PA (walking, exercise (i. e., subcategory of PA with the objective to improve or maintain one or more components of physical fitness), walking+exercise) and utilization of LTC (yes/no) was analyzed using generalized estimating equation logistic models. Corresponding models stratified by sex (females: 2499 observations; males: 2313 observations) examined sex-specific associations. Descriptive analyses assessed the proportion of individuals meeting the suggested minimum values in the German National Physical Activity Recommendations for older adults (GNPAR). Results All types of PA showed a statistically significant association with non-utilization of LTC in the entire cohort. “Walking+exercise” had the strongest association with non-utilization of LTC in the entire cohort (odds ratio (OR): 0.52, 95% confidence interval (CI): 0.39–0.70) and in males (OR: 0.41, CI: 0.26–0.65), whereas in females it was “exercise” (OR: 0.58; CI: 0.35–0.94). The proportion of individuals meeting the GNPAR was higher among those without utilization of LTC (32.7%) than among those with LTC (11.7%) and group differences were statistically significant (p ≤ 0.05). Conclusions The GNPAR are rarely met by older adults. However, doing any type of PA is associated with non-utilization of LTC in community-dwelling older adults. Therefore, older adults should be encouraged to walk or exercise regularly. Furthermore, future PA programs should consider target-groups’ particularities to reach individuals with the highest needs for support. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01322-z.
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Affiliation(s)
- Kathrin Steinbeisser
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. .,Faculty for Applied Healthcare Sciences, Technical University of Deggendorf, Dieter-Görlitz-Platz 1, 94469, Deggendorf, Germany.
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Economics, Martin Luther University Halle-Wittenberg, 06099, Halle (Saale), Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,TUM Department of Sport and Health Sciences, Professorship of Public Health and Prevention, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.,School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.,German Center of Diabetes Research (DZD), Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Rester
- Faculty for Applied Healthcare Sciences, Technical University of Deggendorf, Dieter-Görlitz-Platz 1, 94469, Deggendorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Hildegard Seidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Quality Management and Gender Medicine, München Klinik Schwabing, Kölner Platz 1, 80804, Munich, Germany
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