1
|
Ashizawa R, Honda H, Take K, Yoshizawa K, Kameyama Y, Yamashita S, Wakabayashi T, Yoshimoto Y. Post-discharge sedentary behavior and light-intensity physical activity-associated stroke recurrence in patients with minor ischemic stroke: A preliminary retrospective observational study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2110. [PMID: 39010688 DOI: 10.1002/pri.2110] [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: 01/31/2024] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND AND PURPOSE Evidence regarding whether reducing sedentary behavior and increasing physical activity levels to prevent stroke recurrence is insufficient. Therefore, this study preliminarily investigated whether post-discharge sedentary behavior and physical activity levels in patients with minor ischemic stroke were associated with stroke recurrence. METHODS This retrospective observational study included 73 patients (aged 72.0 years) with minor ischemic stroke from a previous study. The outcome was recurrent stroke 2 years after stroke onset, assessed using medical records. Exposure factors including sedentary behavior and physical activity levels 6 months post-discharge were measured using accelerometers; patients were classified into the recurrence or non-recurrence groups. Logistic regression analyses were then conducted to determine whether sedentary behavior and physical activity 6 months after discharge were associated with stroke recurrence. RESULTS Six patients experienced stroke recurrence (recurrence rate, 8.2%). The recurrence group showed greater sedentary behavior (recurrence group 68.0%, non-recurrence group 52.0%, p = 0.007) and less light-intensity physical activity (LPA) (recurrence group 21.0%, non-recurrence group 37.0%, p = 0.002) than in the non-recurrence group. Logistic regression analysis showed that sedentary behavior (odds ratio = 1.083, 95% confidence interval = 1.007-1.165, p = 0.032) and LPA (odds ratio = 0.874, 95% confidence interval = 0.785-0.975, p = 0.015) were independent factors for recurrence of stroke. DISCUSSION Post-discharge sedentary behavior and LPA in patients with minor ischemic stroke were associated with stroke recurrence. Results suggest that reducing post-discharge sedentary behavior and increasing LPA may be crucial for reducing the risk of stroke recurrence in patients with minor ischemic stroke.
Collapse
Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu-shi, Shizuoka, Japan
- Health Promotional Physical Therapy for Stroke Survivors: HEPPS, Strategic Issues Resolution Commission, Japanese Society of Neurological Physical Therapy, Hamamatsu-shi, Shizuoka, Japan
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-shi, Shizuoka, Japan
| | - Koki Take
- Visiting Nurse Station Sumiyoshi-daini, Seirei Care Center Sumiyoshi-daini, Hamamatsu-shi, Shizuoka, Japan
| | - Kohei Yoshizawa
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-shi, Shizuoka, Japan
| | - Yuto Kameyama
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-shi, Shizuoka, Japan
| | - Shota Yamashita
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-shi, Shizuoka, Japan
| | - Toshiyuki Wakabayashi
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-shi, Shizuoka, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu-shi, Shizuoka, Japan
| |
Collapse
|
2
|
Svalbjørg T, Askim T, Saltvedt I, Alme K, Lydersen S, Eldholm R. Changes in sedentary behavior in the chronic phase following stroke. J Stroke Cerebrovasc Dis 2024; 33:107827. [PMID: 38901471 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107827] [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: 12/04/2023] [Revised: 05/29/2024] [Accepted: 06/18/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Sedentary behavior increases risk for cardiovascular diseases. Little is known about sedentary behavior through the chronic phase after stroke. We aimed to describe how long and short bouts of sedentary behavior changed over the first three years after stroke and if cognition at baseline was an independent risk factor for sedentary behavior. METHODS This is a sub-study of the Norwegian cognitive impairment after stroke (Nor-COAST) study, a multicenter study recruiting patients with acute stroke. Sedentary behavior was monitored with a thigh-worn sensor (ActivPal3®), at three-, 18- and 36-months post stroke. Stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS) and cognition by Montreal cognitive assessment (MoCA). Mixed model analysis with mean number of sedentary minutes accumulated daily as the dependent variable was repeated for all four zones (<30min, 30-60min, 60-90min, >90min) and for total sedentary time. RESULTS The number of included participants was 528 (mean age 71.4, NIHSS on day 1, 2.7). The total amount of sedentary time accumulated between 08.00-22.00 increased significantly from about 9.8 hours at three months to 10.1 hours at 36 months post stroke (p=0.002). Patient characteristics associated with prolonged duration of the sedentary bouts and sedentary time were age, high BMI, comorbidities, and impaired physical function. No significant associations between MoCA score and sedentary time were found. CONCLUSION The participants became increasingly sedentary and had fewer breaks in sedentary time from three to 36 months after stroke. Baseline cognition was not related to later sedentary behavior.
Collapse
Affiliation(s)
- Tone Svalbjørg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway; Department of Geriatrics, Clinic of internal medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Katinka Alme
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Tronheim, Norway
| | - Rannveig Eldholm
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim 7491, Norway; Department of Geriatrics, Clinic of internal medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| |
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
|
Ashizawa R, Honda H, Take K, Yoshizawa K, Kameyama Y, Yoshimoto Y. Effects on sedentary behaviour of an approach to reduce sedentary behaviour in patients with minor ischaemic stroke: A randomised controlled trial. Clin Rehabil 2023; 37:545-556. [PMID: 36357967 DOI: 10.1177/02692155221135412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the effects on sedentary behaviour of an approach that promotes reduction in sedentary behaviour in patients with minor ischaemic stroke after intervention and at follow-up. DESIGN A randomised controlled trial. SETTING During hospitalisation and after hospital discharge. SUBJECTS In total, 86 patients with minor ischaemic stroke admitted to an acute care hospital were assigned to the intervention (n = 43) and control (n = 43) groups. INTERVENTION An intervention group that received an approach to reduce sedentary behaviour upon hospital admission until 3 months after discharge (education, self-monitoring, phone calls, etc.) and a control group that received the usual care during hospitalisation. From 3 to 6 months after discharge, no group received any intervention. MAIN OUTCOME The primary outcome was the change (%) in sedentary behaviour from baseline to post-intervention (3 months after discharge) and follow-up (6 months after discharge). Sedentary behaviour was measured at baseline (upon hospital admission), post-intervention, and at follow-up using accelerometers. RESULTS At the post-intervention stage, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, -22.7%; control group, -14.9%; P = 0.013; effect size = 0.58). At follow-up too, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, -20.4%; control group, -13.6%; P = 0.025; effect size = 0.54). CONCLUSIONS An approach to reduce sedentary behaviour in patients with minor ischaemic stroke effectively reduces sedentary behaviour, which is sustained up to follow-up. TRIAL REGISTRATION This study is registered at www.umin.ac.jp/ctr/index/htm UMIN000038616.
Collapse
Affiliation(s)
- Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan.,Department of Rehabilitation, Hanadaira Care Center, Hamamatsu, Japan
| | - Koki Take
- Visiting Nurse Station Sumiyoshi-daini, Seirei Care Center Sumiyoshi-daini, Hamamatsu, Japan
| | - Kohei Yoshizawa
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu, Japan.,Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, 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
| |
Collapse
|
5
|
de Diego-Alonso C, Alegre-Ayala J, Buesa A, Blasco-Abadía J, López-Royo MP, Roldán-Pérez P, Giner-Nicolás R, Güeita-Rodriguez J, Fini NA, Domenech-Garcia V, Bellosta-López P. Multidimensional analysis of sedentary behaviour and participation in Spanish stroke survivors (Part&Sed-Stroke): a protocol for a longitudinal multicentre study. BMJ Open 2023; 13:e065628. [PMID: 36792320 PMCID: PMC9933767 DOI: 10.1136/bmjopen-2022-065628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Stroke survivors usually experience long-lasting functional, emotional and social consequences that might contribute to sedentary behaviour and participation restrictions, which are important targets to address during rehabilitation. However, the trajectory and inter-relationship between these factors are unknown. METHODS AND ANALYSIS Part&Sed is a research project based on an observational study design with 6 and 12 months of follow-ups in stroke survivors. In addition, a qualitative analysis of the impact of the stroke on the stroke survivor, validation of the Satisfaction with Daily Occupation-Occupational Balance assessment tool and analysis of the reliability of the Fitbit Inspire 2 activity tracker wristband will be carried out. Participants will be chronic stroke survivors with independent walking capacity. Sociodemographic and clinical data, physical activity, ambulation, sleep, quality of life, anxiety and depression, community participation, and occupational satisfaction and balance, as well as data provided by the activity tracker wristband, will be collected. In addition, if the participant has a primary caregiver, the caregiver will also be monitored. A minimum of 130 participants will be recruited to conduct a random-effects multiple regression model. Mixed models for repeated measures will assess the variation over time of the different variables associated with participation and sedentary behaviour. Psychometric properties (eg, internal consistency, construct validity, test-retest reliability) of the Satisfaction with Daily Occupation-Occupational Balance will be determined. Additionally, intraclass correlation coefficients and minimum detectable change will be calculated to assess intrasubject reliability of physical activity and sleep parameters recorded by the Fitbit Inspire 2. The qualitative analysis process will be carried out using the analysis proposed by Giorgi. ETHICS AND DISSEMINATION The study received ethical approval from the Spanish Regional Ethics Committee 'Comité de Ética de la Investigación de la Comunidad de Aragón' (PI21/333). The results will be made available via peer-reviewed publications, international conferences and official channels.
Collapse
Affiliation(s)
- Cristina de Diego-Alonso
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | | | - Almudena Buesa
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Julia Blasco-Abadía
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Pilar López-Royo
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Patricia Roldán-Pérez
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Rafael Giner-Nicolás
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Javier Güeita-Rodriguez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine; Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Universidad Rey Juan Carlos, Health Science Faculty, Alcorcón, Spain
| | - Natalie Ann Fini
- Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
| | - Victor Domenech-Garcia
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Autov.A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| |
Collapse
|