Sedentary time and activity behaviors after stroke rehabilitation: Changes in the first 3 months home

ABSTRACT

Background

Sedentary time is prevalent following stroke, limiting functional improvement, and increasing cardiovascular risk. At discharge we examined: 1) change in sedentary time and activity over the following 3 months’ and 2) physical, psychological or cognitive factors predicting any change. A secondary aim examined cross-sectional associations between factors and activity at 3 months.

Methods

People with stroke (n = 34) were recruited from two rehabilitation units. An activity monitor (ActivPAL3) was worn for 7 days during the first week home and 3 months later. Factors examined included physical, psychological, and cognitive function. Linear mixed models (adjusted for waking hours) were used to examine changes in sedentary time, walking, and step count over time. Interaction terms between time and each factor were added to the model to determine if they modified change over time. Linear regression was performed to determine factors cross-sectionally associated with 3-month activity.

Results

ActivPAL data were available at both time points for 28 (82%) participants (mean age 69 [SD 12] years). At 3 months, participants spent 39 fewer minutes sedentary (95%CI −70,-8 p = .01), 21 minutes more walking (95%CI 2,22 p = .02) and completed 1112 additional steps/day (95%CI 268,1956 p = .01), compared to the first week home. No factors predicted change in activity. At 3 months, greater depression (β 22 mins (95%CI 8,36) p = .004) and slower gait speed (β − 43 mins 95%CI −59,-27 p ≤ 0.001) were associated with more sedentary time and less walking activity, respectively.

Conclusions

Sedentary time reduced and walking activity increased between discharge home and 3 months later. Interventions targeting mood and physical function may warrant testing to reduce sedentary behavior 3 months following discharge.

KEYWORDS:

• Sedentary time
• physical activity
• stroke
• rehabilitation
• depression
• gait speed

Acknowledgments

We would like to acknowledge the support of Frank Nicklason and the Department of Geriatrics Tasmanian Health Service South, Helen Castley and the Department of Neurology Tasmanian Health Service South, and the Department of Physiotherapy Tasmanian Health Service South.

Suppliers

^a activPAL3: PALtechnologies. 50, Richmond Street, Glasgow, G11XP. Scotland, United Kingdom

Additional information

Funding

This study was funded by a project research grant from the Department of Geriatrics, Royal Hobart Hospital, Tasmanian Health Service-South. DS is supported by a Commonwealth Department of Health nursing and allied health postgraduate scholarship. MC is supported by an NHMRC Dementia Research Fellowship (#1135761). CE is supported by a Heart Foundation of Australia Future Leaders Fellowship (#101177). SG is supported by a Heart Foundation of Australia Future Leaders Fellowship (#100446).