The longitudinal association between movement behavior patterns and the course of participation up to one year after stroke

Figures & data

Table 1. Baseline characteristics.

	Total group (n = 200)	Sedentary exercisers (n = 44)	Sedentary movers (n = 90)	Sedentary prolongers (n = 66)
Demographic characteristics
Age, years	67.8 ± 11.2	62.6 ± 11.2	69.2 ± 11.6^a	69.3 ± 10.8^c
Sex, male	64.0	79.5	56.7^a	63.6
High education level	29.8	43.2	23.3	28.8
Comorbidities (CIRS)	3.2 ± 2.8	2.1 ± 2.5	3.5 ± 2.8^a	3.4 ± 2.8^c
Living together with partner	76.3	72.7	72.2	83.3
Stroke characteristics
Ischemic stroke	91.5	93.2	90.0	92.4
Side of stroke, left	53.5	56.8	48.8	57.6
Stroke severity (NIHSS)	4.0 ± 4.0	3.8 ± 3.9	3.6 ± 3.5	4.7 ± 4.7
No symptoms (NIHSS 0)	13.0	13.6	14.4	10.6
Minor symptoms (NIHSS 1–4)	55.5	54.5	57.8	53.0
Moderate/severe symptoms (NIHSS ≥ 5)	31.5	31.8	27.7	36.4
Discharge destination, home	73.5	79.5	75.6	66.7
Physical functioning & movement behavior
SIS Physical	83.9 ± 17.3	94.3 ± 6.8	82.9 ± 16.8^a	78.4 ± 19.9^c
Walking speed (5MWT in seconds)	6.0 ± 3.7	4.5 ± 0.7	6.1 ± 3.3^a	7.2 ± 4.8^c
Sedentary time (hours)	9.3 ± 1.8	9.0 ± 1.6	8.4 ± 1.5	10.6 ± 1.4^b,c
LPA (hours)	3.8 ± 1.5	3.8 ± 1.2	4.6 ± 1.5^a	2.8 ± 0.8^b,c
MVPA (hours)	0.6 ± 0.5	1.3 ± 0.4	0.4 ± 0.3^a	0.4 ± 0.3^c
Psychological and cognitive factors
Impaired cognition (MoCA ≤ 25)	59.0	61.4	58.9	57.6
Symptoms of depression (HADS-D ≥ 8)	26.5	22.7	30.0	24.2
Symptoms of anxiety (HADS-A ≥ 8)	27.0	34.1	28.9	19.7
Self-efficacy (SEsx)	92.9 ± 22.0	98.3 ± 20.6	92.9 ± 23.1	89.4 ± 21.0^c

Values are percentages or mean ± SD.

Abbreviations: 5MWT, Five Minute Walk Test; CIRS, Cumulative Illness Rating Scale; HADS-A, Hospital Anxiety and Depression Scale-Anxiety subscale; HADS-D, Hospital Anxiety and Depression Scale-Depression subscale; LPA, light physical activity; MoCA, Montreal Cognitive Assessment; MVPA, moderate-vigorous physical activity; NIHSS, National Institutes of Health Stroke Scale; SEsx, Self-Efficacy for Symptom Management Scale.

^astatistically significant differences (p < 0.05) between sedentary exercisers and sedentary movers.

^bstatistically significant differences (p < 0.05) between sedentary movers and sedentary prolongers.

^cstatistically significant differences (p < 0.05) between sedentary exercisers and sedentary prolongers.

Figure 1. RISE study flowchart [24].

After discharge from facility-based care, data on movement behavior patterns were collected in 190 participants. Multiple imputations was used for the missing data in 10 participants, so eventually 200 participants were available for GEE analysis.

Figure 2. Distribution movement behavior pattern groups at baseline, 6 months and 1 year (n = 200).

The composition of the movement behavior patterns remained relatively stable over time.

Figure 3. The modelled course of participation during the first year after discharge to the home setting in people with a first-ever stroke per movement behavior pattern at baseline. Abbreviations: SIS Participation: Stroke Impact Scale 3.0 Participation domain. Outcomes are adjusted for the confounding effects of stroke severity (NIHSS), age, sex, symptoms of anxiety (HADS-A) and discharge destination after hospitalization. Note: higher SIS Participation scores indicate better participation outcomes. The error bars represent the standard error (SE). *p < 0.05, comparing mean SIS Participation scores between consecutive time points.

Participation improved up to six months after discharge and stabilized afterwards across all movement behavior patterns. Sedentary prolongers had the most unfavorable course of participation up to one year after stroke.

Table 2. Changes in SIS Participation during the first year after discharge across different movement behavior patterns identified directly after discharge to the home setting.

Time interval after stroke	Sedentary exercisers		Sedentary movers		Sedentary prolongers
	β (95% CI)	SE	β (95% CI)	SE	β (95% CI)	SE
Discharge–6 months	5.54 (1.20–9.89)*	2.22	8.65 (5.09–12.21)*	1.82	6.81 (2.96–10.66)*	1.96
6 months–1 year	−1.36 (−4.87–2.16)	1.80	−0.42 (−2.78–1.95)	1.21	−2.53 (−5.40–0.34)	1.47
Discharge–1 year	4.19 (−0.87–9.24)	2.58	8.23 (4.38–12.07)*	1.96	4.28 (−0.24–8.80)	2.31

Abbreviations: β, regression coefficient for the effect of time; CI, confidence interval; SE, standard error; SIS Participation, Stroke impact scale 3.0 Participation domain.

Outcomes are adjusted for the confounding effects of stroke severity (NIHSS), age, sex, symptoms of anxiety (HADS-A) and discharge destination after hospitalization.

Note: a positive regression coefficient (β) implies an improvement in SIS Participation in the cited time interval with β units.

*p < 0.05.

Table 3. The longitudinal association between the course of SIS Participation and the development of movement behavior patterns over time.

Movement behavior patterns	Course of SIS Participation over time
	β (95% CI)	SE
Sedentary exerciser^a vs. sedentary mover^b	2.65 (−0.69–6.00)	1.71
Sedentary exerciser^a vs. sedentary prolonger^b	4.30 (0.39–8.20)*	1.99
Sedentary mover^a vs. sedentary prolonger^b	1.64 (−1.72–5.01)	1.72

Abbreviations: β, regression coefficient for the effect of time; CI, confidence interval; SE, standard error; SIS Participation, Stroke impact scale 3.0 Participation domain.

Outcomes are adjusted for the confounding effects of stroke severity (NIHSS), age, sex, symptoms of anxiety (HADS-A) and discharge destination after hospitalization.

Note: a positive regression coefficient (β) implies an improvement in SIS Participation on average over time in the cited category (^a) compared to the reference category (^b) with β units (including both within-persons as between-persons effects).

*p < 0.05.

Wondergem R, Veenhof C, Wouters E, et al. Movement behavior patterns in people with first-ever stroke. Stroke. 2019;50(12):3553–3560.

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Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.