R. Wondergem1,2,3, C. Veenhof1,2,4, E. Wouters3,5, R. de Bie6, J. Visser1,7, M. Pisters1,2,3
1University Medical Center Utrecht, Rehabilitation, Physical Therapy Science and Sport, Utrecht, Netherlands, 2Julius Health Care Centers, Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands, 3Fontys University, Health Innovation and Technology, Eindhoven, Netherlands, 4University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, Utrecht, Netherlands, 5Tilburg University, School of Social and Behavioral Sciences, Department of Tranzo, Tilburg, Netherlands, 6Maastricht University, Department of Epidemiology and Caphri research school, Maastricht, Netherlands, 7University Medical Center Utrecht and De Hoogstraat Rehabilitation, Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands

Background: Deterioration of physical functioning after stroke in the long term is regarded as a major problem. Sufficient amount of moderate to vigorous physical activity is protective for decline in physical functioning. The relation between physical functioning and the composition of intensities of physical activity and sedentary behavior during waking hours, called movement behavior patterns, is currently unknown. Ignoring, other components of the movement continuum limits our  understanding of how habitual movement behavior interacts with physical functioning over time. Therefore, the relationship between peoples’ movement behavior pattern directly after stroke and the development of physical functioning over time needs to be investigated.

Purpose: The objectives of the study were to: 1. identify movement behavior patterns by in people with first-ever stroke; 2. explore which factors are associated with the identified patterns; and 3. investigate the course of physical functioning per movement behavior pattern up to two years after returning home.

Methods: 200 people with stroke discharged to the home-setting were visited immediately after discharge, six months, one year and two years later. Movement behavior and physical functioning were determined at every time point. Movement behavior was objectively measured using the Activ8 accelerometer and movement behavior patterns were identified using k-means clustering algorithm. Physical functioning, participation, demographics, stroke characteristics, psychological, cognitive and social factors were obtained. Univariate and multivariate logistic regression analyses were performed to study specific associating factors per movement behavior pattern. To study the course of physical functioning per movement behavior pattern, generalized estimating equations were performed.

Results: On average people with stroke are inactive and sedentary. Three movement behavior patterns were identified: 1. sedentary exercisers (22%) (sufficient active, >63% of waking hours sedentary); 2. sedentary movers (46%) (insufficient active, >63% of waking hours sedentary); and 3. sedentary prolongers (32%) (insufficient active, >77% of waking hours sedentary accumulated in long prolonged bouts). Factors associated with sedentary exercisers were low levels of fatigue and being a community walker, with sedentary movers higher age, a higher level of self-efficacy and female gender, and with sedentary prolongers more stroke symptoms, lower level of pre-stroke physical activity and lower level of self-efficacy. Sedentary exercisers’ physical functioning remained stable. Sedentary movers’ physical functioning improved up to six months and declined afterwards. Sedentary prolongers’ physical functioning improved up to six months and declined significantly more compared to sedentary movers between up to two years.

Conclusion(s): Three distinctive movement behavior patterns are identified in people with stroke returning to their home-setting. The course of physical functioning after stroke depends on people’s movement behavior pattern. Highly sedentary and inactive people with stroke have unfavorable outcomes over time compared to individuals with higher amounts of physical activity.

Implications: Different movement behavior patterns seem to require a tailored approach, in which different target behavior and content of intervention seem to be  needed. Secondary prevention using a behavioral approach to change movement behavior seems to be indicated in people with stroke who have an unfavorable movement behavior pattern.

Funding, acknowledgements: This study was funded by the Dutch Organization for Scientific Research (NWO), Doctoral grant for Teachers, 023.003.136

Keywords: Stroke, Secondary prevention, Physical activitity and sedentary behavior

Topic: Neurology: stroke

Did this work require ethics approval? Yes
Institution: UMC Utrecht
Committee: METC UMC Utrecht
Ethics number: 14/076

All authors, affiliations and abstracts have been published as submitted.

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