P.J. van der Laag1,2, R. Wondergem2,3,4, M.F. Pisters2,3,4
1Physical Therapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, Netherlands, 2Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands, 3Department of Rehabilitation, Physical Therapy Science and Sport, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands, 4Fontys University of Applied Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands
Background: Reducing sedentary time and improving physical activity are known modifiable risk factors to prevent secondary complications after stroke. These single behaviors are not-self-contained but cluster in patterns. Latest research found the most commonly distinct movement behavior patterns in people with stroke (e.g. sedentary exercisers, sedentary movers, sedentary prolongers). Still, studies investigating movement behavior patterns composition and individual changes in membership over time in people with stroke are lacking. A better understanding in the composition of movement behavior patterns and individuals’ membership in movement behavior pattern over time could contribute to the identification of people with unfavorable movement behavior and development of more personalized trajectories in stroke care.
Purpose: The aims of this study were:
1) to investigate the stability of the composition of movement behavior patterns the first two years after discharge to home in people with a first-ever stroke and
2) to determine individuals’ membership changes in movement behavior patterns within the first two years after discharge to home in people with a first-ever stroke.
1) to investigate the stability of the composition of movement behavior patterns the first two years after discharge to home in people with a first-ever stroke and
2) to determine individuals’ membership changes in movement behavior patterns within the first two years after discharge to home in people with a first-ever stroke.
Methods: Accelerometer data of 200 stroke survivors of the RISE cohort study were analyzed. Ten movement behavior variables were measured during waking hours at three weeks, six months, one year and two years after home discharge. On all four time-points, three movement behavior patterns were identified using K-means clustering. The distribution of components and distance of cluster centers within patterns were compared to investigate the stability of the composition of movement behaviors patterns over time. Frequencies of individuals’ membership and membership changes in movement behavior patterns were objectified.
Results: The composition of the movement behavior patterns did not change over time. Thirty-five percent of the stroke survivors changed in movement behavior pattern membership within the first two years after discharge to home. At baseline, the total population consisted of 22% sedentary exercisers (active/sedentary), 45% sedentary movers (inactive/sedentary) and 33% sedentary prolongers (inactive/highly sedentary). In the first six months, the proportion of sedentary exercisers increased to 23.5%, hereafter the proportion decreased to 19%, two years later. In the first year, the proportion of sedentary movers increased to 49.5%, hereafter the proportion decreased to 42%. The proportion of sedentary prolongers decreased to 28.5% in the first six months. Between six months and two years, the proportion of sedentary prolongers increased to 39% of the total population.
Conclusion(s): Although the composition of movement behavior patterns in people with a first-ever stroke remain stable over time, individuals’ movement behavior pattern membership changes. The increase of the most unfavorable movement behavior pattern with most health risks, sedentary prolongers, is of great concern. Further research should determine why the number of sedentary prolongers increases over time.
Implications: The composition of the movement behavior pattern can differ per person, therefore every individual requires a different approach. Preventing people with stroke from unfavorable movement behavior and stimulate to maintain a healthy movement behavior could be a cornerstone for secondary prevention in stroke care. People with stroke should be offered a sustainable and personalized tailored program based on individual movement behavior pattern and needs.
Funding, acknowledgements: This article was funded by Dutch Organization for Scientific Research (NWO), Doctoral Grant for Teachers, 023.003.136
Keywords: Movement behavior, Stroke, Secondary prevention
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? Yes
Institution: University Medical Centre, Utrecht, The Netherlands
Committee: The Medical Ethics Committee of the University Medical Centre Utrecht
Ethics number: NL14-076
All authors, affiliations and abstracts have been published as submitted.
