R. Wondergem1,2,3, C. English4, W. Hendrickx1,2,3, 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 Newcastle, School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia

Background: People with stroke spend the vast majority of their waking hours sedentary (sitting or lying down), and rarely engage in health-enhancing physical activity (of at least moderate intensity). Large scale epidemiology studies have linked high sedentary times with substantial increased risk of both cardiovascular and all-cause mortality. In previous research 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).
However, it remains unknown how movement behaviours are accumulated during the day and if this daily patterns changes over time.

Purpose: What are the daily temporal patterns of movement behaviours (sedentary time, light intensity physical activity and moderate-vigorous physical activity) in people with stroke? Do daily temporal patterns of sedentary time differ
(a) between subgroups of people with different movement behaviour patterns and
(b) over time during the first year after stroke?

Methods: Data of the  longitudinal RISE cohort study (n=197) was used. People with stroke discharged to the home-setting were visited immediately after discharge, six months and one year later. Movement behaviour was objectively measured using the Activ8 activity monitor at every time point. The number of min/hr spent sedentary, in LPA and in MVPA were analysed and graphed using descriptive statistics. We used generalized estimating equations (GEEs) to explore 1) the change in percentages in sedentary activities, LPA and MVPA across the day, and 2) differences in the temporal patterns of sedentary time between different movement behaviour patterns.

Results: In general, participants spent less time sedentary in the morning with proportionally more sedentary time as the day progressed with maximal sedentary time seen in the evening hours. This pattern did not substantially change over time. Sedentary prolongers spent significantly more absolute time sedentary for each hour of the day (almost 10 minutes per hour), but the daily temporal pattern of sedentary time did not differ between this group and either ‘sedentary movers’ or ‘sedentary exercisers’.

Conclusion(s): People living at home after stroke are highly sedentary, particularly in the afternoons and evenings and this pattern does not change during the first year after stroke.

Implications: Clinicians should encourage people with stroke to find meaningful tasks to do during the day to reduce their sitting time. Researchers developing interventions to encourage people to sit less should include particular focus on the afternoon and evening time periods.

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

Keywords: stroke, sedentary behavior, secondary prevention

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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