Wondergem R1,2,3, Veenhof C1,2,4, Wouters E3,5, de Bie R6, Visser-Meily J7,8, Pisters M1,2,3
1Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands, 2Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 3Fontys University of Applied Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands, 4Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, Netherlands, 5Tilburg University, School of Social and Behavioral Sciences, Department of Tranzo, Tilbrug, Netherlands, 6Maastricht University, Department of Epidemiology and Caphri Research School, Maastricht, Netherlands, 7University Medical Center Utrecht, Utrecht University, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, Utrecht, Netherlands, 8Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and de Hoogstraat Rehabilitation, Utrecht, Netherlands

Background: The next decades stroke prevalence will increase worldwide. Patients who survive a stroke are at high risk of recurrent stroke, other cardiovascular events, and premature mortality. Highlighting the increasing need for secondary prevention strategies. Both insufficient amounts of physical activity (PA) and high amounts of sedentary behavior (SB) are independent risk factors for cardiovascular events, including stroke, and premature mortality. People with stroke are only half as physically active as healthy subjects. Additional, SB is increased by almost 1 ½ hours compared to healthy peers. Movement behavior includes SB and all levels of PA (light, moderate and vigorous PA) and focuses on the daily pattern of the whole movement behavior spectrum. Currently, little is known about the daily pattern and movement behavior phenotypes in stroke survivors in their home setting after discharge from facility-based care. This detailed information could lead to new insights which can be used for tailoring intervention strategies.

Purpose: The aim of this study will be to identify movement behavior phenotypes in people with stroke discharged from facility-based care to the home setting.

Methods: Patients, recruited from four stroke-units in the Netherlands, were eligible to participate if the individual had a clinically confirmed first-ever stroke, expected to return home, ADL independent before the stroke, ≥ 18 years, able to keep a conservation going and able to walk with supervision. Participants were excluded when life-expectation was less than two years. Participant and stroke characteristics, functional status, participation restrictions, and movement behavior were obtained within two weeks after discharge from facility-based care. Participants wore an accelerometer for 14 days. Cluster analysis was performed to identify phenotypes of movement behavior using a k-means clustering algorithm.

Results: 190 participants were included. Mean wear time of the accelerometer was 13.69±1.44 hours per day. Mean hours sedentary time during the day was 9.25±1.79 (68%), light PA (LPA) 3.81±1.48 (28%) and moderate-to-vigorous PA (MVPA) 0.62±0.50 (4.6%). Four phenotypes were identified:
1. Highly prolonged sedentary and inactive group: sedentary time 10.90±1.50 (78.63%) hours/day, mean sedentary bouts of 40.4±13.09 minutes and one MPVA bout of 0.13 hours/day;
2. Sedentary and inactive group: sedentary for 9.50±0.99 (69.89%) hours/day, mean sedentary bout of 19.36±6.84 minutes and one MPVA bouts of 0.11 hours/day;
3. Inactive but less sedentary group: sedentary for 6.96±1.29 (53.67%) hours/day, mean sedentary bout of 11.64±8.07 minutes and one MPVA bout of 0.11 hours/day;
4. Active but sedentary group: sedentary for 8.99±1.43(63.30%) hours/day, mean sedentary bout of 16.25±7.37 minutes and one MPVA bouts of 0.69 hours per day.

Conclusion(s): Four phenotypes were identified based on the movement behavior in people with the first-ever stroke discharged to the home setting after facility-based care. All individuals can improve their movement behavior but the majority can improve both behaviors. Further research is needed to investigate the course of movement behavior.

Implications: For clinicians, it is important to be aware of different subgroups within the stroke population. It is important to objectify the movement behavior of an individual stroke survivor and identify which phenotype fits the individual.

Keywords: Stroke, Movement Behavior, Secondary prevention

Funding acknowledgements: Netherlands Organization for Scientific Research (NWO)

Topic: Neurology: stroke; Health promotion & wellbeing/healthy ageing; Non-communicable diseases (NCDs) & risk factors

Ethics approval required: Yes
Institution: University Medical Centre, Utrecht, The Netherlands
Ethics 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.

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