Physical activity measured by accelerometer after acute stroke – How physically active are stroke survivors during the acute phase of rehabilitation?

To determine stroke survivors' level of PA during hospital admission and the first week after discharge.

Participants were enrolled during the acute in-hospital stay at section for stroke in Nordsjælland’s Hospital, Denmark, from 2. February to 18. August 2023. Participants eligible for the cohort study were stroke survivors receiving a regular rehabilitation plan with a referral to rehabilitation in municipalities after discharge. The level of PA was measured during admission and seven days post discharge using a SENS motion ® sensor attached to the right thigh of the participant. Data were categorized into four subcategories: steps, moderate-vigorous PA (MVPA), total PA, and sedentary time (including sleep-time). Time trends were analyzed with linear mixed models.

The cohort consisted of 122 participants. From these 81 participants were included in the present analysis. Mean ± SD age was 72 ± 10 years, 65% were men, Scandinavian Stroke Scale was median (IQR) 52 (44-58), and strokes were ischemic 76.4%, hemorrhagic 19.5%, and transient cerebral ischemic attack 1.6%. During the in-hospital stay of 2.5±3.5 days participants managed a range between 2336-2869 steps/day. After discharge participants increased number of steps to a range between 5405-6466 steps/day during seven days (mean [95%CI] 6026 [5754; 6298] steps/day). Steps remained unchanged after discharge during the week, p=0.148 (day one 5405 steps/day and day seven 6111 steps/day). Mean MVPA per day was 3.8 [2.9; 4.6] minutes with a range from 2.3-5.5 minutes/day. Mean sedentary time per day at 20.8 [20.6; 21.1] hours remained unchanged during the week. 
PA measured as steps in stroke survivors is a way of detecting changes during acute rehabilitation treatment from hospital to municipality. From admission to post discharge stroke survivors increased their overall PA level. Even though patients with a rehabilitation plan were recruited, only few of them reached WHO’s recommended weekly 150 min of MVPA. There was a trend towards participants being more physically active post discharge and increasing their PA/day throughout the seven days.

Level of PA in stroke survivors increased after hospital discharge, where only few participants reached minimum recommendations in terms of MVPA/day. In addition, sedentary time was high and needs attention in clinical practice. Thus, it is suggested that stroke survivors are at a high risk of having a low level of MVPA and high level of sedentary time during and after in-hospital stay.

Ongoing research regarding motivation and ability to enhance PA in the cross-sectoral rehabilitation course for stroke survivors should help establish more continuity and constant level of activity. Sedentary time for this patient group also need attention and should be reduced.