Movement behavior in people with a first-ever stroke The RISE cohort study

Abstract

Globally, stroke affects 16 million individuals every year. Patients who survive a stroke are at high risk for recurrent stroke and other cardiovascular events. In the next decades, the prevalence of stroke is expected to increase worldwide, highlighting the need for effective disease management and secondary prevention strategies. A lack of moderate to vigorous physical activity (MVPA) and high amounts of sedentary behavior (SB) are independent risk factors for all-cause mortality, cardiovascular diseases and functional decline. Although the independent health risks of these single behaviors are highlighted in research, these behaviors are not self-contained but cluster in patterns (e.g., high MVPA/high LPA/low SB or low MVPA/low LPA/high SB). There is a growing interest in the optimal distribution of daily activities, more specifically, the interplay between SB and PA levels in people with stroke. Movement behavior patterns reflect the total habitual behavior during waking hours. The results are based on the RISE (Reducing sedentary behavior, Identification of people at risk, in people with Stroke, Effectiveness in daily living) cohort study with 200 participants involved. The period shortly after stroke seems to be crucial to change movement behavior. Most recovery of function occurs within the first week after stroke, when most people still receive professional care and motivational preparedness to achieve the desired behavior change is potentially high. However, in this thesis no changes in movement behavior were objectified. Overall, it seems that people with stroke are highly sedentary compared to healthy peers. Three movement behavior patterns were identified: Sedentary exercisers (22.6%) were sedentary; however, sedentary time was often interrupted, and overall, these participants were sufficiently active. Sedentary movers’ (45.6%) sedentary behavior was comparable to sedentary exercisers’ sedentary behavior. However, this group was inactive. The time sedentary exercisers spent in MVPA, sedentary movers spent in light physical activity. Sedentary prolongers (31.6%) were highly sedentary, accumulated their sedentary time in long prolonged bouts and were physically inactive. Low-levels of self-efficacy seems to be an important associating factor with sedentary prolongers. Physical functioning at baseline and in the course of the first year after stroke differ between movement behavior patterns. Physical functioning remained relatively stable during the first year after stroke in sedentary exercisers. Physical functioning improved during the first six months after discharge in sedentary movers and sedentary prolongers and deteriorated in the following six months. Sedentary prolongers deteriorated significant more compared to sedentary movers. It seems that physical functioning outcomes at baseline are decisive for the course of physical functioning within the first year. In summary, three distinctive movement behavior patterns are identified in people with stroke returning to their home-setting. These patterns seem to require a tailored approach, in which different target behavior and content of intervention seem to be needed. An unfavorable movement behavior pattern, with less physical activity and high sedentary behavior, is associated with a functional decline in the long-term. 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.