Towards sustainable movement behaviour change in people with stroke: Development of the RISE intervention

Abstract

Stroke affects approximately 12.2 million people each year and remains the second leading cause of death and the third leading cause of disability worldwide. People who have suffered a stroke are at high risk of recurrent stroke. High amounts of sedentary behaviour and low levels of physical activity increase the risk of (recurrent) stroke. Sedentary behaviour is defined as ‘any waking behaviour characterized by an energy expenditure ≤1.5 metabolic equivalent of task while in a sitting, reclining, or lying posture’. About 78% of people with stroke are highly sedentary and inactive. First, we identified what is needed to support people with stroke to sustainably reduce and interrupt their sedentary behaviour. Variability in sedentary behaviour was largely unaccounted for by physical capabilities or stroke sequelae. It is mainly based on personal habits and daily routines and therefore influenced by the physical and social environment of that person. Additionally, people with stroke who are highly sedentary accumulated a significantly higher proportion of their sedentary time in prolonged bouts (p<0.001), further increasing health risks. There is not just one unique accumulation pattern for high sedentary time. This suggests that interventions to reduce and interrupt sedentary time should be tailored to the individual and include objectively determining accumulation patterns. These findings were utilized in the cocreation development process of the RISE intervention, a 15-weeks blended behavioural intervention in which a primary care physiotherapist coached participants to reduce and interrupt their sedentary time. Physiotherapists provided personalised coaching to people with a stroke in their home setting by using behaviour change techniques and the RISE eCoaching system. The RISE eCoaching system consists of 1) an activity monitor, 2) a smartphone application that provides real-time feedback and contains e-learning modules, and 3) a monitoring dashboard for the physiotherapist. The participants received participatory support from someone from their social network (e.g., partner or close friend) who joined them in the intervention. A preliminary evaluation study, using a randomised multiple baseline design, showed that the RISE intervention appears promising for supporting community-dwelling people with stroke who are highly sedentary to reduce and interrupt their sedentary time. The participants (n=14) significantly reduced their total sedentary time (p=0.01) by 1.3 hours on average and increased their fragmentation (i.e. interruption) of sedentary time (p<0.01). Subgroup analyses showed significant improvements in total sedentary time (p=0.03) and fragmentation (p=0.03) in the group with participatory support. Only fragmentation was significantly improved in the group without participatory support (p=0.04). This indicates that including participatory support provided by someone from their social network (e.g., partner or close friend) who joins the participant in the RISE intervention appears to contribute to greater results. Thirteen of 14 participants (93%) completed the intervention, and no related adverse events occurred. Moreover, the participants reported sufficient satisfaction with the intervention.