Beyond steps per day: other measures of real-world walking after stroke related to cardiovascular risk

Speed- and Endurance-Based Classifications of Community Ambulation Post-Stroke Revisited: The Importance of Location in Walking Performance Measurement

BACKGROUND

Gait speed or 6-minute walk test are frequently used to project community ambulation abilities post-stroke by categorizing individuals as household ambulators, limited, or unlimited community ambulators. However, whether improved clinically-assessed gait outcomes truly translate into enhanced real-world community ambulation remains uncertain.

OBJECTIVE

This cross-sectional study aimed to examine differences in home and community ambulation between established categories of speed- and endurance-based classification systems of community ambulation post-stroke and compare these with healthy controls.

METHODS

Sixty stroke survivors and 18 healthy controls participated. Stroke survivors were categorized into low-speed, medium-speed, or high-speed groups based on speed-based classifications and into low-endurance, medium-endurance, or high-endurance groups based on the endurance-based classification. Home and community steps/day were quantified using Global Positioning System and accelerometer devices over 7 days.

RESULTS

The low-speed groups exhibited fewer home and community steps/day than their medium- and high-speed counterparts (P < .05). The low-endurance group took fewer community steps/day than the high-endurance group (P < .05). Despite vast differences in clinical measures of gait speed and endurance, the medium-speed/endurance groups did not differ in their home and community steps/day from the high-speed/endurance groups, respectively. Stroke survivors took 48% fewer home steps/day and 77% fewer community steps/day than healthy controls.

CONCLUSIONS

Clinical classification systems may only distinguish home ambulators from community ambulators, but not between levels of community ambulation, especially beyond certain thresholds of gait speed and endurance. Clinicians should use caution when predicting community ambulation status through clinical measures, due to the limited translation of these classification systems into the real world.

Feasibility of an Application-Based Outpatient Rehabilitation Program for Stroke Survivors: Acceptability and Preliminary Results for Patient-Reported Outcomes

BACKGROUND

The majority of stroke survivors experience long-term impairments. Regular physical activity and other lifestyle modifications play an important role in rehabilitation. Outpatient rehabilitation using telemedicine might be suitable to improve functional ability and long-term secondary prevention. The Strokecoach Intervention Program (SIP, Strokecoach GmbH, Cologne, Germany) comprises training, coaching and monitoring with the aim of improving or at least maintaining functional independence and preventing further stroke through more targeted physical activity. The SIP is provided as blended care, which refers to the integrated and coordinated delivery of healthcare services that combines traditional in-person interactions with technology-mediated interventions, optimizing the use of both face-to-face and virtual modalities to enhance patient outcomes.

OBJECTIVE

The aim of this study was to evaluate the acceptance of the SIP by the participants and its practical application, as well as to obtain initial indications of effects of the SIP on the basis of patient-related outcome measures, blood pressure measurements and recording of physical activity in parallel with the intervention.

METHODS

Data from individuals with stroke participating in the SIP were analyzed retrospectively. Within the SIP, participants received an application-based training program, were instructed to measure their blood pressure daily and to wear an activity tracker (pedometer). During the intervention period of either 6 or 12 weeks, the participants were supported and motivated by a personal coach via a messenger application. The primary outcomes of the analysis were recruitment, acceptance of and satisfaction with the SIP. Secondary outcomes included functional measures, mobility and health-related quality of life.

RESULTS

A total of 122 individuals with stroke could be recruited for the SIP. A total of 96 out of 122 were able to start the program (54% female, mean age 54.8 (SD = 13.1), 6.1 (SD = 6.6) years after stroke onset) and 88 completed the SIP. Participants wore the activity tracker on 66% and tracked their blood pressure on 72% of their intervention days. A further analyzed subgroup of 38 participants showed small improvements in patient-reported outcomes such as health-related quality of life (SF-36) with an increase of 12 points in the subdomain mental health, vitality (12.6) and physical functioning (9.1). However, no statistically significant improvements were found in other performance-based measures (Timed Up and Go test, gait speed).

CONCLUSIONS

This study showed that a blended therapy approach for stroke survivors with mild to moderate impairments in the chronic phase is feasible and was highly accepted by participants, who benefitted from the additional coaching.

Daily activity patterns in older adults receiving initial support: the association between daily steps and sitting in bouts of at least 60 min

BACKGROUND

Aging has a significant impact on health, underlining the importance of maintaining physical function and reducing time spent sitting among older adults. To understand how to reduce prolonged sitting or increase physical activity, factors related to the daily living and observed daily activity patterns should be explored. This study aimed to investigate the association between daily steps, self-rated health, physical activity, sedentary behavior, motivation to exercise and fear of falling among older adults receiving initial support.

METHOD

Cross-sectional design with total population questionnaire data from adults aged ≥ 60 years (n = 917), living at home with initial support from municipal care in southern Sweden. The older adults were offered to participate in a follow-up study measuring daily activity patterns with accelerometers (n = 72). Linear regression was used to analyze associations between daily steps and possible predictors.

RESULTS

The linear model ([Formula: see text]0.478) showed that sitting in unbroken bouts of > 60 min (β = -0.313, p < 0.05), walking independently outdoors (β = 0.301, p < 0.05), intending to increase physical activity (β = -0.294, p < 0.05), sex (β = 0.279, p < 0.05), relative autonomy index (β = 0.258, p < 0.05), fear of falling (β = -0.238, p < 0.05), and self-rated health (β = 0.213, p < 0.05) predicted daily steps.

CONCLUSION

The model of predictors brings new understanding regarding daily steps among community-dwelling older adults. The association between sitting in bouts of > 60 min and daily steps is interesting as 35% of participants had a number of sitting bouts that on average, showed 30% less steps taken. Minimizing long sitting bouts and maintaining physical functioning to promote independence when walking outdoors can be tools for clinical practitioners devising interventions to break prolonged sitting among community-dwelling older adults. Future research should prioritize studying older adults' outdoor walking independence, including its relation to walking with or without assistive devices and its impact on physical activity and sedentary behavior.

Relationships between cardiorespiratory fitness, physical activity practices, and functional outcomes one-year post-stroke in northern Benin: A case-control study

BACKGROUND

Currently, little is known on the relationships between cardiorespiratory fitness (CF), physical activity (PA), and functional outcomes after stroke, especially in low- and middle-income countries.

OBJECTIVES

We examine the relationships between CF, PA, and functional outcomes in one-year poststroke in Benin, a lower middle-income country.

METHODS

A case-control study was carried out in northern Benin. Twenty-one participants with chronic strokes were matched to 42 controls according to sex and age. PA patterns and associated energy expenditure (EE) were assessed with a BodyMedia's senseWear armband. CF was evaluated with the Physical Working Capacity at 75% of the predicted maximal heart rate index. The functional outcomes were evaluated using the modified Rankin scale (mRS) and the ACTIVLIM-Stroke scale.

RESULTS

Both people with stroke and the healthy pairs spent much time in sedentary behavior (median [P25; P75]: 672 [460; 793] min vs 515 [287; 666] min, p = 0.006). Although people with chronic stroke performed fewer steps compared to healthy controls (median: 2767 vs 5524, p = 0.005), results showed that total EE was not statistically significant in either group (median: 7166 Kcal vs 8245 Kcal, p = 0.07). In addition, the mRS score (r = 0.47, p = 0.033) and the ACTIVLIM-Stroke measure (r = 0.52, p = 0.016) were moderately associated with the CF index of people with chronic stroke.

CONCLUSION

The study showed clear trends for lower levels of PA in both people with chronic stroke and health controls. A correlation exists between CF, disability, and functional outcomes among stroke patients.

How should we measure physical activity after stroke? An international consensus

BACKGROUND

Physical activity is important for secondary stroke prevention. Currently, there is inconsistency of outcomes and tools used to measure physical activity following stroke.

AIM

To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity.

METHODS

Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney's Value-Focused Thinking Methodology. Survey 1 identified physical activity tools, outcomes, and measurement considerations which were ranked in Survey 2. Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3, participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations.

RESULTS

Twenty-five stroke survivors, 5 carers, 18 researchers, and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included the ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort, and ability to detect changes. Consensus recommendations included using the Actigraph, Actical, and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations.

CONCLUSIONS

These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge, and resources. Comprehensive measurement requires the use of devices and questionnaires.