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Moulaee Conradsson D, Aktar B, Bezuidenhout L. Characterizing physical activity bouts in people with stroke with different ambulation statuses. PLoS One 2025; 20:e0307625. [PMID: 40367046 PMCID: PMC12077672 DOI: 10.1371/journal.pone.0307625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 04/09/2025] [Indexed: 05/16/2025] Open
Abstract
BACKGROUND AND PURPOSE While physical activity is crucial for maintaining function, health, and well-being after a stroke, there is limited understanding of how individuals post-stroke accumulate their daily activity in terms of bouts and intensities. This study aimed to characterize and contrast the daily patterns, frequency and intensity of physical activity bouts between people post stroke with different ambulation statuses compared to healthy controls. METHODS AND MATERIALS In this cross-sectional study, physical activity bouts patterns, frequencies, and intensities were evaluated using Actigraph GT3X+ accelerometers across three groups: 17 limited community ambulators (LCA) post-stroke (walking speed: < 0.8 m/s), 22 community ambulators (CA) post-stroke (walking speed: ≥ 0.8 m/s), and 28 healthy controls. RESULTS People post stroke primarily engaged in 1-5 min bouts (LCA: 79%, CA: 76%), with less frequent engagement in 5-10 min (12-14%) and > 10 min bouts (9-10%) during the day. The LCA group engaged comparable or greater time spent in light physical activity during >5-10 and > 10 min bouts compared to CA and healthy controls, but less time in moderate to vigorous physical activity (P < .009). Both post-stroke ambulation groups were most active between 12-5 pm. CONCLUSIONS CA people post stroke exhibited patterns similar to healthy controls in physical activity bouts, whereas LCA primarily engaged in short bouts and light activity. In the context of secondary stroke prevention, encouraging LCA people post stroke to engage in frequent short bouts of moderate to vigorous physical activity or longer bouts of light physical activity might be realistic targets to improve cardiovascular health.
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Affiliation(s)
- David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Burcin Aktar
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Lucian Bezuidenhout
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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Zhang R, Zhou E, Liu L, Wang Y, Xiao F, Hong F. Nap duration and its association with hypertension-diabetes comorbidity in minority populations: evidence from the CMEC study. Front Endocrinol (Lausanne) 2025; 16:1563944. [PMID: 40357202 PMCID: PMC12066342 DOI: 10.3389/fendo.2025.1563944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 04/04/2025] [Indexed: 05/15/2025] Open
Abstract
Objective Limited information is available on the effect of nap duration and hypertension-diabetes comorbidity (HDC) in minority people. We aimed to explore the relationship between nap duration and HDC for the co-management of hypertension and diabetes mellitus in the minority. Methods A total of 16,911 participants from the China Multi-Ethnic Cohort (CMEC) were enrolled in this cross-sectional study. Nap duration was then categorized into four groups: 0 hours (reference group), 0-0.5 hours, 0.5-1 hour, and >1 hour. Multiple logistic regression was applied to analyze the association between nap duration and HDC. Restricted cubic splines (RCS) analysis was conducted to assess the nonlinear relationship between nap duration and the co-occurrence of HDC. Subgroup analyses were subsequently performed, stratified by sex, age, and ethnicity. Results Among 16,911 participants with a median age of 51.79 years, of whom 66.00% were female. A total of 647 subjects were in the HDC group, representing a prevalence rate of 3.83% in the entire study population. Multivariate logistic regression analysis showed that, after multivariate adjustments, the odds ratios (95% CI) for HDC across the four groups (0h, 0-0.5h, 0.5-1h and > 1h) were: reference, 1.305 (1.027, 1.650), 1.254 (1.016, 1.542), 1.612 (1.261, 2.046), respectively. RCS analyses revealed distinct associations between naptime duration and HDC: no significant relationship in participants aged <45 years (P-overall=0.529); a linear positive correlation in those aged 45-60 years (P-overall=0.001); and an inverse J-shaped association peaking at 60 minutes in individuals aged >60 years (P-overall=0.026, P-nonlinearity=0.015). The subgroup analysis revealed that among >45 years, male, Dong or Miao, a longer nap duration was also associated with an increased prevalence risk of HDC. Conclusion Longer napping duration were associated with an increased risk of HDC and monitoring nap duration may aid in identifying high-risk groups.
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Affiliation(s)
| | | | | | | | | | - Feng Hong
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and
Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
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Bezuidenhout L, Humphries S, Moulaee Conradsson D. Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden. Front Neurol 2024; 15:1463162. [PMID: 39539658 PMCID: PMC11557396 DOI: 10.3389/fneur.2024.1463162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 10/14/2024] [Indexed: 11/16/2024] Open
Abstract
Background and purpose Physical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day). Methods A cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time. Results The study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time. Discussion and conclusions In this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA.
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Affiliation(s)
- Lucian Bezuidenhout
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sophia Humphries
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - David Moulaee Conradsson
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
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Edwardson CL, Maylor BD, Biddle SJ, Clemes SA, Cox E, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Hadjiconstantinou M, Healy GN, Jaicim NB, Lawton S, Mandalia P, Munir F, Richardson G, Walker S, Yates T, Clarke-Cornwell AM. A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-229. [PMID: 37786938 DOI: 10.3310/dnyc2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Objective Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. Design A three-arm cluster randomised controlled trial. Setting Councils in England. Participants Office workers. Intervention SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. Main outcome measures The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. Results A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. Limitations The study was carried out in one sector, limiting generalisability. Conclusions The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. Future work There is a need for longer-term follow-up, as well as follow-up within different organisations. Trial registration Current Controlled Trials ISRCTN11618007.
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Affiliation(s)
| | | | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Sarah Lawton
- School of Health & Society, University of Salford, Salford, UK
| | - Panna Mandalia
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Bodilsen SS, Aadahl M, Wienecke T, Thomsen TH. Development of a tailored intervention targeting sedentary behavior and physical activity in people with stroke and diabetes: A qualitative study using a co-creation framework. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1114537. [PMID: 36860816 PMCID: PMC9968882 DOI: 10.3389/fresc.2023.1114537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
Purpose Type 2 diabetes and sedentary behavior pose serious health risks in stroke survivors. Using a co-creation framework, this study aimed to develop an intervention in collaboration with stroke survivors with type 2 diabetes, relatives, and cross-sectoral health care professionals to reduce sedentary behavior and increase physical activity. Materials and methods This qualitative explorative study used a co-creation framework consisting of a workshop and focus group interviews with stroke survivors with type 2 diabetes (n = 3), relative (n = 1), and health care professionals (n = 10) to develop the intervention. A content analysis was used to analyze data. Results The developed "Everyday Life is Rehabilitation" (ELiR) intervention consisted of a tailored 12-week home-based behavior change intervention with two consultations of action planning, goal setting, motivational interviewing, and fatigue management including education on sedentary behavior, physical activity, and fatigue. The intervention has a minimalistic setup using a double-page paper "Everyday Life is Rehabilitation" (ELiR) instrument making it implementable and tangible. Conclusions In this study, a theoretical framework was used to develop a tailored 12-week home-based behavior change intervention. Strategies to reduce sedentary behavior and increase physical activity through activities of daily living along with fatigue management in stroke survivors with type 2 diabetes were identified.
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Affiliation(s)
- Stefan Sjørslev Bodilsen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark,Department of Physiotherapy and Occupational Therapy, Zealand University Hospital, Køge-Roskilde, Denmark,Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark,Correspondence: Stefan Sjørslev Bodilsen
| | - Mette Aadahl
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Troels Wienecke
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Hørmann Thomsen
- Movement Disorder Clinic, Department of Brain - and Nerve Injuries, Rigshospitalet, Glostrup, Denmark,The Parkinson's Association, The House of Disabled People's Organizations, Copenhagen, Denmark
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Edelmann D, Pfirrmann D, Heller S, Dietz P, Reichel JL, Werner AM, Schäfer M, Tibubos AN, Deci N, Letzel S, Simon P, Kalo K. Physical Activity and Sedentary Behavior in University Students–The Role of Gender, Age, Field of Study, Targeted Degree, and Study Semester. Front Public Health 2022; 10:821703. [PMID: 35784227 PMCID: PMC9244168 DOI: 10.3389/fpubh.2022.821703] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Physical inactivity and sedentary behavior are modifiable risk factors for an unhealthy lifestyle in university students. The aim of this study was to identify subgroups among German university students with an increased risk for unhealthy behavior. For this purpose, differences in physical activity and sedentary behavior with respect to sociodemographic and study related factors were examined. Methods A total of 4,351 students participated in an online survey. The amount of physical activity (metabolic equivalent of task-min/week) and the sitting time (h/day) were assessed using the German short form of the International Physical Activity Questionnaire. Differences in gender and age as well as field of study, targeted degree and study semester were analyzed using a single factorial ANOVA with Tukey correction or a Welch-ANOVA with Games-Howell correction. Results For physical activity, significant differences were found for gender (F(2, 80.46) = 17.79, p < 0.001, ηp2 = 0.009), for field of study (F(5, 1738.09) = 7.41, p < 0.001, ηp2 = 0.01), and for study semester (F(1, 948.12) = 5.53, p < 0.05, ηp2 =0.001), but not for age and targeted degree (p > 0.05). For sedentary behavior, significant differences were found for field of study (F(5, 3816) = 5.69, p < 0.001, ηp2 = 0.01) and targeted degree (F(3, 3868) = 3.94, p < 0.01, ηp2 = 0.003), but not for gender, age and study semester (p > 0.05). Conclusion Female students, students enrolled in “natural sciences, mathematics and informatics” and first year students appear to have an increased risk of an unhealthy lifestyle. Future research should identify barriers to and incentives of physical activity as well as reasons for high amounts of SB in sub-populations of university students. Suitable prevention and intervention programs are necessary.
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Affiliation(s)
- Dennis Edelmann
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Pfirrmann
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sebastian Heller
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Pavel Dietz
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Jennifer L. Reichel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Antonia M. Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Markus Schäfer
- Department of Communication, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ana N. Tibubos
- Diagnostics in Healthcare and E-Health, University of Trier, Trier, Germany
| | - Nicole Deci
- Department of Work and Organizational Psychology, Faculty of Psychology, Medical School Hamburg, Hamburg, Germany
| | - Stephan Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
| | - Perikles Simon
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kristin Kalo
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the University of Mainz, Mainz, Germany
- *Correspondence: Kristin Kalo
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The Relationship between Sleep Duration and Stroke Risk: The Mediating Role of Physical Activity. Brain Sci 2022; 12:brainsci12050601. [PMID: 35624988 PMCID: PMC9139141 DOI: 10.3390/brainsci12050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background: This study aimed to investigate the mediating effect of physical activity (PA) on the relationship between average sleep duration and risk of stroke in suburban residents without stroke. Methods: A cross-sectional study was executed, and participants were recruited through a multistage, stratified, probability-proportional-to-size sampling method in this research. The stroke risk was measured using a risk assessment form for a high-risk stroke population. The PA score was calculated by the Physical Activity Rating Scale-3 (PARS-3). The average sleep duration was calculated by adding up night sleep and afternoon nap durations. A multiple linear regression analysis was conducted to identify the association between stroke risk, average sleep duration, and PA. The direct and indirect effects of average sleep duration on stroke risk were analyzed by using the PA in a mediation framework. Results: A total of 5312 suburban residents (average: 54.96 ± 12.21 years, 2970 women) participated in the study. After adjusting for covariates, relatively inappropriate sleep duration (<7 h/>8 h~9 h/>9 h) and stroke risk were significantly associated, compared with the moderate average sleep duration (7~8 h) (β = 0.038, 95% CI: 0.024~0.128; β = 0.078, 95% CI: 0.128~0.250; β = 0.150, 95% CI: 0.390~0.549). The PA total score (indirect effect ab = 0.013, 95% CI: 0.003~0.022) partially mediated the relationship between the long average sleep duration and stroke risk, in which the activity intensity (ab = −0.015, 95% CI: −0.021~−0.008), the activity duration (ab = 0.043, 95% CI: 0.029~0.058), and the activity frequency (ab = 0.012, 95% CI: 0.004~0.020; ab = 0.037, 95% CI: 0.026~0.050) all played a mediating role in the different sleep duration. Conclusions: A significant relationship between a long average sleep duration and stroke risk factors among people without stroke was found in this study. The PA and its components partially mediated the association between a long average sleep duration and stroke risk. Suitable prevention methods and interventions for PA and sleep may reduce the risk of stroke.
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Hendrickx W, Riveros C, Askim T, Bussmann JBJ, Callisaya ML, Chastin SFM, Dean C, Ezeugwu V, Jones TM, Kuys SS, Mahendran N, Manns PJ, Mead G, Moore SA, Paul L, Pisters MF, Saunders DH, Simpson DB, Tieges Z, Verschuren O, English C. An Exploration of Sedentary Behavior Patterns in Community-Dwelling People With Stroke: A Cluster-Based Analysis. J Neurol Phys Ther 2021; 45:221-227. [PMID: 33867457 DOI: 10.1097/npt.0000000000000357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Long periods of daily sedentary time, particularly accumulated in long uninterrupted bouts, are a risk factor for cardiovascular disease. People with stroke are at high risk of recurrent events and prolonged sedentary time may increase this risk. We aimed to explore how people with stroke distribute their periods of sedentary behavior, which factors influence this distribution, and whether sedentary behavior clusters can be distinguished? METHODS This was a secondary analysis of original accelerometry data from adults with stroke living in the community. We conducted data-driven clustering analyses to identify unique accumulation patterns of sedentary time across participants, followed by multinomial logistical regression to determine the association between the clusters, and the total amount of sedentary time, age, gender, body mass index (BMI), walking speed, and wake time. RESULTS Participants in the highest quartile of total sedentary time accumulated a significantly higher proportion of their sedentary time in prolonged bouts (P < 0.001). Six unique accumulation patterns were identified, all of which were characterized by high sedentary time. Total sedentary time, age, gender, BMI, and walking speed were significantly associated with the probability of a person being in a specific accumulation pattern cluster, P < 0.001 - P = 0.002. DISCUSSION AND CONCLUSIONS Although unique accumulation patterns were identified, there is not just one accumulation pattern for high sedentary time. This suggests that interventions to reduce sedentary time must be individually tailored.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A343).
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Affiliation(s)
- Wendy Hendrickx
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (W.H., M.F.P.); School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia (W.H., D.B.S., C.E.); Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands (W.H., M.F.P.); Bioinformatics, Hunter Medical Research Institute, and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia (C.R.); Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway (T.A.); Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands (J.B.J.B.); Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia (M.L.C.); School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom (S.F.M.C., L.P., Z.T.); Department of Movement and Sports Sciences, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium (S.F.M.C.); Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (C.D., T.M.J.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada (V.E., P.J.M.); National Head, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia (S.S.K.); Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia (N.M.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.M.); Stroke Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.); Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands (M.F.P.); Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (D.H.S.); Department of Geriatric Medicine, University of Edinburgh, United Kingdom (Z.T.); UMC Utrecht Brain Center, Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (O.V.); and Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Newcastle, Australia (C.E.)
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The Effects of Interrupting Prolonged Sitting With Frequent Bouts of Light-Intensity Standing Exercises on Blood Pressure in Stroke Survivors: A Dose Escalation Trial. J Phys Act Health 2021; 18:988-997. [PMID: 34186510 DOI: 10.1123/jpah.2020-0763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interrupting prolonged sitting acutely lowers blood pressure in nonstroke populations. However, the dose-response effect in stroke survivors is unknown. The authors investigated different doses of light-intensity standing exercises that interrupt prolonged sitting and reduce blood pressure immediately and over 24 hours in stroke survivors. METHODS Within-participant, laboratory-based, dose escalation trial. Conditions (8 h) were prolonged sitting and 2 experimental conditions of standing exercises with increasing frequency (3 cohorts, 2 × 5 min to 6 × 5 min). The primary outcome is the mean systolic blood pressure. RESULTS Twenty-nine stroke survivors (aged 66 [12] y) participated. Frequent bouts of standing exercises lowered the mean systolic blood pressure following the 4 × 5-minute (-2.1 mm Hg; 95% confidence interval [CI], -3.6 to -0.6) and 6 × 5-minute conditions (-2.3 mm Hg; 95% CI, -4.2 to -0.5) compared with prolonged sitting. Diastolic blood pressure was lowered following the 6 × 5-minute condition (-1.4 mm Hg; 95% CI, -2.7 to -0.2). The 24-hour systolic blood pressure increased following the 2 × 5-minute condition (6.9 mm Hg; 95% CI, 3.1 to 10.6). CONCLUSIONS Interrupting prolonged sitting with more frequent bouts of standing exercises lowers systolic and diastolic blood pressure in stroke survivors. However, reductions may only be short term, and investigations on sustained effects are warranted.
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Saunders DH, Mead GE, Fitzsimons C, Kelly P, van Wijck F, Verschuren O, Backx K, English C. Interventions for reducing sedentary behaviour in people with stroke. Cochrane Database Syst Rev 2021; 6:CD012996. [PMID: 34184251 PMCID: PMC8238669 DOI: 10.1002/14651858.cd012996.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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Acute Effects of Frequent Light-Intensity Standing-Based Exercises That Interrupt 8 Hours of Prolonged Sitting on Postprandial Glucose in Stroke Survivors: A Dose-Escalation Trial. J Phys Act Health 2021; 18:644-652. [PMID: 33952707 DOI: 10.1123/jpah.2020-0516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interrupting prolonged sitting can attenuate postprandial glucose responses in overweight adults. The dose-response effect in stroke survivors is unknown. The authors investigated the effects of interrupting 8 hours of prolonged sitting with increasingly frequent bouts of light-intensity standing-based exercises on the postprandial glucose response in stroke survivors. METHODS Within-participant, laboratory-based, dose-escalation trial. Participants completed three 8-hour conditions: prolonged sitting and 2 experimental conditions. Experimental conditions involved light-intensity standing-based exercises of increasing frequency (2 × 5 min to 6 × 5 min bouts). Postprandial glucose is reported. RESULTS Twenty-nine stroke survivors (aged 66 y) participated. Interrupting 8 hours of prolonged sitting with light-intensity standing-based exercises every 90 minutes significantly decreased postprandial glucose (positive incremental area under the curve; -1.1 mmol/L·7 h; 95% confidence interval, -2.0 to -0.1). In the morning (08:00-11:00), postprandial glucose decreased during the 4 × 5 minutes and 6 × 5 minutes conditions (positive incremental area under the curve; -0.8 mmol/L·3 h; 95% confidence interval, -1.3 to -0.3 and -0.8 mmol/L·3 h; 95% confidence interval, -1.5 to -0.2, respectively) compared with prolonged sitting. CONCLUSION Interrupting 8 hours of prolonged sitting at least every 90 minutes with light-intensity standing-based exercises attenuates postprandial glucose in stroke survivors. During the morning, postprandial glucose is attenuated when sitting is interrupted every 60 and 90 minutes.
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Dobashi S, Kawaguchi S, Ando D, Koyama K. Alternating work posture improves postprandial glucose response without reducing computer task performance in the early afternoon. Physiol Behav 2021; 237:113431. [PMID: 33887321 DOI: 10.1016/j.physbeh.2021.113431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
In the workplace, sit-stand workstations are being installed to reduce excessive sitting time and the consequent risk factors for cardiovascular ailments (e.g., postprandial hyperglycemia). However, a prolonged standing posture also has detrimental effects in terms of musculoskeletal symptoms and work efficiency. We thus investigated whether alternating between a sitting and standing work posture improves postprandial glucose response and computer task performance. Nine healthy young males completed 4 × 20-min computer tasks in the early afternoon (i.e., 30 min after eating lunch) under three different work conditions, had no change in posture (only sitting=the control trial, CON), and engaged in two styles of alternating between sitting and standing every 20 min (sitting → standing → sitting → standing, SIT-STAND; standing → sitting → standing → sitting, STAND-SIT). For the computer tasks, all participants had to subtract a two-digit number from a four-digit number and to input the answer in the answer column on the computer. Task performance was evaluated as the number of achievements and accuracy rate every 20 min. Blood glucose concentration was assessed before, immediately after, 30 min, 52 min, 74 min, 96 min, and 118 min after eating lunch. The number of achievements and accuracy rate did not differ among the three trials. The total area under the curve (AUC) for blood glucose concentration was significantly lower in the SIT-STAND and STAND-SIT trials compared with CON, whereas no significant difference was observed between the SIT-STAND and STAND-SIT trials. In conclusion, alternating between a sitting and standing work posture attenuated postprandial blood glucose accumulation without reducing task performance, irrespective of the order of changes in work posture.
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Affiliation(s)
- Shohei Dobashi
- Institute of Health and Sports & Medicine, Juntendo University, Inzai, Japan; Graduate School Department of Medicine, Engineering, and Agricultural Sciences, University of Yamanashi, Kofu, Japan
| | - Saito Kawaguchi
- Faculty of Education and Human Sciences, University of Yamanashi, Kofu, Japan
| | - Daisuke Ando
- Graduate School Department of Interdisciplinary Research, University of Yamanashi, Kofu, Japan
| | - Katsuhiro Koyama
- Graduate School Department of Interdisciplinary Research, University of Yamanashi, Kofu, Japan; Faculty of Sport Science, Yamanashi Gakuin University, Kofu, Japan.
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English C, Weerasekara I, Carlos A, Chastin S, Crowfoot G, Fitzsimons C, Forster A, Holliday E, Janssen H, Mackie P, Mead G, Dunstan D. Investigating the rigour of research findings in experimental studies assessing the effects of breaking up prolonged sitting - extended scoping review. Braz J Phys Ther 2021; 25:4-16. [PMID: 32439303 PMCID: PMC7817869 DOI: 10.1016/j.bjpt.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Sedentary behaviour research is a relatively new field, much of which has emerged since the widespread acceptance of clinical trial registration. The aim of this study was to investigate the trial registration and related issues in studies investigating the effect of frequent activity interruptions to prolonged sitting-time. METHODS Secondary analysis of a scoping review including systematic searches of databases and trial registries. We included experimental studies investigating the effects of frequent activity interruptions to prolonged sitting-time. RESULTS We identified 32 trials published in 45 papers. Only 16 (50%) trials were registered, with all 16 trials being completed and published. Of the unregistered trials, we identified three (19%) for which similarities in the sample size and participant demographics across papers was suggestive of duplicate publication. Identification of potential duplicate publications was difficult for the remaining 13 (81%). Results from 53 (76%) of the 70 registered outcomes were published, but 11 (69%) registered trials reported results from additional outcomes not prospectively registered. A total of 46 different outcomes (out of 53 reported outcome measures, similar measures were collated) were reported across all trials, 31 (67%) of which were collected in ≤2 trials. CONCLUSIONS We found direct evidence of trial registration issues in experimental trials of breaking up sitting-time. The lack of prospective registration of all trials, and the large number of outcomes measured per trial are key considerations for future research in this field. These issues are unlikely to be confined to the field of sedentary behaviour research.
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Affiliation(s)
- Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Newcastle, Australia.
| | - Ishanka Weerasekara
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Anjelica Carlos
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Sebastien Chastin
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Health and Life Science, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Gary Crowfoot
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre, Institute of Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Heidi Janssen
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Paul Mackie
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Gillian Mead
- Geriatric Medicine, Division of Health Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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14
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Sammut M, Fini N, Haracz K, Nilsson M, English C, Janssen H. Increasing time spent engaging in moderate-to-vigorous physical activity by community-dwelling adults following a transient ischemic attack or non-disabling stroke: a systematic review. Disabil Rehabil 2020; 44:337-352. [PMID: 32478574 DOI: 10.1080/09638288.2020.1768599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose: The risk of recurrent stroke following a transient ischaemic attack (TIA) or non-disabling stroke is high. Clinical guidelines recommend this patient population accumulate at least 150 minutes of moderate-to-vigorous physical activity each week to reduce the risk of recurrent stroke. We aimed to identify interventions that increase time adults spend in moderate-to-vigorous physical activity following TIA or non-disabling stroke.Method: We searched thirteen databases for articles of secondary prevention interventions reporting outcomes for duration in moderate-to-vigorous physical activity or exercise capacity.Results: Eight trials were identified (n = 2653). Of these, three (n = 198) reported changes in time spent in moderate-to-vigorous physical activity. Only one trial (n = 70), reported significant change in time spent engaging in moderate-to-vigorous physical activity (between-group difference: 11.7 min/day [95% CI 4.07-19.33]) when comparing participation in a six-month exercise education intervention to usual care. No trial measured moderate-to-vigorous physical activity after intervention end.Conclusion: Despite recommendations to participate in regular physical activity at moderate-to-vigorous intensity for secondary stroke prevention, there is very little evidence for effective interventions for this patient population. There is need for clinically feasible interventions that result in long-term participation in physical activity in line with clinical guidelines. Trial registration: Protocol registration: PROSPERO CRD42018092840Implications for rehabilitationThere is limited evidence of the effectiveness of interventions that aim to increase time spent engaging in moderate-to-vigorous physical activity (MVPA) for people following a TIA or non-disabling stroke.A program comprising aerobic and resistance exercises ≥2 per week, supervised by a health professional (supplemented with a home program) over at least 24 weeks appears to be effective in assisting people adhere to recommended levels of moderate to vigorous physical activity after TIA or non-disabling stroke.Secondary prevention programs which include health professional supervised exercise sessions contribute to better adherence to physical activity guidelines; didactic sessions alone outlining frequency and intensity are unlikely to be sufficient.
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Affiliation(s)
- Maria Sammut
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Natalie Fini
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kirsti Haracz
- School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, New Lambton Heights, Australia.,Florey Institute of Neuroscience, University of Melbourne, Melbourne, Australia
| | - Heidi Janssen
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Recovery, Hunter Medical Research Institute, New Lambton Heights, Australia.,Stroke Service, Hunter New England Local Health District, Newcastle, Australia
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