Tamaya Van Criekinge, PT

Wondergem R, Veenhof C, Wouters EMJ, de Bie RA, Visser-Meily JMA, Pisters MF. Movement Behavior Patterns in People With First-Ever Stroke. Stroke. 2019;50:3553–3560.

Are you reaching the recommended daily step goal of 10,000 steps for achieving a desirable level of physical activity? During routine daily activities, this is already considered a difficult task, and it becomes harder when having to deal with activity impairments. People living with stroke spend only half of the recommended time being active as compared to healthy individuals and are subsequently at high risk of developing sedentary behavior. Since prolonged sedentary behavior can damage your physical and mental health, it is important to gain insight into these unhealthy movement behavior patterns of people living with stroke. As the authors suggest, this provides health care providers with important information regarding the identification of the right persons with specific behaviors for targeted interventions.

In this cross-sectional study, 190 community-living stroke survivors were assessed with an accelerometer (Activ8) worn in the front pocket of their trousers for two consecutive weeks. Different movement behavior modes were assessed by differentiating several activities such as sedentary behavior, standing, walking, cycling and running. A diary log was kept by the participants to delete non-wear time from the dataset. Results showed a mean wear time of the device of 13.7 hours a day for 90.4% of all days. The participants were sedentary for 9.3 hours (67.8%), lightly physically active for 3.8 hours (27.7%), and moderate to vigorously active for 0.6 hours (4.6%). These results support the hypothesis that there still is a considerable amount of sedentary behavior in people living with stroke. In addition, the authors identified the following three movement behaviors: 1) sedentary exercisers (n=22.6%) showed interrupted sedentary and active patterns, and was seen more in younger survivors with low pack-years, light drinkers and fewer activity limitations; 2) sedentary movers (n=45.8%) were characterized by interrupted sedentary and inactive patterns, and was related to less severe stroke symptoms, higher activity limitations (assessed by Late Life Function and Disability Instrument Computerized Adaptive Test) and higher levels of self-efficacy (assessed by Self-efficacy for Symptom Management Scale); and 3) sedentary prolongers (n=31.6%) who were prolonged and highly sedentary and inactive, they were characterized by increased pack-years, lower levels of self-efficacy and more severe stroke symptoms.

In conclusion, health care providers should take into account that self-efficacy, severity and age are important discriminators between motor behavior patterns. However, the strongest associating factor was the individual’s self-efficacy, which shows the need for individualized approaches in providing feedback and planning during rehabilitation. It is crucial to identify people with unfavorable movement behavior patterns for secondary prevention  to optimize secondary prevention by providing individual tailored coaching to increase their physical activity.