Factors influencing sedentary behaviours after stroke:Findings from qualitative observations and interviews with stroke survivors and their caregivers

Background Stroke survivors are more sedentary than healthy, age-matched controls, independent of functional capacity. Interventions are needed to encourage a reduction in overall sedentary time, and regular breaks in prolonged periods of sedentary behaviour. This study captured the views and experiences of stroke survivors and their caregivers related to sedentary behaviour after stroke, to inform the development of an intervention to reduce sedentary behaviour. Methods Mixed-methods qualitative study. Non-participant observations were completed in two stroke services, inclusive of inpatient and community settings in the United Kingdom. Semi-structured interviews were conducted with stroke survivors and their caregivers (if available) at six- or nine-months post-stroke. Underpinned by the capability, opportunity and motivation (COM-B) model of behaviour change, observational data (132 h) were analysed thematically and interview data (n = 31 stroke survivors, n = 12 caregivers) were analysed using the Framework approach. Results Observation participants differed in functional ability whereas stroke survivor interviewees were all ambulant. Six themes related to sedentary behaviour after stroke were generated: (1) sedentary behaviour levels and patterns after stroke; (2) the physical and social environment in the stroke service and in the home; (3) standing and movement capability after stroke; (4) emotion and motivation after stroke; (5) caregivers’ influence on, and role in influencing stroke survivors’ sedentary behaviour; and (6) intervening to reduce sedentary behaviour after stroke. Capability, opportunity and motivation were influenced by the impact of the stroke and caregivers’ inclination to support sedentary behaviour reduction. Stroke survivors reported being more sedentary than they were pre-stroke due to impaired balance and co-ordination, increased fatigue, and reduced confidence in mobilising. Caregivers inclination to support stroke survivors to reduce sedentary behaviour depended on factors including their willingness to withdraw from the caregiver role, and their perception of whether the stroke survivor would act on their encouragement. Conclusions Many stroke survivors indicate being open to reducing sedentary behaviour, with appropriate support from stroke service staff and caregivers. The findings from this study have contributed to an intervention development process using the Behaviour Change Wheel (BCW) approach to develop strategies to reduce sedentary behaviour after stroke

RELIABILITY OF THE TOTAL BODY RECUMBENT STEPPER SUBMAXIMAL EXERCISE TEST

David R. Wilson, Anna E. Mattlage, Abdulfattah S. Alqahtani, Nicole M. Seier, Jonathan D. Todd, Brian G. Price & Sandra A. Billinger University of Kansas Medical Center, Kansas City Kansas Submaximal exercise testing presents a practical alternative for measurement of cardio-respiratory fitness in a clinical setting where peak exercise testing my not be feasible. Previously, our lab developed a prediction equation to estimate peak VO2 using a total body recumbent stepper (TBRS) based on the Young Men’s Christian Association (YMCA) protocol. The peak VO2 prediction equation was cross-validated in a group of healthy adults and in individuals 60-80 years of age. However, we have not yet tested the reliability of the TBRS submaximal exercise test. PURPOSE: The purpose of the present study was to determine the reliability of the TBRS submaximal exercise test in healthy adults from 20-70 years of age. METHODS: A total of 40 subjects (27 M, 13 F, 39.6 yrs ± 10.3) were recruited from the Kansas City Metro and surrounding area and screened to determine eligibility. Subjects completed 2 submaximal exercise tests separated by a minimum of 24 hours and a maximum of 5 days. Testing was conducted at similar times of day. Participants were informed not to consume food or drink (except water) within 2-3 hours of the exercise tests and avoid caffeinated products for 6 hours prior to the exercise test. Participants were asked to avoid vigorous physical activity for 24 hours prior to exercise testing. Height, weight, pre-exercise HR and blood pressure (BP) were obtained prior to exercise testing. Data was analyzed using SPSS for test-retest reliability with an intraclass correlation coefficient (ICC) computation. RESULTS: We found a significant correlation between predicted peak VO2 at visit 1 and visit 2 (ICC 2,1 = 0.986, CI =.974-.993). Repeated Measures ANOVA showed no significant difference in predicted values between visits (p= 0.153). CONCLUSION: These results suggest that the TBRS submaximal exercise test and peak VO2 prediction equation can be used to reliably predict peak oxygen consumption. This is essential information for clinical professionals who want to provide their patients or clients with information regarding their cardiorespiratory fitness

Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy

Introduction: Post-stroke cardiovascular fitness is typically half that of healthy age-matched people. Cardiovascular deconditioning is a risk factor for recurrent stroke that may be overlooked during routine rehabilitation. This study investigated the cardiovascular responses of two upper limb rehabilitation protocols. Methods: Forty-six stroke patients completed a dose-matched program of Wii-based Movement Therapy ( WMT ) or modified Constraint-induced Movement Therapy ( mCIMT ). Heart rate and stepping were recorded during early ( day 2 )- and late ( day 12–14 )-therapy. Pre- and post-therapy motor assessments included the Wolf Motor Function Test and 6-min walk. Results: Upper limb motor function improved for both groups after therapy ( WMT p = 0.003, mCIMT p = 0.04 ). Relative peak heart rate increased from early- to late-therapy WMT by 33% ( p < 0.001 ) and heart rate recovery ( HRR ) time was 40% faster ( p = 0.04 ). Peak heart rate was higher and HRR faster during mCIMT than WMT, but neither measure changed during mCIMT. Stepping increased by 88% during Wii-tennis ( p < 0.001 ) and 21% during Wii-boxing ( p = 0.045 ) while mCIMT activities were predominantly sedentary. Six-min walk distances increased by 8% ( p = 0.001 ) and 4% ( p = 0.02 ) for WMT and mCIMT, respectively. Discussion: Cardiovascular benefits were evident after WMT as both a cardiovascular challenge and improved cardiovascular fitness. The peak heart rate gradient across WMT activities suggests this therapy can be further individualized to address cardiovascular needs. The mCIMT data suggest a cardiovascular stress response. Conclusions: This is the first study to demonstrate a cardiovascular benefit during specifically targeted upper limb rehabilitation. Thus, WMT not only improves upper limb motor function but also improves cardiovascular fitness