Unravelling perceived fatigue and activity pacing in maintaining a physically active lifestyle after stroke rehabilitation:a longitudinal cohort study

Purposes To identify fatigue trajectories during/after stroke rehabilitation, to determine characteristics associated with trajectory membership before discharge and to investigate how these trajectories and activity pacing are associated with sustained physical activity after rehabilitation. Methods People after stroke (n = 206) were followed from 3–6 weeks before discharge (T0) to 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation in the ReSpAct study. Latent Class analysis was used to identify trajectories of perceived fatigue. Binomial multivariable logistic regression analyses were performed to determine characteristics associated with trajectory membership (T0). Multilevel regression analyses were used to investigate how perceived fatigue and activity pacing were associated with self-reported physical activity (T0–T3). Results Three fatigue trajectories were identified: high (n = 163), low (n = 41) and recovery (n = 2). Compared with the high fatigue trajectory, people in the low fatigue trajectory were more likely to report higher levels of health-related quality of life (HR-QoL) (OR = 3.07, 95%CI = 1.51–6.26) and physical activity (OR = 1.93, 95%CI = 1.07–3.47). Sustained high levels of physical activity after rehabilitation were significantly associated with low perceived fatigue and high perceived risk of overactivity. Conclusions Three fatigue trajectories after stroke rehabilitation were identified. High levels of HR-QoL and physical activity before discharge identified people in the low fatigue trajectory. A physically active lifestyle after rehabilitation was associated with low perceived fatigue and perceived risk of overactivity. IMPLICATIONS FOR REHABILITATION Since almost 80% of people after stroke in this study perceived severe fatigue up to 1 year after stroke rehabilitation, activities focusing on the management of fatigue symptoms should be integrated in general stroke rehabilitation. In clinical practice, low levels of health-related quality of life and low levels of self-reported physical activity before discharge from stroke rehabilitation should be considered by rehabilitation professionals (e.g., physicians, physiotherapists, and physical activity counsellors) since these characteristics can predict chronic perceived fatigue up to 1 year after stroke rehabilitation. A physical activity counselling programme delivered during and after stroke rehabilitation may be improved by incorporating tailored advice regarding the management of fatigue

Assessment of Activity Pacing in Relation to Physical Activity and Health-Related Quality of Life in Adults with Multiple Sclerosis

Background: Activity pacing is a behavioral strategy for coping with fatigue, optimizing physical activity (PA) levels, and achieving a paced approach to lifestyle and sustainable self-regulated exercise practice to optimize health and well-being. Yet little is known about how activity pacing affects PA and health-related quality of life (HRQOL) while controlling for fatigue and demographic characteristics over time in adults with multiple sclerosis (MS). This study examined the natural use of activity pacing and how it is associated with PA and HRQOL over time in adults with MS. Methods: Sixty-eight adults with MS (mean ± SD age, 45.2 ± 10.9 years) completed questionnaires on their activity pacing, fatigue, PA, and HRQOL 14, 33, and 52 weeks after rehabilitation. Associations between the variables were examined using multilevel models. Results: No associations were found between activity pacing and PA (β = -0.01, P = .89) or between activity pacing and HRQOL (β = -0.15, P = .09). Conclusions: This study provides an initial understanding of how activity pacing relates to PA and HRQOL in people with MS over time and indicates that there is no clear strategy among adults with MS that is successful in improving PA and HRQOL in the short or long term. Persons with MS may benefit from goal-directed activity pacing interventions to improve longitudinal engagement in PA, and the present study provides a foundation for further intervention development

Longitudinal associations between activity pacing, fatigue, and physical activity in adults with multiple sclerosis

PURPOSE: The purpose of this study was to evaluate how activity pacing relates to physical activity and health-related quality of life over a one year period in a sample of adults with multiple sclerosis. METHODS: 68 adults with multiple sclerosis (mean age= 42 ± 11 years) filled in questionnaires on their active engagement in pacing decisions and perceived difficulty in preventing overactivity (5-point Activity Pacing and 2-point Risk of Overactivity Questionnaire), fatigue (7-point Fatigue Severity Scale), physical activity (adapted Short Questionnaire to Assess Health-Enhancing Physical Activity) and health-related quality of life (RAND-12 Health Survey) post rehabilitation and at one year follow up, as part of the Rehabilitation, Sports and Active lifestyle study (a nationwide multi-centre program aimed at stimulating and promoting an active lifestyle in rehabilitation in the Netherlands). Multilevel modelling was used to analyse the associations between activity pacing, fatigue, physical activity and health-related quality of life. RESULTS: No associations were found between activity pacing and physical activity (β = -0.21; p > 0.05), and between activity pacing and health-related quality of life (β = -0.10; p > 0.05) at long-term. Fatigue was negatively related to health-related quality of life (β = -0.35; p < 0.001). Perceived risk of overactivity moderated the association between fatigue and health-related quality of life (β = -0.13; p = 0.039). CONCLUSIONS: These findings suggest that persons who experience decreases in health-related quality of life with increased fatigue, are more likely to be engaging in ‘overactive’ behaviour. The lack of associations between activity pacing and physical activity, and between activity pacing and health-related quality of life suggests there is no clear strategy among persons with MS that is successful in improving physical activity and quality of life either in short or long-term when no interventions are introduced

Physical activity behaviour up to 1 year post-rehabilitation among adults with physical disabilities and/or chronic diseases: results of the prospective cohort study ReSpAct

Background Little is known of physical activity behaviouramong adults with a disability and/or chronic disease during and up to 1 year post-rehabilitation. We aimed to explore (1) dose characteristics of physical activity behaviour among adults with physical disabilities and/or chronic diseases during that period, and (2) the effects of personal characteristics and diagnosis on the development of physical activity over time.Methods Adults with physical disabilities and/or chronic diseases (N=1256), enrolled in the Rehabilitation, Sports and Active lifestyle study, were followed with questionnaires: 3–6 weeks before (T0) and 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. Physical activity was assessed with the adepted version of the Short Questionnaire to ASsess Health enhancing physical activity. Dose characteristics of physical activity were descriptively analysed. Multilevel regression models were performed to assess physical activity over time and the effect of personal and diagnosis characteristics on physical activity over time.Results Median total physical activity ranged from 1545 (IQR: 853–2453) at T0 to 1710 (IQR: 960–2730) at T3 min/ week. Household (495–600 min/week) and light intensity (900–998 min/week) activities accrued the most minutes. Analyses showed a significant increase in total physical activity moderate-intensity to vigorous-intensity physical activity and work/commuting physical activity for all time points (T1–T3) compared with baseline (T0). Diagnosis, age, sex and body mass index had a significant effect on baseline total physical activity. Conclusion Physical activity is highly diverse among adults with physical disabilities and/or chronic diseases. Understanding this diversity in physical activity can help improve physical activity promotion activities

Test-retest reliability and concurrent validity of the Adapted Short QUestionnaire to ASsess Health-enhancing physical activity (Adapted-SQUASH) in adults with disabilities

The current study determined the test-retest reliability and concurrent validity of the Adapted Short QUestionnaire to ASsess Health-enhancing physical activity (Adapted-SQUASH) in adults with disabilities. Before filling in the Adapted-SQUASH twice with a recall period of 2 weeks, participants wore the Actiheart activity monitor up to 1 week. For the test-retest reliability (N = 68), Intraclass correlation coefficients (ICCs) were 0.67 (p <0.001) for the total activity score (min x intensity/week) and 0.76 (p <0.001) for the total minutes of activity (min/week). For the concurrent validity (N = 58), the Spearman correlation coefficient was 0.40 (p = 0.002) between the total activity score of the first administration of the Adapted-SQUASH and activity energy expenditure from the Actiheart (kcals kg min ). The ICC was 0.22 (p = 0.027) between the total minutes of activity assessed with the first administration of the Adapted-SQUASH and Actiheart. The Adapted-SQUASH is an acceptable measure to assess self-reported physical activity in large populations of adults with disabilities but is not applicable at the individual level due to wide limits of agreement. Self-reported physical activity assessed with the Adapted-SQUASH does not accurately represent physical activity assessed with the Actiheart in adults with disabilities, as indicated with a systematic bias between both instruments in the Bland-Altman analysis

RehabMove 2018: UNRAVELLING FATIGUE AND ACTIVITY PACING IN MAINTAINING A PHYSICALLY ACTIVE LIFESTYLE AFTER STROKE REHABILITATION

PURPOSES: 1) To identify fatigue trajectories after stroke rehabilitation, 2) to determine which factors are associated with trajectory membership before discharge, and 3) to investigate how fatigue and activity pacing are related to physical activity after stroke rehabilitation. METHODS: Stroke patients(N=303) were followed from baseline(T0:3-6 weeks before discharge) to 14(T1), 33(T2) and 52(T3) weeks after discharge from rehabilitation in the Rehabilitation, Sports and Active lifestyle study. Latent Class analysis was conducted to determine fatigue trajectories(T1-T3) using self-reported data of the Fatigue Severity Scale. Binomial regression analyses were performed to determine personal and health-related factors and behaviours of activity pacing associated with trajectory membership at T0. Multilevel analyses were used to investigate how self-reported physical activity levels were related to fatigue and activity pacing after rehabilitation(T1-T3). RESULTS: Three fatigue trajectories were identified: high(N=167), low(N=33) and recovery(N=6). Compared with the low fatigue trajectory, stroke patients in the high fatigue trajectory were less likely to be highly educated(p=.023), experienced a lower quality of life(p=.004) and were more aware of their activity pacing(p=.015). Sustained physical activity was related to less fatigue(p=.006) and less awareness of activity pacing(p=.002) after rehabilitation. CONCLUSIONS: This study identified three fatigue trajectories after stroke rehabilitation. Low education level, low quality of life scores, and high awareness of activity pacing before discharge identified stroke patients in the high fatigue trajectory. Lower levels of physical activity after stroke rehabilitation were related to a higher awareness of activity pacing, but without advice on activity pacing patients did not succeed to reduce their fatigue. These findings highlight the need to focus on the potential of activity pacing in today’s rehabilitation practice

Associations between Activity Pacing, Fatigue, and Physical Activity in Adults with Multiple Sclerosis: A Cross Sectional Study

Fatigue is common in people with multiple sclerosis (MS). Activity pacing is a behavioral way to cope with fatigue and limited energy resources. However, little is known about how people with MS naturally pace activities to manage their fatigue and optimize daily activities. This study explored how activity pacing relates to fatigue and physical activity in people with MS. Participants were 80 individuals (60 females, 20 males) with a diagnosis of MS. The participants filled in questionnaires on their activity pacing, fatigue, physical activity, and health-related quality of life, 3–6 weeks before discharge from rehabilitation. The relationships between the variables were examined using hierarchical regression. After controlling for demographics, health-related quality of life, and perceived risk of overactivity, no associations were found between activity pacing and fatigue (β = 0.20; t = 1.43, p = 0.16) or between activity pacing and physical activity (β = −0.24; t = −1.61, p = 0.12). The lack of significant associations between activity pacing and fatigue or physical activity suggests that without interventions, there appears to be no clear strategy amongst people with MS to manage fatigue and improve physical activity. People with MS may benefit from interventions to manage fatigue and optimize engagement in physical activity.Health and Social Development, Faculty of (Okanagan)Non UBCReviewedFacult