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

Rehabilitation:mobility, exercise &amp; sports; a critical position stand on current and future research perspectives

Background Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of “RehabMove” congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration. Methods This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress. Results The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate “human and technology asset management” at both individual and organization levels and over the lifespan. Conclusions With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention. IMPLICATIONS FOR REHABILITATION Continued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences. Notions from “human and technology asset management and ergonomics” are fundamental to rehabilitation practice and research. The rehabilitation concept will further merge into general health care and the quality there-off

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

Sustained physical activity and health following rehabilitation: unravelling the role of perceived fatigue and activity pacing behaviour

This thesis aimed to investigate the role of fatigue and activity pacing on sustained physical activity and health among people with physical disabilities and/or chronic diseases following discharge from rehabilitation, and especially in stroke survivors. This thesis took a diagnosis-overarching and disease-specific (stroke) approach to investigate this aim. Moreover, this aim was investigated by using divers methodologies, including quantitative study designs (cohort studies and cross-sectional studies), a narrative literature review and qualitative study designs (a semi-structured interview study and a focus group study). High levels of perceived fatigue are associated with low levels of physical activity and low levels of HR-QoL in people with physical disabilities and/or chronic diseases following discharge from rehabilitation, and especially in stroke survivors. Advice on activity pacing seems to have the potential to manage fatigue and to increase physical activity and HR-QoL in this target population in rehabilitation practice and in follow-up care. The findings of this thesis will help guide improvement of fatigue guidance (e.g., advice on activity pacing) in rehabilitation programmes and follow-up care. Especially in stroke survivors, the advice on activity pacing should be person-centred through considering the acceptance of the disease, the capability, opportunity and motivation to change physical activity behaviour, and the distinct notions of perceived fatigue (mental and physical fatigue). Besides, information on post-stroke fatigue should be provided to stroke survivors well before discharge. Also, follow-up support after rehabilitation by a stroke coach should be implemented nationwide, since survivors and professionals expressed a need for it