Adherence to physical activity and cardiovascular recommendations during the 2years after stroke rehabilitation discharge

Natalie A Fini; Julie Bernhardt; Leonid Churilov; Rebecca Clark; Anne E Holland

doi:10.1016/j.rehab.2020.03.018

Adherence to physical activity and cardiovascular recommendations during the 2years after stroke rehabilitation discharge

Ann Phys Rehabil Med. 2021 Mar;64(2):101455. doi: 10.1016/j.rehab.2020.03.018. Epub 2020 Nov 28.

Authors

Natalie A Fini¹, Julie Bernhardt², Leonid Churilov³, Rebecca Clark⁴, Anne E Holland⁵

Affiliations

¹ Physiotherapy Department, Alfred Health, Melbourne, Australia; Physiotherapy Department, La Trobe University, Melbourne, Australia; Physiotherapy Department, The University of Melbourne, Parkville, Australia. Electronic address: natalie.fini@unimelb.edu.au.
² Stroke Division, Florey Institute of Neurosciences and Mental Health, Heidelberg, Australia.
³ Melbourne Medical School, The University of Melbourne, Parkville, Australia.
⁴ Physiotherapy Department, Alfred Health, Melbourne, Australia.
⁵ Physiotherapy Department, Alfred Health, Melbourne, Australia; Physiotherapy Department, La Trobe University, Melbourne, Australia; Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.

PMID: 33189943
DOI: 10.1016/j.rehab.2020.03.018

Abstract

Background: Objective measurement is essential to represent habitual physical activity. To date only one study has objectively measured physical activity for>12months after stroke.

Objectives: This study aimed to measure physical activity, cardiovascular risk factors, mobility, mood, fatigue and cognition during the 2years after rehabilitation discharge and to investigate whether stroke survivors meet physical activity and cardiovascular risk recommendations.

Methods: This was a longitudinal observational study. Survivors of a first-ever stroke admitted to a large metropolitan rehabilitation hospital were recruited. Outcomes were measured at rehabilitation discharge and 6, 12 and 24months later. Outcomes were physical activity measured by the SenseWear Armband (e.g., moderate-vigorous physical activity, steps/day) and cardiovascular risk factors (e.g., blood pressure, fasting lipid profile and plasma glucose, waist circumference, body mass index), mobility, mood, fatigue and cognition. Changes over time were evaluated with random-effects regression modelling.

Results: Participants (n=79, 33% female) had mean (SD) age of 65 (14) years and median gait speed 1.2m/s (interquartile range: 0.8-1.4) at baseline. We found no change in physical activity levels over time. Step count and time spent in bouts of moderate-vigorous physical activity remained low. Many participants achieved the recommended 30min of daily moderate-vigorous physical activity at baseline, but this was decreased at 2years (72% [57/79] versus 65% [37/57]). Adherence to cardiovascular recommendations decreased over time, notably for body mass index, plasma glucose and triglyceride levels. Waist circumference and body mass index increased at each time point relative to baseline (by a mean of 3.2cm and 1.2kg.m², respectively, at 2years, P<0.01).

Conclusions: This is the largest longitudinal study of objectively measured physical activity after stroke. Adherence to cardiovascular risk recommendations decreased over time post-stroke, and physical activity levels remained low. Stroke survivors may benefit from annual multidisciplinary reviews to identify increasing risk and initiate appropriate interventions.

Keywords: Adherence; Cardiovascular; Longitudinal; Physical activity; Recommendations; Stroke.

Publication types

Observational Study

MeSH terms

Aged
Exercise*
Female
Heart Disease Risk Factors
Humans
Longitudinal Studies
Male
Middle Aged
Patient Compliance*
Patient Discharge
Stroke Rehabilitation*
Stroke* / complications