Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke

Hiroki Kubo; Masashi Kanai; Masafumi Nozoe; Asami Inamoto; Akira Taguchi; Ayano Makihara; Daiki Hosokawa; Shingo Mitsue; Tsuyoshi Asai; Shinichi Shimada

doi:10.1016/j.apmr.2023.04.030

Association of Malnutrition With Physical Activity Intensity in Patients With Subacute Stroke

Arch Phys Med Rehabil. 2023 Oct;104(10):1652-1660. doi: 10.1016/j.apmr.2023.04.030. Epub 2023 May 29.

Authors

Affiliations

¹ Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan; Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan; Researcher, Kansai Medical University, Hirakata, Japan. Electronic address: hiro.k16862@gmail.com.
² Institute of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan.
³ Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan.
⁴ Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan.
⁵ Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan.

PMID: 37257550
DOI: 10.1016/j.apmr.2023.04.030

Abstract

Objective: To investigate the relationship between nutritional status measured by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the intensity of physical activity, and to determine the association between these factors and the activities of daily living (ADLs) in patients with subacute stroke during hospitalization.

Design: A cross-sectional study.

Setting: The study was conducted in the rehabilitation unit at a neurosurgical hospital.

Participants: One hundred and twenty-eight patients with subacute stroke (N=128).

Interventions: Not applicable.

Main outcome measures: Nutritional status was assessed using GLIM criteria. Sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer. Multiple regression analysis was used to investigate the relationship between nutritional status and intensity of physical activity. Moreover, the association of nutritional status and physical activity intensity with ADLs was determined using multiple regression analysis and mediation analysis.

Results: Malnutrition was associated with SB time (B = 16.241, P=.009) and LIPA time (B = -17.656, P=.002), but not MVPA time (B = -0.472, P=.776). SB time (B = -0.063, P=.009) and LIPA time (B = 0.093, P<.001) were associated with functional independence measure for motor function, while MVPA time (B = -0.080, P=.379) was not. SB time (coefficient = -10.785, P<.001) and LIPA time (coefficient = -12.054, P<.001) were significant mediators between nutrition status and ADLs.

Conclusions: Malnutrition was associated with a SB time and LIPA time, but not MVPA time, in patients with sub-acute stroke. SB and LIPA times were associated with ADLs and mediated between nutrition status and ADLs in these patients. The association of nutritional status on physical activity and ADLs should be considered in stroke rehabilitation.

Keywords: Functional outcome; GLIM criteria; Physical activity; Rehabilitation; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Cross-Sectional Studies
Exercise
Humans
Malnutrition*
Stroke* / complications