The course of physical functioning in the first two years after stroke depends on peoples’ individual movement behavior patterns

 Good to know your solution to solving stroke is to blame the survivor for not recovering rather than blaming the doctor for not having protocols to recover. People wouldn't be sedentary if you had EXACT PROTOCOLS leading to 100% recovery. They would be too busy counting the millions of reps needed to get there. And would keep going til exhaustion.

The course of physical functioning in the first two years after stroke depends on peoples’ individual movement behavior patterns

Show all authors

Roderick Wondergem, Martijn F Pisters, Eveline JM Wouters, ...

First Published April 7, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/17474930211006293

Article information

Abstract

Background and purpose

Deterioration of physical functioning after stroke in the long term is regarded as a major problem. Currently, the relationship between “peoples'” movement behavior patterns (the composition of sedentary behavior and physical activity during waking hours) directly after stroke and the development of physical functioning over time is unknown. Therefore, the objectives of this study were to investigate (1) the course of physical functioning within the first two years after returning home after stroke, and (2) the association between physical functioning and baseline movement behavior patterns.

(You missed correlating the doctor behavior patterns to survivor recovery. With no protocols your doctor is completely to blame for lack of recovery. Unless your doctor passed off blame for lack of recovery to the therapists by writing E.T.(Evaluate and Treat)prescriptions.)

Method

In the longitudinal RISE cohort study, 200 persons with a first-ever stroke discharged to the home-setting were included. Participants’ physical functioning was assessed within three weeks, at six months, and one and two years after discharge using the Stroke Impact Scale (SIS) 3.0 subscale physical and the five-meter walk test (5MWT). Three distinct movement behavior patterns were identified in a previous study at baseline and were used in the current study: (1) sedentary exercisers (sufficiently active and 64% of waking hours sedentary), (2) sedentary movers’ (inactive and 63% of waking hours sedentary), and (3) sedentary prolongers (inactive and >78% of waking hours sedentary accumulated in long prolonged bouts). The association between movement behavior patterns and the course of physical functioning was determined using longitudinal generalized estimating equations analyses.

Results

Overall participants’ physical functioning increased between discharge and six months and declined from six months up to two years. Physical functioning remained stable during the first two years after stroke in sedentary exercisers. Physical functioning improved during the first six months after discharge in sedentary movers and sedentary prolongers and deteriorated in the following six months. Only physical functioning (SIS) of sedentary prolongers further declined from one up to two years. A similar pattern was observed in the 5MWT.

Conclusion

Movement behavior patterns identified directly after returning home in people with stroke are associated with and are predictive of the course of physical functioning. Highly sedentary and inactive people with stroke have unfavorable outcomes over time than individuals with higher amounts of physical activity.

Keywords Stroke, physical activity, sedentary behavior, physical functioning, movement behavior, secondary prevention

Background

Physical functioning after stroke is an important determinant for social reintegration.¹ Deterioration of physical functioning is regarded as a major problem, as it could lead to dependency in daily life and participation restrictions.^2–4 Over 50% of people with stroke report longer-term problems with physical functioning aspects, such as mobility and falls.⁵ Moreover, physical functioning declines over time after stroke in a substantial part of the population. Over 25% of all people with stroke decline in physical functioning within the first year after stroke,² increasing to 40% percent in the first three years after the event.⁶ Therefore, prevention of deterioration of physical functioning in people with a first-ever stroke is important.

A sufficient amount of moderate to vigorous physical activity (MVPA) is associated with improved physical functioning after stroke^7,8 and physical inactivity with decreased physical functioning.⁹ Although a sufficient amount of MVPA is protective for a decrease in physical functioning, it accounts for a small proportion of the day (<5%). Ignoring the other components of the movement continuum (sedentary behavior (SB) and light physical activity (LPA)) limits the understanding of how habitual movement behavior interacts to impact physical functioning. Therefore, “individuals'” movement behavior patterns, the composition of all levels of physical activity(light, moderate and vigorous) and SB during waking hours,¹⁰ and their relationship with the course of physical functioning over time need to be explored.

Our research group recently investigated the most commonly distinct movement behavior patterns in stroke patients, and three different groups of patients with distinct movement behavior patterns emerged: sedentary exercisers (22%), sedentary movers (46%) and sedentary prolongers (32%).¹¹ Sedentary exercisers were sedentary for 64% of their waking hours and spent 27% of their waking hours in LPA and 10% in MVPA. During 63% of their waking hours, sedentary movers were sedentary, spent 34% in LPA and 3% in MVPA. Both sedentary exercisers and sedentary movers interrupted their SB frequently with physical activity. The third pattern, sedentary prolongers, were highly sedentary (78%), spent 20% of their time in LPA and 2% in MVPA. Sedentary prolongers spent their sedentary time in long prolonged bouts (≥30 min of uninterrupted sedentary behavior).

Based on previous literature in an older adult population, it could be expected that replacing sedentary behavior with LPA and MVPA will be associated with less loss of physical functioning.^12,13 Currently, research investigating the course of physical functioning and the relationship with movement behavior patterns in people with stroke is lacking. Therefore, this study’s objectives were to investigate (1) the course of physical functioning within the first two years after returning home after stroke, and (2) the association between physical functioning and baseline movement behavior patterns.

More at link,