The direct cause of all this sedentary time is the failure to have 100% recovery protocols. Quit blaming the survivor. We've known about 69% sedentary time for over two years, so solve that problem, don't just lazily tell us it exists. I'd have you all fired.
69 percent sedentary time (1 post to August 2019)
Objectively Measured Physical Activity and Sedentary Time Among Adults With and Without Stroke: A National Cohort Study
Abstract
Background and Purpose:
We examined differences in the volume and pattern of physical activity (PA) and sedentary behavior between adults with and without stroke.
Methods:
We studied cohort members with an adjudicated or self-reported stroke (n=401) and age-, sex-, race-, region of residence-, and body mass index-matched participants without a history of stroke (n=1203) from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Sedentary behavior (total volume and bouts), light-intensity PA, and moderate-to-vigorous-intensity PA were objectively measured for 7 days via hip-worn accelerometer.
Results:
Sedentary time (790.5±80.4 versus 752.4±81.9 min/d) and mean sedentary bout duration (15.7±12.6 versus 11.9±8.1 min/d) were higher and PA (light-intensity PA: 160.5±74.6 versus 192.9±73.5 min/d and moderate-to-vigorous-intensity PA: 9.0±11.9 versus 14.7±17.0 min/d) lower for stroke survivors compared with controls (P<0.001). Stroke survivors also accrued fewer activity breaks (65.5±21.9 versus 73.31±18.9 breaks/d) that were shorter (2.4±0.7 versus 2.7±0.8 minutes) and lower in intensity (188.4±60.8 versus 217.9±72.2 counts per minute) than controls (P<0.001).
Conclusions:
Stroke survivors accrued a lower volume of PA, higher volume of sedentary time, and exhibited accrual patterns of more prolonged sedentary bouts and shorter, lower intensity activity breaks compared with persons without stroke.
Despite acute care improvements, the risk of subsequent vascular events remains substantial among stroke survivors.1 While moderate-to-vigorous-intensity physical activity (MVPA) reduces subsequent cardiovascular event risk,2 few stroke survivors meet MVPA recommendations (≈20%).3 Research has emerged documenting the health benefits of light-intensity physical activity (LIPA) and sedentary behavior reduction4; accelerating a paradigm shift towards targeting the full movement continuum (versus MVPA alone) for behavioral interventions in general and clinical populations. Given the poor poststroke adherence to MVPA guidelines, sedentary behavior and LIPA may be more achievable behavioral intervention targets. However, it is largely unclear if the physical activity (PA) profiles of stroke survivors are different from their nonstroke peers and which components of the PA continuum should be targeted to improve poststroke prognosis. Using data from a national cohort study, we examine differences in the volume and pattern of objectively measured PA and sedentary behavior among stroke survivors relative to their peers.
Methods
We studied participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a national population-based study designed to examine racial/regional disparities in stroke.5 Briefly, demographic and risk factor data were collected upon enrollment (2003–2007). Thereafter, follow-up was conducted biannually by telephone to ascertain potential strokes and vital status.
Objective measures of PA were collected from 2009 to 2013. Participants who self-reported an ability to ambulate were invited to wear a hip-based Actical accelerometer during waking hours for 7 days.6 Present analyses included participants with compliant accelerometer wear who either had a self-reported history of stroke or an adjudicated first-time stroke that preceded accelerometer data collection.7 Accelerometer protocol, data processing, and stroke adjudication details are provided in the Data Supplement.
For group comparisons, participants with valid accelerometer wear and without an adjudicated/self-reported stroke were included as a control (Figure in the Data Supplement). Three age-, sex, race-, region of residence-, and body mass index-matched participants were selected for each stroke case using a propensity score model (Data Supplement). Methods were approved by Institutional Review Boards and all participants provided informed consent. STROBE reporting guidelines were followed (Data Supplement). The data that support the findings of this study are available from the corresponding author upon reasonable request.
Statistical Analysis
Two-sample t tests and Wilcoxon signed-rank tests were used to compare stroke survivors and controls. As a sensitivity analysis, analyses were repeated restricting stroke cases to participants who self-reported a history of stroke (n=281) and, separately, those with an adjudicated stroke (n=120). We also conducted a sensitivity analysis additionally matching participants for select comorbidities and marital status.
Results
There were 1604 participants successfully matched and included in the analysis, of which 401 had a stroke (self-report: n=281 and adjudicated: n=120) and 1203 did not (Table 1; Figure in the Data Supplement). Time (mean±SD) since the first self-reported stroke and adjudicated stroke was 14.5 (10.5) years and 2.9 (2.0) years, respectively. Compared with controls, stroke survivors had significantly greater sedentary time and accumulated a greater volume of their sedentary time in prolonged bouts of ≥30, ≥60, and ≥90 minutes (Table 2). Conversely, stroke survivors had significantly lower LIPA and MVPA compared with their nonstroke peers. With respect to activity breaks, stroke survivors accrued fewer breaks and their activity breaks were, on average, shorter in duration and at a lower intensity relative to their nonstroke peers. In sensitivity analyses, similar results were observed when defining stroke survivors by self-reported stroke and adjudicated stroke, separately (Tables I and II in the Data Supplement) and when additionally matching participants for comorbidities and marital status (Table III in the Data Supplement).
Values presented as mean (SD) or %. BMI indicates body mass index.
* P value<0.001.
Discussion
In this US national cohort study, stroke survivors accrued a higher volume of sedentary time and a lower volume of LIPA and MVPA relative to their nonstroke peers. The pattern in which PA and sedentary time was accrued also differed between participants with and without stroke. Stroke survivors accumulated fewer activity breaks, and, on average, these activity breaks were shorter in duration and lower in intensity relative to nonstroke participants. These findings emphasize LIPA and sedentary behavior (total volume and pattern), in addition to MVPA, as potential targets for behavioral interventions among stroke survivors.
English et al8 previously found that stroke survivors (n=40) spent significantly more time sitting (10.9±2.0 h/d versus 8.3±2.0 h/d) and less time physically active (LIPA: 3.4±1.6 versus 6.0±1.4 h/d; MVPA: 4.9±5.8 versus 38.0±31.0 min/d) compared with sex- and age-matched controls.8 Similarly, in a nationally representative sample (n=262), Butler and Evenson9 demonstrated that stroke survivors spent significantly less time in accelerometer-measured LIPA (212.0±6.0 versus 237.2±3.6 min/d) and more time in sedentary behavior (10.0±0.2 versus 9.2±0.1 h/d) compared with age-, race- and ethnicity-, and sex-matched controls.9 These studies provided initial evidence that stroke survivors, beyond having low MVPA, also exhibit a poorer overall PA profile relative to their peers. The present study confirms and extends upon previous work to show in a national, diverse population-based sample that stroke survivors are more sedentary and less active than their peers, even when controlling for key comorbidities. We observed differences in established determinants of PA (quality of life and depression) between participants with and without stroke, however, future research is needed to elucidate contributing factors.
Evidence indicates that the manner in which sedentary time is accumulated (eg, sitting for hours at a time) influences disease risk; suggestive that regularly breaking up sedentary time may have clinical relevance. English et al8 reported stroke survivors accumulated a greater percentage of their sedentary time in bouts ≥30 minutes compared with controls. Our findings confirm that stroke survivors accumulate more sedentary time not only from bouts ≥30 minutes but also from bouts ≥60 and ≥90 minutes relative to their nonstroke peers. Furthermore, our findings impart new knowledge that stroke survivors engage in fewer activity breaks than those without stroke and that these breaks, on average, are shorter in duration and intensity. Thus, future behavioral interventions may need to emphasize not only the frequency but also the quality of activity breaks.
Limitations of the present study include self-reported stroke assessment for some participants, inability of the Actical to distinguish between sitting/standing postures, lack of disability status information, use of day-level accelerometer measures (temporal patterns were not characterized), and limited generalizability to other races and ethnicities beyond Black and White participants. These limitations notwithstanding, while increasing MVPA should remain a secondary prevention target for stroke survivors, our findings highlight a potential need to promote sitting less, moving more (of any intensity), and moving frequently in this high-risk population.
Sources of Funding
This project is supported by U01-NS041588 co-funded by the National Institute of Neurological Disorders and Stroke and National Institute on Aging and R01-NS061846. Additional funding was provided by an unrestricted grant from the Coca-Cola Company.
Supplemental Materials
Online Figure
Online Tables I–IV
Disclosures B. Hutto, Dr Howard, and Dr Colabianchi received grants from the National Institutes of Health during the conduct of the study. Dr Colabianchi received a speaker fee from the University of Alabama-Birmingham. The other authors report no conflicts.
Footnotes
| 160.5 (74.6) | 192.9 (73.5) | <0.001 | |
| Percent of wear time | |||
| LIPA | |||
| Activity breaks | |||
| Number of activity breaks, breaks/d | 65.5 (21.9) | 73.3 (18.9) | <0.001 |
| Mean activity break duration, min | 2.4 (0.7) | 2.7 (0.8) | <0.001 |
| Mean activity break intensity, cpm | 188.4 (60.8) | 217.9 (72.2) | <0.001 |
| Sedentary bouts | |||
| Mean sedentary bout duration, min | 15.7 (12.6) | 11.9 (8.1) | <0.001 |
| Sedentary time in bouts >30 min, min/d | 412.2 (186.4) | 354.8 (155.3) | <0.001 |
| Percent of sedentary time in bouts >30 min, % | 55.6 (18.1) | 49.4 (15.7) | <0.001 |
| Sedentary time in bouts >60 min, min/d | 254.2 (179.9) | 198.8 (138.6) | <0.001 |
| Percent of sedentary time in bouts >60 min (%) | 33.5 (19.5) | 27.1 (15.8) | <0.001 |
| Sedentary time in bouts >90 min, min/d | 154.6 (153.0) | 111.9 (113.5) | <0.001 |
| Percent of sedentary time in bouts >90 min (%) | 19.9 (17.2) | 15.0 (13.4) | <0.001 |
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