Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States

Damn, cherry picking again. I and all stroke survivors expect recovery for all, not just the lesser disabled.  THIS is precisely why stroke survivors need to be in charge, we won't leave any survivors behind.

Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States 

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Mary Stuart, ScD, Alexander W. Dromerick, MD, Richard Macko, MD, ...

First Published July 11, 2019 Research Article

https://doi.org/10.1177/1545968319862562

Article information

Abstract

Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility.  
Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States.  
Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors.  
Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion.  
Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.

Keywords stroke, exercise, community-based exercise program, rehabilitation

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Long-term sitting affects vascular health

What EXACTLY is your responsible doctor doing to assure your time in the hospital is not spent sitting or lying in bed? Studies have shown stroke survivors spent vast amounts of time not doing anything. Of course your doctor can deflect this argument since the research was in healthy subjects. If s/he does that deflection you need to demand a competent doctor. 

Long-term sitting affects vascular health

Credeur DP, et al. Am J Cardiol. 2018;doi:10.1016/j.amjcard.2018.10.014.

January 3, 2019

Long bouts of uninterrupted sitting in relatively healthy patients negatively impacted markers of peripheral and central vascular health, according to a study published in The American Journal of Cardiology.
Daniel P. Credeur, PhD, assistant professor at The University of Southern Mississippi School of Kinesiology in Hattiesburg, and colleagues analyzed data from 20 patients (mean age, 26 years; 7 women; mean BMI = 30 kg/m²) free from any metabolic, CV or neurological diseases. Patients were also nonsmokers, not pregnant and were asymptomatic, as shown by a resting BP below 140 mm Hg systolic/90 mm Hg diastolic.

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After completing several assessments and measurements, patients rested for 15 minutes before they sat in a chair for 3 hours. During this time, patients were allowed to perform standard tasks. Tasks such as listening to heavy music and moving their legs were not permitted during the 3 hours.
CV measures were taken at 10 minutes and at every hour. Assessments after 3 hours were also performed, and patients were given a triaxial accelerometer to determine physical activity status over a 7-day period.
After patients sat for 3 hours, there was a significant increase in aortic pulse wave velocity (5.7 m/s to 6.1 m/s; P = .009) and a decrease in augmentation index (13% to 3%; P < .001).
Reflection magnitude did not significantly change during sitting (P = .13).
Decreases were also seen in flow-mediated dilation (0.5 mm to 0.3 mm; P = .014) and microvascular area under the curve (2,194 to 1,157; P = .003). Low-flow mediated constriction was unaffected during sitting (P = .85).
“Our data support the view that a single bout of prolonged, uninterrupted sitting may serve as a precursor for initiating the deleterious cardiovascular health response associated with long-term sedentarism,” Credeur and colleagues wrote. – by Darlene Dobkowski

Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: Breaking Up Sitting Time after Stroke (BUST-Stroke) trial

Well then YOUR DOCTOR needs to get you to the point you can do these exercises maybe by having your doctor stop the 5 causes of the neuronal cascade of death in the first week.
Otherwise this is just blaming the patient for their problems.

Frequent, short bouts of light-intensity exercises while standing decreases systolic blood pressure: Breaking Up Sitting Time after Stroke (BUST-Stroke) trial 

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Coralie English, Heidi Janssen, Gary Crowfoot, ...

First Published September 17, 2018 Research Article

Article information

Abstract

Background

Stroke survivors sit for long periods each day. Uninterrupted sitting is associated with increased risk of cardiovascular disease. Breaking up uninterrupted sitting with frequent, short bouts of light-intensity physical activity has an immediate positive effect on blood pressure and plasma clotting factors in healthy, overweight, and type 2 diabetic populations.

Aim

We examined the effect of frequent, short bouts of light-intensity physical activity on blood pressure and plasma fibrinogen in stroke survivors.

Methods

Prespecified secondary analyses from a three-armed randomized, within-participant, crossover trial. Participants were 19 stroke survivors (nine female, aged 68 years old, 90% able to walk independently). The experimental conditions were sitting for 8 h uninterrupted, sitting with 3 min bouts of light-intensity exercise while standing every 30 min, or sitting with 3 min of walking every 30 min. Blood pressure was measured every 30 min over 8 h and plasma fibrinogen at the beginning, middle, and end of each day. Intention-to-treat analyses were performed using linear mixed models including fixed effects for condition, period, and order, and a random intercept for participant to account for repeated measures and missing data.

Results

Sitting with 3 min bouts of light-intensity exercise while standing every 30 min decreased systolic blood pressure by 3.5 mmHg (95% CI 1.7–5.4) compared with sitting for 8 h uninterrupted. For participants not taking antihypertensive medications, sitting with 3 min of walking every 30 min decreased systolic blood pressure by 5.0 mmHg (95% CI −7.9 to 2.0) and sitting with 3 min bouts light-intensity exercise while standing every 30 min decreased systolic blood pressure by 4.2 mmHg (95% CI −7.2 to −1.3) compared with sitting for 8 h uninterrupted. There was no effect of condition on diastolic blood pressure (p = 0.45) or plasma fibrinogen levels (p = 0.91).

Conclusion

Frequent, short bouts of light-intensity physical activity decreases systolic blood pressure in stroke survivors. However, before translation into clinical practice, the optimal duration and timing of physical activity bouts needs to be determined.

Clinical trial registration

Australian and New Zealand Clinical Trials Registry http://www.anzctr.org.au ANZTR12615001189516.

Sitting too much affects brain thickness, study finds

How is your doctor making sure this problem doesn't happen to you post stroke? And telling you to exercise and move around is too fucking lazy to even be considered medical advice.
https://www.upi.com/https:/www.upi.com/Health_News/2018/04/12/Sitting-too-much-affects-brain-thickness-study-finds/6221523551908/

April 12 (UPI) -- You'd better not be taking this sitting down -- researchers say sitting too much can result in less thickness of the brain.
Researchers at UCLA have found that long stretches of sedentary behavior by middle-aged and older adults affects brain health, in addition to potentially increasing the risk for heart disease, diabetes and premature death. In their findings, published Thursday in PLOS One, the researchers determined sitting affects regions of the brain critical to memory formation by thinning the medial temporal lobe.

And they found out that even high levels of physical activity isn't enough to dramatically offset the harmful effects of sitting for extended periods.
Brain thinning can be a precursor to cognitive decline and dementia in middle-aged and older adults.
UCLA researchers studied 35 people between the ages of 45 and 75, asking them about their physical activity levels and the average number of hours per day they spent sitting over the previous week.
Each person received a high-resolution MRI scan for a detailed look at the medial temporal lobe.
Sitting ranged from three hours per day up to 15 hours during weekdays.
"With every hour of sitting each day there is a 2 percent decrease in thickness," study author Prabha Siddarth, a biostatistician at the Semel Institute for Neuroscience and Human Behavior at UCLA, told UPI. "If you are able to decrease it by five hours, there would be a 10 percent decrease."
The researchers found no significant correlations between physical activity levels and MTL thickness.
But she cautioned: "We're not trying to give message that physical activity doesn't help."
Siddarth said in studies that do not include sitting, additional physical activity improves brain thickness, and has other physical benefits, including heart health. She also said preserving thickness of the brain region could be possible by taking breaks.
"It's possible if we didn't sit continuously for extended period of times," Siddarth said. "None of the people were also asked about mentally active sitting -- like Sudoku. All those need to be worked out."
The researchers say that further exploration and understanding of the effects of sedentary behavior are needed in order to reduce the harms of "the global epidemic of physical inactivity and sedentary lifestyles."

Too Much Sitting Ages You Faster - 8 years

Your doctor and therapists should have you exercising for hours each day post-stroke. With only 2-3 hours of therapy a day, sleeping 8 hours,  what are you doing the other 13 hours?
http://www.webmd.com/healthy-aging/news/20170118/too-much-sitting-ages-you-faster
You might age a lot faster if you sit too much, a new study warns.

Researchers who assessed nearly 1,500 older women found those who sat most of the day and got little exercise had cells that were biologically older by eight years than the women's actual age.

"Our study found cells age faster with a sedentary lifestyle. Chronological age doesn't always match biological age," said lead author Aladdin Shadyab. He's from the University of California, San Diego's School of Medicine.

The women, aged 64 to 95, answered questionnaires and wore a device for seven days to track their activity levels.

The study doesn't establish a cause-and-effect relationship between accelerated aging and lack of exercise.

Still, "discussions about the benefits of exercise should start when we are young, and physical activity should continue to be part of our daily lives as we get older, even at 80 years old," Shadyab said in a university news release.

Specifically, the researchers found that women who sat for more than 10 hours a day and got less than 40 minutes of moderate-to-vigorous physical activity daily had shorter telomeres. These are caps on the end of DNA strands that protect chromosomes from deterioration.

Telomeres naturally shorten with age, but health and lifestyle factors -- such as smoking and obesity -- can accelerate the process. Shortened telomeres are linked with heart disease, diabetes and cancer, the researchers explained in background notes.

"We found that women who sat longer did not have shorter telomere length if they exercised for at least 30 minutes a day, the national recommended guideline," Shadyab said.

He and his colleagues plan future studies to examine the link between exercise and telomere length in younger adults and in men.

The study was published online Jan. 18 in the American Journal of Epidemiology.

If you’re sitting down, don’t sit still, new research suggests - fidgeting

This would seem to be very important for us as survivors since it is likely that we are sitting around a lot because of our deficits and fatigue. But I bet your doctor will not be creating a stroke protocol on this. I try to bounce my affected leg while at work sitting.

If you’re sitting down, don’t sit still, new research suggests - fidgeting

New research suggests that the movements involved in fidgeting may counteract the adverse health impacts of sitting for long periods.
In a study published today in the American Journal of Preventive Medicine, a team of researchers, co-led by the University of Leeds and UCL, report that an increased risk of mortality from sitting for long periods was only found in those who consider themselves very occasional fidgeters.
They found no increased risk of mortality from longer sitting times, compared to more active women, in those who considered themselves as moderately or very fidgety.
The study examined data from the University of Leeds’ UK Women’s Cohort Study, which is one of the largest cohort studies of diet and health of women in the UK.
Study co-lead author Professor Janet Cade, from the School of Food Science and Nutrition at the University of Leeds said: “While further research is needed, the findings raise questions about whether the negative associations with fidgeting, such as rudeness or lack of concentration, should persist if such simple movements are beneficial for our health.”
Even among adults who meet recommended physical activity levels and who sleep for eight hours per night, it is possible to spend the vast majority of the day (up to 15 hours) sitting down.
The study builds on growing evidence suggesting that a sedentary lifestyle is bad for your health, even if you are physically active outside work.
Breaks in sitting time have previously been shown to improve markers of good health, such as body mass index and your body’s glucose and insulin responses. But until now, no study has ever examined whether fidgeting might modify an association between sitting time and death rates.
The University of Leeds’ UK Women’s Cohort Study gathered information on a wide range of eating patterns of more than 35,000 women aged 35 to 69 who are living in the UK.
The new study analyses data from a follow-up survey sent to the same women, which included questions on health behaviours, chronic disease, physical activity levels and fidgeting. More than 14,000 responses were received.
Study co-lead author Dr Gareth Hagger-Johnson from UCL, who conducted the data analysis, said: “Our results support the suggestion that it's best to avoid sitting still for long periods of time, and even fidgeting may offer enough of a break to make a difference.”

• Full bibliographic informationThe research paper, ‘Sitting-time, fidgeting and all-cause mortality in the UK Women's Cohort Study’, is published online in the American Journal of Preventive Medicine.