Physical inactivity after stroke: Incidence and early predictors based on 190 individuals in a 1-year follow-up of the fall study of Gothenburg

Authors

  • Sara Botö Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Rehabilitation Medicine, Gothenburg, Sweden.
  • Dongni Buvarp
  • Per-Olof Hansson
  • Katharina S. Sunnerhagen
  • Carina U. Persson

DOI:

https://doi.org/10.2340/16501977-2852

Keywords:

stroke, physical activity, rehabilitation

Abstract

Objective: To determine the incidence of physical inactivity and factors prior to stroke and in acute stroke that are associated with physical inactivity 1 year after stroke

Design: Prospective longitudinal cohort

Patients: A total of 190 consecutively included individuals with acute stroke

Methods: A follow-up questionnaire, relating to physical activity level using the Saltin-Grimby Physical Activity Scale, was sent to participants in the Fall Study of Gothenburg 1 year after stroke. Predictors of physical inactivity at baseline were identified using univariable and multivariable logistic regression analyses.

Results: Physical inactivity 1 year after stroke was reported by 70 (37%) of the 190 patients who answered the questionnaire and was associated with physical inactivity before the stroke, odds ratio (OR) 4.07 (95% confidence interval (95% CI) 1.69–9.80, p = 0.002); stroke severity (assessed by National Institutes of Health Stroke Scale (NIHSS), score 1–4), OR 2.65 (95% CI) 1.04–6.80, p = 0.042) and fear of falling in acute stroke, OR 2.37 (95% CI 1.01–5.60, p = 0.048).

Conclusion: Almost 4 in 10 participants reported physical inactivity 1 year after stroke. Physical inactivity before the stroke, stroke severity and fear of falling in acute stroke are the 3 main factors that predict physical inactivity 1 year after stroke.

Lay Abstract

After a stroke, there is a risk of becoming physically inactive, which could affect one’s health. In order to create a rehabilitation plan with individualized preventive actions and interventions against physical inactivity, it is important, early after stroke onset, to identify patients who are at risk of becoming physically inactive. Previous studies of the early prediction of physical inactivity are few in number, with small sample sizes. This research on 190 individuals describes which factors prior to and in acute stroke (which is the first week after stroke) are associated with physical inactivity 1 year after stroke. The results showed that physical inactivity before stroke, stroke severity, and a fear of falling in acute stroke are associated with physical inactivity 1 year after stroke.

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References

World Health Organization (WHO) 2010 [cited 2020 18 Nov]. Global recommendations on physical activity for health. Available from: https://apps.who.int/iris/bitstream/handle/10665/44399/9789241599979_eng.pdf; jsessionid = D890D8822DCB6CCBE1E1E88BDD40E2E5?sequence = 1.

World Health Organization (WHO) 2020. Fact sheet, physical activity. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity.

World Health Organization (WHO). Physical activity - key facts 2018 [updated 2018 Feb 23, cited 2020 Nov 11]. Available from: https: //www.who.int/news-room/fact-sheets/detail/physical-activity.

English C, Manns PJ, Tucak C, Bernhardt J. Physical activity and sedentary behaviors in people with stroke living in the community: a systematic review. Phys Ther 2014; 94: 185-196. https://doi.org/10.2522/ptj.20130175

Danielsson A, Meirelles C, Willen C, Sunnerhagen KS. Physical activity in community-dwelling stroke survivors and a healthy population is not explained by motor function only. PM R 2014; 6: 139-145. https://doi.org/10.1016/j.pmrj.2013.08.593

Danielsson A, Willén C, Sunnerhagen KS. Physical activity, ambulation, and motor impairment late after stroke. Stroke Res Treat 2012; 2012: 818513. https://doi.org/10.1155/2012/818513

Rand D, Eng JJ, Tang PF, Jeng JS, Hung C. How active are people with stroke?: use of accelerometers to assess physical activity. Stroke 2009; 40: 163-18. https://doi.org/10.1161/STROKEAHA.108.523621

López-Cancio E, Ricciardi AC, Sobrino T, Cortés J, de la Ossa NP, Millán M, et al. Reported prestroke physical activity is associated with vascular endothelial growth factor expression and good outcomes after stroke. J Stroke Cerebrovasc Dis 2017; 26: 425-430.

https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.004

Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2532-2553. https://doi.org/10.1161/STR.0000000000000022

Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How physically active are people following stroke? Systematic review and quantitative synthesis. Phys Ther 2017; 97: 707-717. https://doi.org/10.1093/ptj/pzx038

Thilarajah S, Mentiplay BF, Bower KJ, Tan D, Pua YH, Williams G, et al. Factors associated with post-stroke physical activity: a systematic review and meta-analysis. Arch Phys Med Rehabil 2018; 99: 1876-1889. https://doi.org/10.1016/j.apmr.2017.09.117

Olsson OA, Persson HC, Alt Murphy M, Sunnerhagen KS. Early prediction of physical activity level 1 year after stroke: a longitudinal cohort study. BMJ Open 2017; 7: e016369. https://doi.org/10.1136/bmjopen-2017-016369

Persson CU, Hansson PO. Early prediction of physical inactivity in 215 individuals 6 months after a mild stroke: the Fall Study of Gothenburg. J Rehabil Med 2020; 52: jrm00077. https://doi.org/10.2340/16501977-2707

Larén A, Odqvist A, Hansson PO, Persson CU. Fear of falling in acute stroke: the Fall Study of Gothenburg (FallsGOT). Top Stroke Rehabil 2018; 25: 256-260. https://doi.org/10.1080/10749357.2018.1443876

Rödjer L, Jonsdottir IH, Rosengren A, Björck L, Grimby G, Thelle DS, et al. Self-reported leisure time physical activity: a useful assessment tool in everyday health care. BMC Public Health 2012; 12: 693. https://doi.org/10.1186/1471-2458-12-693

Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 1968; 38: 1104-1115. https://doi.org/10.1161/01.CIR.38.6.1104

Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med 1995; 27: 27-36.

Persson CU, Hansson PO, Sunnerhagen KS. Clinical tests performed in acute stroke identify the risk of falling during the first year: postural stroke study in Gothenburg (POSTGOT). J Rehabil Med 2011; 43: 348-353. https://doi.org/10.2340/16501977-0677

Persson CU, Hansson PO, Danielsson A, Sunnerhagen KS. A validation study using a modified version of Postural Assessment Scale for Stroke Patients: Postural Stroke Study in Gothenburg (POSTGOT). J Neuroeng Rehabil 2011; 8: 57. https://doi.org/10.1186/1743-0003-8-57

Persson CU, Sunnerhagen KS, Danielsson A, Grimby-Ekman A, Hansson PO. Responsiveness of a modified version of the postural assessment scale for stroke patients and longitudinal change in postural control after stroke - Postural Stroke Study in Gothenburg (POSTGOT). J Neuroeng Rehabil 2013; 10: 8. https://doi.org/10.1186/1743-0003-10-8

Persson CU, Linder A, Hagell P. Measurement properties of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) using Rasch analysis. Eur J Phys Rehabil Med 2017; 53: 848-855. https://doi.org/10.23736/S1973-9087.17.04607-X

Bergqvist GM, Nasic S, Persson CU. Inter-rater reliability of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in the acute phase after stroke. Top Stroke Rehabil 2019; 26: 366-372. https://doi.org/10.1080/10749357.2019.1601911

Persson CU, Sunnerhagen KS, Lundgren-Nilsson A. Rasch analysis of the modified version of the postural assessment scale for stroke patients: postural stroke study in Gothenburg (POSTGOT). BMC Neurol 2014; 14: 134. https://doi.org/10.1186/1471-2377-14-134

Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke 1997; 28: 307-310. https://doi.org/10.1161/01.STR.28.2.307

Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 2010; 5: 1315-1316.

https://doi.org/10.1097/JTO.0b013e3181ec173d

Persson CU, Hansson PO, Lappas G, Danielsson A. Physical activity levels and their associations with postural control in the first year after stroke. Phys Ther 2016; 96: 1389-1396. https://doi.org/10.2522/ptj.20150367

Reinholdsson M, Palstam A, Sunnerhagen KS. Prestroke physical activity could influence acute stroke severity (part of PAPSIGOT). Neurology 2018; 91: e1461-e1467. https://doi.org/10.1212/WNL.0000000000006354

Mahendran N, Kuys SS, Brauer SG. Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke? Disabil Rehabil 2020; 42): 763-769. https://doi.org/10.1080/09638288.2018.1508513

Espernberger KR, Fini NA, Peiris CL. Personal and social factors that influence physical activity levels in community-dwelling stroke survivors: a systematic review of qualitative literature. Clin Rehabil 2021: 269215521993690. https://doi.org/10.1177/0269215521993690

Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol 2017; 32: 541-556. https://doi.org/10.1097/HCO.0000000000000437

Aguiar LT, Nadeau S, Teixeira-Salmela LF, Reis MTF, Peniche PDC, Faria C. Perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise reported by individuals with chronic stroke in a developing country. Disabil Rehabil 2020: 1-6. https://doi.org/10.1080/09638288.2020.1855260

Persson CU, Kjellberg S, Lernfelt B, Westerlind E, Cruce M, Hansson PO. Risk of falling in a stroke unit after acute stroke: the Fall Study of Gothenburg (FallsGOT). Clin Rehabil 2018; 32: 398-409. https://doi.org/10.1177/0269215517728325

Pohl P, Ahlgren C, Nordin E, Lundquist A, Lundin-Olsson L. Gender perspective on fear of falling using the classification of functioning as the model. Disabil Rehabil 2015; 37: 214-222. https://doi.org/10.3109/09638288.2014.914584

Langhammer B, Stanghelle JK, Lindmark B. An evaluation of two different exercise regimes during the first year following stroke: a randomised controlled trial. Physiother Theory Pract 2009; 25: 55-68. https://doi.org/10.1080/09593980802686938

Vahlberg B Med Dr PT, Bring A Med Dr PT, Hellström KP, Zetterberg L Med Dr PT. Level of physical activity in men and women with chronic stroke. Physiother Theory Pract 2019; 35: 947-955. https://doi.org/10.1080/09593985.2018.1460646

Grimby G, Börjesson M, Jonsdottir IH, Schnohr P, Thelle DS, Saltin B. The "Saltin-Grimby Physical Activity Level Scale" and its application to health research. Scand J Med Sci Sports 2015; 25 Suppl 4: 119-125. https://doi.org/10.1111/sms.12611

Grimby G. Physical activity and muscle training in the elderly. Acta Med Scand Suppl 1986; 711: 233-237. https://doi.org/10.1111/j.0954-6820.1986.tb08956.x

Mattiasson-Nilo I, Sonn U, Johannesson K, Gosman-Hedström G, Persson GB, Grimby G. Domestic activities and walking in the elderly: evaluation from a 30-hour heart rate recording. Aging (Milano) 1990; 2: 191-198. https://doi.org/10.1007/BF03323916

Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act 2008; 5: 56. https://doi.org/10.1186/1479-5868-5-56

Kwakkel G, Lannin NA, Borschmann K, English C, Ali M, Churilov L, et al. Standardized measurement of sensorimotor recovery in stroke trials: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2017; 12: 451-461. https://doi.org/10.1177/1747493017711813

Published

2021-09-09

How to Cite

Botö, S., Buvarp, D., Hansson, P.-O., Sunnerhagen, K. S., & Persson, C. U. (2021). Physical inactivity after stroke: Incidence and early predictors based on 190 individuals in a 1-year follow-up of the fall study of Gothenburg. Journal of Rehabilitation Medicine, 53(9), jrm00224. https://doi.org/10.2340/16501977-2852

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