Introduction: Physical activity (PA) levels in stroke survivors are typically lower than those observed in the general older population. Higher PA after stroke has been associated with improved mobility, balance and quality of life. A greater understanding of ways to increase daily PA in stroke survivors is paramount to long-term recovery. The purpose of this study was to compare and contrast daily PA quantities, patterns, and trends in stroke survivors with and without a caregiver, and with and without clinical motivation to engage in regular walking activity.
Methods: PA was objectively assessed using an Actigraph wrist worn accelerometer over a 7-day period in 40 stroke survivors within one year of stroke. All had modified Rankin scores of <3. Half were randomized to receive clinical motivation with instructions to take three 10-minute daily walks that were timed to target the late afternoon, a period associated with low PA in older adults. The other half were told to maintain their normal activity levels.
Results: 39 patients returned their accelerometer within a week of wear time. Mean age was 63.3 (± 11.5) years, 53.8% were female and 48.7% were African American. In linear regression models, unadjusted and adjusted for age, BMI, and sex, total daily PA was lower with increasing age in the afternoon and evening hours (P < 0.05). This effect was attenuated in those who were currently employed in the unadjusted (p=0.02) but not the adjusted model (p=0.10). There were no differences by race (p=0.73) or gender (p=0.27). Although clinical motivation did not contribute to higher PA levels at any time of day, the presence of a caregiver increased PA in the late afternoon in the adjusted model (P = 0.04). Interestingly, among all participants, as time since stroke increased, daily PA tended to decrease (p = 0.08).
Conclusions: Effective and sustainable interventions are needed to increase and maintain PA after stroke. Involving caregivers appears to contribute to higher PA, although a brief motivational intervention did not further augment that effect. The negative association between time since stroke and daily PA suggests the challenges stroke survivors face to preserve daily PA. Future research is needed to expand these findings across a greater age and mobility range.