The Longitudinal Course of Physical Activity Behavior Poststroke and its Variation across Subgroups: The nor-COAST Study.

Abstract

Importance: Despite its importance as a modifiable target poststroke, the longitudinal course of physical activity (PA) is not fully understood.

Objective: This study aimed to describe the course of poststroke PA behavior from 3 to 36 months and identify subgroups with different PA patterns using multi-trajectory modeling.

Design: A prospective multicenter cohort study design was used.

Setting: Follow-up at 3-, 18-, and 36-months poststroke was community-based.

Participants: In total, 277 individuals (age = 70.1 [SD = 10.9]; 116 [41.9%] female) with primarily mild strokes were included. Participants provided at least 2 follow-up periods with accelerometer data each lasting at least 3 consecutive days.

Main outcomes and measures: At each follow-up, daily estimates of upright time, time spent in light physical activity (LPA), time spent in moderate physical activity (MPA), step count, and the number of sit-to-stand transitions were measured.

Results: Average daily upright time declined by -7.4 minutes (95% CI = -10.09 to 4.64), and average daily step count declined by -132 steps (95% CI = -176 to -88) each year. Four distinct groups of individuals with different characteristics were identified, following a similar developmental course across PA dimensions over time: one-fourth of the participants (25.6%) were characterized by stable low PA estimates and a tendency to decline over time. Two groups, making up 32.4% and 20.8% of the sample, were characterized by intermediate levels of LPA and MPA, with differing levels of sit-to-stand transitions; and 1 group (21.2% of participants) was characterized by stable high PA duration estimates over time.

Conclusions: The overall course of PA poststroke was characterized by a modest decrease over 3 years. Differing PA trajectory groups characterized by different demographic and clinical features highlight the diverse needs for supporting people living with stroke in becoming more active.

Relevance: Findings may help clinicians identify subgroups of people with stroke who need extended professional follow-up in long-term rehabilitation.