Reducing Sitting Time After Stroke: A Phase II Safety and Feasibility Randomized Controlled Trial

doi:10.1016/j.apmr.2015.10.094

Archives of Physical Medicine and Rehabilitation

Volume 97, Issue 2, February 2016, Pages 273-280

Presented in part as a poster to the European Stroke Organization, April 17–19, 2015, Glasgow, United Kingdom; and Stroke 2015 (a combined conference of the Stroke Society of Australasia and Smartstrokes NSW), September 1–5, 2015, Melbourne, VIC, Australia.

https://doi.org/10.1016/j.apmr.2015.10.094 Get rights and content

Abstract

Objective

To test the safety, feasibility, and effectiveness of reducing sitting time in stroke survivors.

Design

Randomized controlled trial with attention-matched controls and blinded assessments.

Setting

Community.

Participants

Stroke survivors (N=35; 22 men; mean age, 66.9±12.7y).

Interventions

Four counseling sessions over 7 weeks with a message of sit less and move more (intervention group) or calcium for bone health (attention-matched control group).

Main Outcome Measures

Measures included safety (adverse events, increases in pain, spasticity, or fatigue) and feasibility (adherence to trial protocol). Secondary measures included time spent sitting (including in prolonged bouts ≥30min), standing, and stepping as measured by the thigh-worn inclinometer (7d, 24h/d protocol) and time spent in physical activity of at least moderate intensity as measured by a triaxial accelerometer. The Multimedia Activity Recall for Children and Adults was used to describe changes in use of time.

Results

Thirty-three participants completed the full protocol. Four participants reported falls during the intervention period with no other adverse events. From a baseline average of 640.7±99.6min/d, daily sitting time reduced on average by 30±50.6min/d (95% confidence interval [CI], 5.8–54.6) in the intervention group and 40.4±92.5min/d in the control group (95% CI, 13.0–93.8). Participants in both groups also reduced their time spent in prolonged sitting bouts (≥30min) and increased time spent standing and stepping.

Conclusions

Our protocol was both safe and feasible. Participants in both groups spent less time sitting and more time standing and stepping postintervention, but outcomes were not superior for intervention participants. Attention matching is desirable in clinical trials and may have contributed to the positive outcomes for control participants.

Section snippets

Methods

This was a pilot randomized controlled trial with an attention-matched control group, concealed allocation, and blinded assessment of outcome. The trial was registered with the Australian and New Zealand Trial Registry (ACTRN12612000958886). Participants were unaware of the intervention of interest. They were told only that this was a trial of healthy living after stroke. A 1:1 randomization sequence was prepared by a statistician independent of the project. A research assistant independent of

Results

Participants were recruited between February 2013 and February 2014, with final data collected in May 2014. Figure 1 presents the flow of participants through the trial. Table 1 presents baseline characteristics of the 35 participants. Four (intervention: n=2; control: n=2) participants reported falls during the intervention period. None of the falls were injurious. There were no other adverse events reported. Pain, spasticity, and fatigue did not change between baseline and postintervention

Discussion

Stroke survivors are both sedentary (spending large proportions of their day sitting down), and physically inactive. Previous research has largely focused on encouraging stroke survivors to increase their time in physical activity of at least moderate intensity. This is the first clinical trial to investigate an intervention aimed at encouraging stroke survivors to replace sitting time with light-intensity activity (ie, sit less and move more). Our protocol was both safe and feasible, with no

Conclusions

To our knowledge, this is the first clinical trial to demonstrate that it is possible for people with stroke to sit less each day. We have demonstrated that the clinical trial protocol is both safe and feasible and leads to reductions in daily sitting time. However, the health benefits associated with sitting less each day remain unclear.

Suppliers

a.
PAL Technologies.
b.
Microsoft Access 2010; Microsoft.
c.
Actigraph.
d.
Sensewear arm band; Temple Healthcare.

Acknowledgment

We thanks Samantha McKenzie, BAppSci (Phty), for assistance with data collection.

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This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in individuals with stroke.
The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023.
The StArt 3.0.3 BETA software was used to screen titles, abstracts, and full texts for studies with randomized controlled trial designs; individuals with stroke (≥18 years of age); interventions aimed at increasing PA or decreasing SB; and objective measurement instruments.
Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed.
Twenty-eight studies involving 1855 patients were included. Meta-analyses revealed that in the post-stroke acute/subacute phase, exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P=.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=0.68, P=.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (SMD (low-intensity physical activity)=0.36, P=.02; SMD (MVPA)=0.56, P=.0004) and decreased SB with low-quality evidence (SMD=0.48, P=.03). In the post-stroke chronic phase, there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P=.002). In general, the risk of bias in the included studies was low.
In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps.
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The objective of this pilot study was to examine the feasibility of a remote physical activity monitoring program, quantify baseline activity levels, and examine predictors of activity among rurally residing adults with Parkinson disease (PD) or stroke.
Thirty-day observational study. Participants completed standardized assessments, connected a wearable device, and synced daily step counts via a remote monitoring platform.
Community-based remote monitoring.
Rurally residing adults with PD or stroke enrolled in the Veterans Health Administration.
N/A.
Feasibility was evaluated using recruitment data (response rates), study completion (completed assessments and connected the wearable device), and device adherence (days recording ≥100 steps). Daily step counts were examined descriptively. Predictors of daily steps were explored across the full sample, then by diagnosis, using linear mixed-effects regression analyses.
Forty participants (n=20 PD; n=20 stroke) were included in the analysis with a mean (SD) age of 72.9 (7.6) years. Participants resided 252.6 (105.6) miles from the coordinating site. Recruitment response rates were 11% (PD) and 6% (stroke). Study completion rates were 71% (PD) and 80% (stroke). Device adherence rates were 97.0% (PD) and 95.2% (stroke). Participants with PD achieved a median [interquartile range] of 2618 [3896] steps per day and participants with stroke achieved 4832 [7383] steps. Age was the only significant predictor of daily steps for the full sample (-265 steps, 95% confidence interval [-407, -123]) and by diagnosis (PD, -175 steps, [-335, -15]; stroke, -357 steps [-603, -112]).
A remote physical activity monitoring program for rurally residing individuals with PD or stroke was feasible. This study establishes a model for a scalable physical activity program for rural, older populations with neurologic conditions from a central coordinating site.
Lifestyle interventions to reduce sedentary behaviour in clinical populations: A systematic review and meta-analysis of different strategies and effects on cardiometabolic health
2021, Preventive Medicine
Cardiometabolic comorbidities are highly prevalent in clinical populations, and have been associated (partly) with their sedentary lifestyle. Although lifestyle interventions targeting sedentary behaviour (SB) have been studied extensively in the general population, the effect of such strategies in clinical populations is not yet clear. Therefore, this systematic review and meta-analysis evaluated the effect of different lifestyle interventions on SB and cardiometabolic health in clinical populations.
Randomised controlled trials were collected from five bibliographic databases (PubMed, Embase, Web of Science, The Cochrane Central Register of Controlled Trials, and Scopus). Studies were eligible for inclusion if they evaluated a lifestyle intervention to reduce objectively measured SB, in comparison with a control intervention among persons with a clinical condition. Data were pooled using a random-effects meta-analysis.
In total, 7094 studies were identified. Eighteen studies met the inclusion criteria and were categorised in five population groups: overweight/obesity, type 2 diabetes mellitus, cardiovascular, neurological/cognitive and musculoskeletal diseases. Participants reduced their SB by 64 min/day (95%CI: [−91, −38] min/day; p < 0.001), with larger within-group differences of multicomponent behavioural interventions including motivational counselling, self-monitoring, social facilitation and technologies (−89 min/day; 95%CI: [−132, −46] min/day; p < 0.001). Blood glycated haemoglobin concentration (−0.17%; 95% CI: [−0.30, −0.04]%; p = 0.01), fat percentage (−0.66%; 95% CI: [−1.26, −0.06]%, p = 0.03) and waist circumference (−1.52 cm; 95%CI: [−2.84, −0.21] cm; p = 0.02) were significantly reduced in the intervention groups compared to control groups.
Behavioural lifestyle interventions reduce SB among clinical populations and improve cardiometabolic risk markers such as waist circumference, fat percentage, and glycaemic control.
Sedentary behaviour, Cardiometabolic health, Clinical populations.
The Effects of Combining Transcranial Direct Current Stimulation and Gait Training with Functional Electrical Stimulation on Trunk Acceleration During Walking in Patients with Subacute Stroke
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This study aimed to investigate whether the combination of transcranial direct current stimulation (tDCS) and gait training with FES affected walking speed and trunk accelerometry-based gait characteristics in patients with subacute stroke, compared with FES or tDCS gait training only.
Stroke patients (n = 34; female 15; mean age, 72.5 ± 11.2 years; mean days poststroke, 38.7) with resultant paresis in the lower extremity (mean Fugl-Meyer score, 25.5) were enrolled. Patients were randomly assigned to one of three groups: combined anodal tDCS and gait training with FES (tDCS+FES, n = 11), anodal tDCS with gait training (tDCS, n = 11), or combined sham tDCS and gait training with FES (FES, n = 12). Participants received the intervention for 20 minutes and a 40-minute conventional rehabilitative intervention daily for a week. Patients’ walking ability was evaluated using walking speed, harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) along each axis using a wearable trunk accelerometer.
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The combination of anodal tDCS and gait training with FES improved the post-stroke patients’ gait regularity than FES gait training intervention only. Thus, combined tDCS and FES gait training, as a novel intervention, could be an important therapeutic tool in improving walking performance.
The SitLess With MS Program: Intervention Feasibility and Change in Sedentary Behavior
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View all citing articles on Scopus

: Current affiliation for English, School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia.

: Supported by the National Stroke Foundation Nancy and Vic Meyers Prevention Grant; a National Health and Medical Research Council Training Fellowship (no. 610312); a National Health and Medical Research Council Career Development Fellowship (no. 108029); a Heart Foundation Postdoctoral Fellowship (no. PH 12B 7054); a National Health and Medical Research Council Established Research Fellowship (no. 1058635); infrastructure support from the Victorian State Government; and the Australian Government's Collaborative Research Networks program.

: Australian and New Zealand Trial Registry No.: ACTRN12612000958886.

: Disclosures: none.

View full text

Original researchReducing Sitting Time After Stroke: A Phase II Safety and Feasibility Randomized Controlled Trial

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Suppliers

Acknowledgment

Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010

Lancet

Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study

Stroke

Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study

Lancet

Managing sedentary behavior to reduce the risk of diabetes and cardiovascular disease

Curr Diab Rep

Too much sitting–a health hazard

Diabetes Res Clin Pract

Sitting and activity time in people with stroke

Phys Ther

Physical activity and sedentary behaviors in people with stroke living in the community: a systematic review

Phys Ther

Physical inactivity post-stroke: a 3-year longitudinal study

Disabil Rehabil

Physical activity, sedentary behaviour and metabolic control following stroke: a cross-sectional and longitudinal study

PLoS One

Physical activity profiles and sedentary behaviour in people following stroke: a cross-sectional study

Disabil Rehabil

Sedentary behavior in the first year after stroke: a longitudinal cohort study with objective measures

Arch Phys Med Rehabil

Breaking up prolonged sitting reduces postprandial glucose and insulin responses

Diabetes Care

Mortality benefits for replacing sitting time with different physical activities

Med Sci Sports Exerc

Reducing sitting time in office workers: short-term efficacy of a multicomponent intervention

Prev Med

Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis

Br J Sports Med

Motivational interviewing: a systematic review and meta-analysis

Br J Gen Pract

A qualitative theory guided analysis of stroke survivors' perceived barriers and facilitators to physical activity

Disabil Rehabil

Can a food frequency questionnaire be used to capture dietary intake data in a 4 week clinical intervention trial?

Asia Pac J Clin Nutr

Original research
Reducing Sitting Time After Stroke: A Phase II Safety and Feasibility Randomized Controlled Trial