Abstract P198: Daily Step Count at Two Months is the Strongest Predictor of Daily Steps at One Year Post-Stroke

Abstract

For survivors of stroke, walking can improve endurance, community participation and decrease risk of subsequent stroke. Unfortunately, survivors take 4000 fewer steps per day compared to other adults. Early identification of survivors prone to long-term inactivity would be valuable, as interventions could be implemented to improve physical activity (PA) levels and reduce subsequent stroke risk. Secondary data from the Locomotor Experience Applied Post Stroke (LEAPS) trial was used. Included participants had walking speeds of <0.80 m/s at 2 months post-stroke. Daily steps were assessed at 2 months and 1 year post-stroke using an activity monitor. Stepwise regression was used to predict daily step counts at 1 year based on modifiable (walking speed, endurance, balance, balance confidence, daily step counts) and nonmodifiable (age at time of stroke, gender, race, ethnicity, initial stroke severity, side of stroke and LEAPS intervention group) factors. Data was available for 206 survivors, mean age=63 (13) years, 43% female (88/206), mean walking speed=.41 (.22) m/s, mean step count=2922 (2749) steps per day. The strongest predictor of daily steps at 1 year was daily steps at 2 months (p=<0.001, adjusted R 2 =.34). For every 1-step increase at 2 months, there was an increase of .54 (95% CI .38, .71) steps at 1 year. The next strongest predictor was walking endurance (Six Minute Walk), which significantly increased adjusted R 2 by .02 (p=.009). For every 1-meter increase in Six Minute Walk distance at 2 months, there was an increase of 8 (95% CI 2, 14) steps at 1 year. Together, baseline steps and Six Minute Walk distance explained 36% of the variance in daily steps at 1 year. No other factors significantly added to the prediction model. Daily steps at 2 months post-stroke was the strongest predictor (explaining 34% of the variance) of steps at 1 year. Survivors with low daily steps early after stroke may benefit from targeted walking interventions to increase PA and long term health outcomes.