Abstract
Reduced moderate-to-vigorous physical activity (MVPA) and increased sedentary behavior (SB) are common following stroke, which can limit stroke recovery and contribute to greater cognitive decline. Hence, the MVPA and SB of adults with stroke should be measured concurrently using objective methods. One currently available method for objectively measuring MVPA and SB is the MotionWatch8© (MW8). However, adults with stroke can have significant mobility restrictions (depending on stroke severity) and thus it is important to determine separate MVPA and SB cut-points for adults with stroke, as well as validate separate cut-points: (1) when the MW8 is worn on the stroke affected side compared to the non-affected side; and (2) for adults with mild stroke versus adults with moderate-to-severe stroke. In the current study, we concurrently measured MW8 actigraphy (worn on both the stroke affected side and the non-affected side) and indirect calorimetry during 10 different activities of daily living for 43 adults with stroke (aged 55–87 years). Using intra-class correlations (ICC), we first investigated the agreement of the MW8 when placed on the affected side as compared to the non-affected side for: (1) all participants irrespective of stroke severity; (2) participants with mild stroke, classified as a Fugl Meyer motor score of ≥79/100; and (3) participants with moderate-to-severe stroke (i.e., Fugl Meyer < 79/100). We then determined cut-points for all participants—as well as separate cut-points based on stroke severity—on both the stroke affected side and non-affected side for SB and MVPA using receiver operating characteristic curves. The results of our analyses indicate that the agreement in MW8 output between the stroke affected and non-affected sides was moderate across all participants (ICC = 0.67), as well as for each sub-group (mild stroke: ICC = 0.64; moderate-to-severe stroke: ICC = 0.77). Additionally, the results of our cut-point analyses support using different cut-points for different levels of stroke severity and also for the stroke affected side. We determined the following cut-points: (1) for the affected side, adults with mild stroke have cut-points of SB ≤134 counts per minute (CPM) and MVPA ≥704 CPM, while adults with moderate-to-severe stroke have cut-points of SB ≤281 CPM and MVPA ≥468 CPM; and (2) the non-affected side, adults with mild stroke have cut-points of SB ≤162 CPM and MVPA ≥661 CPM, while adults with moderate-to-severe stroke have cut-points of SB ≤281 CPM and MVPA ≥738 CPM. Hence, these data provide a new measure for concurrently examining the dynamic relationships between MVPA and SB among adults with stroke.
Highlights
One new case of stroke occurs every 40 s in the United States alone (Go et al, 2014)
Decreases in physical activity (PA) levels after stroke can lead to disuse atrophy and cardiovascular deconditioning, which combined with social isolation and associated psychological factors can lead to an increased risk for secondary cardiac complications and recurrent stroke (Billinger et al, 2014)
When we stratified participants according to stroke severity, there were no significant group differences in age, body mass index (BMI), or sex
Summary
One new case of stroke occurs every 40 s in the United States alone (Go et al, 2014). Increasing physical activity (PA) may be critical to maintain and restore health post-stroke (McDonnell, 2010). There is mounting evidence that high SB is linked to a greater risk of early death (Biswas et al, 2015), diabetes mellitus (Owen et al, 2010), cardiovascular disease (Ford and Caspersen, 2012), and cognitive decline (Falck et al, 2016a). Considerable evidence indicates greater amounts of PA improves cognitive function and reduces dementia risk (Colcombe and Kramer, 2003; Hamer and Chida, 2009), and increasing PA among adults with stroke can significantly improve cognitive function (Cumming et al, 2012). It is important to concurrently examine the implications of each of these behaviors on cognitive health—and each other (Landry et al, 2015; Falck et al, 2016b)
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