Walking Characteristics In Individuals With Stroke Differ Based On Walking Speed, Endurance And Daily Steps

Abstract

PURPOSE: Walking is an ideal means of obtaining physical activity, yet people with stroke take few daily steps. The purpose of this study was to examine how the walking characteristics of bouts per day, maximum steps per bout and time spent walking differ between individuals with various walking speeds, walking endurance and daily steps. Additionally, we aimed to identify cutoff values for differentiating active and inactive ambulators (i.e. those who do and do not achieve physical activity guidelines through walking). METHODS: Stepping data from 252 individuals with chronic stroke (>6 months) with mean age of 63 (13) years and step count of 4,277 (3,064) steps per day were analyzed. Individuals were placed into previously established levels of ambulation (i.e. household ambulators, limited community and unlimited community ambulators), based on walking speed, walking endurance and daily steps (via two days of StepWatch activity monitoring). Differences in walking characteristics were assessed between ambulation levels (e.g. household vs. community ambulators). Linear regression determined which characteristics best predicted daily step counts. Receiver Operating Characteristic (ROC) curves and area under the curve (AUC) determined which variable was most accurate in classifying active (>5,500 steps) and inactive (<5,500 steps) individuals. RESULTS: Regardless of categorization by walking speed, walking endurance or daily steps, household ambulators had significantly fewer bouts per day, maximum steps per bout and time spent walking compared to both limited and unlimited community ambulators (p = <0.001). Only 81 (32%) participants obtained >5,500 steps per day. The two highest AUC values were 0.91 (95% CI 0.88, 0.95) for maximum steps per bout and 0.83 (95% CI 0.78, 0.88) for bouts per day. Cutoff values of 648 maximum steps per bout or 53 bouts were used to differentiate active and inactive ambulators. CONCLUSIONS: Walking characteristics differed based on an individual’s walking speed, walking endurance and daily steps. Differences in daily steps between household and community ambulators are largely due to shorter and fewer walking bouts. Interventions aimed at improving walking after stroke should promote increased walking bouts of any length to increase physical activity after stroke.