Post-stroke Physical Activity Research Articles

Abstract TMP26: Density of Physical Activity Resources is Associated With Post-Stroke Physical Activity

Background: Exercise post-stroke can improve health-related quality of life and promote physical fitness, walking, and balance. Physical activity (PA) is important in post-stroke rehabilitation and recovery through the reduction of cardiovascular risk factors and lowering the risk of recurrent stroke and mortality. Objective: To assess if area PA resources influence the change in PA 12-months post-stroke. Methods: Addresses of 546 mild stroke survivors from the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study were geocoded to the census tract level and merged with the density of physical activity resources from the National Neighborhood Data Archive (NaNDA). We modeled the odds of perceived change in PA at 12-months post-stroke (more active vs. about the same vs. less active) and number of fitness and recreational sports centers per square mile using multinomial logistic regression. Selection bias due to loss-to-follow-up was accounted for using stablized inverse probability weights with robust standard errors. Models were adjusted for age, gender, race/ethnicity, education, insurance, BMI, and intervention. Results: A total of 333 participants had 12-month PA data with 17.2% reporting being more physically active and 48.0% being about the same at 12 months. The adjusted odds of being more active compared to less active were 1.57 times larger when comparing the 90 th percentile of PA resources to the 10 th percentile (range: 58 resources; 95% CI: 0.99, 2.48). Similarly, adjusted odds of reporting the same level of PA compared to less active were 1.47 times larger when the 90 th and 10 th percentiles of PA resources are compared (95% CI: 0.99, 2.17). Conclusion: Stroke survivors report higher odds of both maintaining the same level of PA and being more physically active when there are more PA resources in the area. This study demonstrates the potentially important role of the physical and built environment on physical fitness post-stroke.

Pre-stroke physical activity is associated with post-stroke physical activity and sedentary behavior in the acute phase

This study investigated the link between pre-stroke and acute-stage physical activity (PA) and sedentary behavior. Forty individuals with stroke (aged 73.6 ± 8.9 years) were enrolled. Post-stroke activity, including metabolic equivalents (METs), sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA), was measured using a tri-axial accelerometer (ActiGraph wGT3X-BT) over 11 consecutive days starting from the 4th day post-stroke. Pre-stroke PA levels were assessed using the International Physical Activity Questionnaire (IPAQ). We measured skeletal muscle mass index (SMI) and phase angle using a bioelectrical impedance analyzer (Inbody S10) upon admission. Physical therapists assessed the Brunnstrom recovery stage (BRS) within 3 days post-stroke. Total daily activity averaged 1.05 ± 0.05 METs. Throughout the day, 91.2 ± 5.1, 7.6 ± 4.1, and 1.2 ± 1.3% was spent in sedentary behavior, light PA, and MVPA, respectively. Only pre-stroke PA was independently associated with METs (β = 0.66), sedentary behavior (β = −0.58), light PA (β = 0.50), and MVPA (β = 0.71) after adjusting for age, sex, stroke severity, and activities of daily living. This suggests that pre-stroke PA might play a crucial role in reducing sedentary behavior and promoting PA during the acute phase.

How should we measure physical activity after stroke? An international consensus.

Physical activity is important for secondary stroke prevention. Currently, there is inconsistency of outcomes and tools used to measure physical activity following stroke. To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity. Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney's Value-Focused Thinking Methodology. Survey 1 identified physical activity tools, outcomes, and measurement considerations which were ranked in Survey 2. Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3, participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations. Twenty-five stroke survivors, 5 carers, 18 researchers, and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included the ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort, and ability to detect changes. Consensus recommendations included using the Actigraph, Actical, and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations. These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge, and resources. Comprehensive measurement requires the use of devices and questionnaires.

Physical Activity Trajectories and Functional Recovery After Acute Stroke Among Adults in Sweden

The optimum level and timing of poststroke physical activity interventions to enhance functional recovery remain unclear. To assess the level of physical activity in the first 6 months after stroke among individuals with similar physical activity patterns over time and to investigate the association between physical activity trajectories and functional recovery at 6 months after stroke. This cohort study obtained data from the Efficacy of Fluoxetine-a Randomized Controlled Trial in Stroke, which was conducted in 35 stroke and rehabilitation centers across Sweden from October 2014 to June 2019. Adult participants (aged >18 years) were recruited between 2 and 15 days after stroke onset and followed up for 6 months. Participants who withdrew or were lost to follow-up were excluded from the longitudinal analysis. Data analyses were performed between August 15 and October 28, 2022. Physical activity was assessed at 1 week, 1 month, 3 months, and 6 months. Multiple factors associated with physical activity trajectories were investigated. Association of the distinct trajectories with functional recovery was assessed in multivariable logistic regression. The primary outcomes were the distinct physical activity trajectories over time, which were identified using group-based trajectory modeling. The secondary outcome was the functional recovery at 6 months after stroke, which was assessed using the modified Rankin Scale. Of the 1367 included participants (median [IQR] age, 72 years [65-79] years; 844 males [62%]), 2 distinct trajectory groups were identified: increaser (n = 720 [53%]) and decreaser (647 [47%]). The increaser group demonstrated a significant increase in physical activity level (mean difference, 0.27; linear slope β1 = 0.46; P < .001) and sustained it at light intensity from 1 week to 6 months, whereas the decreaser group showed a decline in physical activity and eventually became inactive (mean difference, -0.26; linear slope β1 = 1.81; P < .001). Male participants and those with normal cognition had higher odds of being in the increaser group, regardless of stroke severity. Increasing physical activity and sustaining it at light intensity were associated with a good functional outcome at 6 months (adjusted odds ratio, 2.54; 99% CI, 1.72-3.75; P < .001). Results of this study suggest that increased physical activity was associated with functional recovery 6 months after stroke. Interventions targeting individuals with decreasing physical activity in the subacute phase of stroke may play a role in improved functional outcomes.

Motivation, Physical Activity, and Affect in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Approach.

Motivation is a frequently reported but far less studied driver for post-stroke physical activity participation. Motivation and physical activity may be important contributors to the prevention management and alleviation of affective symptoms among stroke survivors. To investigate the real-time associations between motivation, physical activity, and affect in the daily lives of community-dwelling stroke survivors using ecological momentary assessment (EMA) and accelerometry. Forty community-dwelling stroke survivors wore an accelerometer on the thigh and completed EMA surveys assessing motivation (autonomous motivation, controlled motivation) and affect (negative affect, positive affect) eight times daily for 7 days. Multivariate regression analysis and multilevel modeling investigated the associations between motivation, physical activity, and affect. Greater autonomous motivation for physical activity was associated with less sedentary behavior (β = -0.40, p = .049) and more moderate-to-vigorous physical activity (β = 0.45, p = .020) participation in daily life. Greater autonomous motivation was momentarily associated with less depressed affect (β = -0.05, p < .001) and greater positive affect (β = 0.13, p < .001). Moreover, greater controlled motivation was momentarily associated with greater depressed affect (β = 0.06, p < .001). More intense physical activity was momentarily associated with greater positive affect (β = 0.13, p = .016). No moderating effect of motivation on the association between physical activity and affect was found. Motivation and physical activity are momentarily associated with affect among stroke survivors. Assessing and fostering autonomous motivation may be beneficial for promoting physical activity and managing positive and depressed affect as stroke survivors return to the community.

Identity, social engagement and community participation impact physical activity levels of stroke survivors: A mixed-methods study

Objective To explore how personal characteristics and social engagement impact the physical activity levels of chronic stroke survivors. Design A mixed-methods study comprising in-depth semi-structured interviews and objective 24-h physical activity monitoring. Interviews were thematically analysed, and activity diaries were compared to activity monitor data to attain a complete picture of physical activity. Triangulation explored the relationship between perceptions, beliefs, activity levels and social engagement. Setting Community. Participants Community-dwelling, independently mobile, adult stroke survivors (n = 19). The mean age was 74 (11 SD) years, 52% female, mean time post-stroke 41 (SD 61) months. Main measures Qualitative and quantitative measures including individual semi-structured interviews, accelerometry, activity diaries, self-efficacy, Frenchay Activities Index and Barthel Index. Results Individual identity had the greatest perceived influence on post-stroke physical activity. Pre-stroke identity, meaningful activities and family culture contributed to identity; while social and community activities, self-efficacy, co-morbidities, stroke symptoms and exercise, also impacted physical activity. Participants averaged 5365 (IQR 3378–7854) steps per day and reported a mean self-efficacy for exercise score of 51 (SD 20). Triangulation showed convergent relationships between post-stroke physical activity levels and participant motivation, comorbidities, level of social and community participation, self-efficacy and pre-stroke activity levels. Conclusion Personal identity, social engagement and community participation are important factors to consider when implementing a person-centred approach to increasing physical activity participation post-stroke.

Poststroke White Matter Hyperintensities and Physical Activity: A CANVAS Study Exploratory Analysis.

White matter hyperintensities (WMHs) are associated with poststroke cognitive decline and mortality. Physical activity (PA) may decrease WMH risk by reducing vascular risk factors and promoting cerebral perfusion. However, the association between poststroke PA and WMH progression remains unclear. We examined the association between PA and WMH volume 12 months after stroke, and between PA and change in WMH volume between 3 and 12 months after stroke. We included ischemic stroke survivors from the Cognition And Neocortical Volume After Stroke cohort with available brain magnetic resonance imaging and objective PA data. Total, periventricular, and deep WMH volumes (in milliliters) were estimated with manually edited, automated segmentations (Wisconsin White Matter Hyperintensities Segmentation toolbox). Moderate-to-vigorous intensity PA (MVPA) was estimated using the SenseWear® Armband. Participants with MVPA ≥30 min·d -1 were classified as "meeting PA guidelines." We used quantile regression to estimate the associations between PA (MVPA and meeting PA guidelines) with WMH volume at 12 months and change in WMH volume between 3 and 12 months after stroke. A total of 100 participants were included (median National Institutes of Health Stroke Scale 2; interquartile range, 1-4). MVPA was not associated with WMH volume. In univariable analysis, meeting PA guidelines was associated with lower total, periventricular, and deep WMH volumes by 3.0 mL (95% confidence interval (CI), 0.5-9.7 mL), 2.8 mL (95% CI, 0.5-7.1 mL), and 0.9 mL (95% CI, 0.1-3.0 mL), respectively. However, in multivariable analysis, meeting PA guidelines was not associated with WMH volume, and older age was associated with greater WMH volume at 12 months. PA was not associated with change in WMH volume. Meeting PA guidelines was associated with lower WMH volume at 12 months in univariable analysis, but not in multivariable analysis. Age consistently predicted greater WMH volume.

Types of physical activity performed pre and post stroke

BackgroundThe relationship between pre- and post-stroke physical activity levels is underexplored. ObjectiveTo determine whether self-reported physical activity changes from pre-stroke to two years post-stroke; and to explore the relationship between self-reported and objectively measured physical activity post-stroke. MethodsStroke survivors admitted to rehabilitation were included in this observational study. Participants were assessed at rehabilitation discharge (five months post-stroke) and two years later. Participants were asked about their pre-stroke and current activity levels. The Sensewear Armband was worn for one week to measure physical activity at each timepoint. The relationship between self-reported and objectively measured physical activity was explored with Spearman correlation coefficients and multiple regression models. ResultsSixty-eight stroke survivors (65% male, mean age 64) participated at baseline. Fifty participants reported undertaking physical activity pre-stroke, and 48 of these active participants reported undertaking physical activity two years post-stroke. At two years one third of the active participants reported doing the same type of activity (primarily walking). Approximately one third reported doing the same type of activity and more and approximately one third had to modify the type of activity undertaken. Self-reporting of physical activity time was positively correlated with objective measures of physical activity at two years (r = 0.61, p<0.001). Objectively measured physical activity, age, and sex predicted 26.5% of the variance in self-reported physical activity (p<0.001). ConclusionIn this single-site study of relatively able participants, stroke survivors frequently returned to their pre-stroke types of physical activity. A positive correlation between self-reported and objective measures of physical activity was demonstrated, but self-reported activity overestimates objective physical activity post-stroke.

The Relationship Between Environmental Exposures and Post-Stroke Physical Activity

Post-stroke physical activity has widespread health benefits. Environmental exposures may shape post-stroke physical activity behavior. This study investigates the relationships between environmental exposures and post-stroke physical activity. Stroke survivors (n=374) from a cohort of Black and White adults with post-stroke accelerometer data (2009-2013) were eligible for this study. Participants' home addresses were linked with secondary data to capture environmental characteristics, including annual density of neighborhood resources (e.g., parks, physical activity facilities, and intellectual stimulation destinations), 2010 neighborhood SES, 2010 neighborhood crime, and daily information on extremely cold days. Post-stroke light physical activity and moderate-to-vigorous physical activity were captured using accelerometers over a 7-day period. Linear regression and 2-part/hurdle models were used to estimate the relationship between the density of neighborhood resources with light physical activity and with moderate-to-vigorous physical activity, respectively. Analyses were conducted in 2021. A 10% increase in the number of extremely cold days was associated with 6.37 fewer minutes of daily light physical activity (95% CI= -11.37, -1.37). A 1-SD increase in neighborhood SES was associated with greater odds (OR=1.10, 95% CI=1.02, 1.19) of doing any moderate-to-vigorous physical activity. Among participants obtaining any moderate-to-vigorous physical activity, a 1-unit (count/km2) increase in destinations for intellectual stimulation was associated with 0.99 (95% CI=0.02, 1.97) more minutes of daily moderate-to-vigorous physical activity. All other environmental exposures were not associated with post-stroke light physical activity or moderate-to-vigorous physical activity. Environmental exposures may facilitate physical activity participation among stroke survivors. This study found that weather, neighborhood SES, and proximity to destinations for intellectual stimulation were associated with physical activity over and above individual factors.

Objectively measured physical activity was not associated with neighborhood walkability attributes in community-dwelling patients with stroke

Although the built environment may affect physical activity, there is little evidence on how neighborhood walkability attributes influence post-stroke physical activity. This study aimed to explore associations between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke. This cross-sectional study recruited patients who could ambulate outside free of assistance. We assessed objectively measured physical activity comprising the number of steps taken and time spent in moderate-to-vigorous physical activity (MVPA) with an accelerometer. Neighborhood walkability attributes were evaluated using the Walk Score. Multiple linear regression analyses were used to determine whether the Walk Score was independently associated with the number of steps taken or MVPA. Eighty participants with a mean age of 65.9 ± 11.1 years were included. The participants took an average of 5900.6 ± 2947.3 steps/day and spent an average of 19.7 ± 21.7 min/day in MVPA. The mean Walk Score was 71.4 ± 17.2. Multiple linear regression analyses showed that no significant associations were found between the Walk Score and the number of steps taken or MVPA. No associations were found between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke in an Asian area.

How Many Hours of Device Wear Time Are Required to Accurately Measure Physical Activity Post Stroke?

Background. Inadequate physical activity participation is a risk factor for secondary stroke. Before implementing appropriate management strategies, we need to accurately measure the physical activity of stroke survivors. We aimed to determine the duration of physical activity monitoring post-stroke that constitutes a valid day. Methods. We sampled stroke survivors’ physical activity for one week following discharge from inpatient rehabilitation using the Sensewear Armband (Bodymedia, Pittsburgh, PA, USA). To determine the impact of total daily wear time on activity estimate (sedentary, light, and moderate to vigorous physical activity) accuracy, we performed simulations, removing one, two, three, or four hours from a 14-h reference day, and analysed them with linear mixed models. Results. Sixty-nine participants (46 male, 65 ± 15 years) with 271 days of physical activity data were included. All physical activity variables were significantly underestimated for all data sets (10, 11, 12, or 13 h) compared to the 14-h reference data set. The number of days classified as not meeting physical activity recommendations increased as daily monitoring duration decreased: 13% misclassification with 10-h compared to 14-h dataset (p = 0.011). Conclusions. The accuracy of physical activity estimates increases with longer daily monitoring periods following stroke, and researchers should aim to monitor post-stroke physical activity for 14 daytime hours.

Sex Differences in Physical Activity in People After Stroke: A Cross-sectional Study.

Adequate physical activity after stroke is critical for cardiovascular health. Although sex is a potential factor associated with post-stroke physical activity, its mechanism remains unclear. This study aimed to examine sex differences in human physical activity following stroke. A cross-sectional study with 62 participants (men: 42, women: 20) was conducted. Physical activity was measured for three consecutive days using a step activity monitor. The walking durations per day in light physical activity, moderate-to-vigorous physical activity, and total physical activity were calculated. Sex differences in walking duration were compared using Welch's t-tests or Mann-Whitney U tests. Women had a significantly greater walking duration in light physical activity and in total than did the men. In contrast, no significant differences were found in moderate-to-vigorous physical activity. This study reported sex differences in the walking duration after stroke. Moreover, it found that women spent more time in low intensity physical activity than men. Our results will be useful for planning interventions to increase physical activity and decrease sedentary behavior after stroke.

How Adults with Stroke Conceptualize Physical Activity: An Exploratory Qualitative Study

<h3>Research Objectives</h3> To explore how adults with stroke conceptualize physical activity as a means of promoting physical activity following stroke. <h3>Design</h3> Qualitative, phenomenological study. Participants completed one 90-minute semi-structured interview. <h3>Setting</h3> Interviews were conducted in participant's homes or in a university conference room. <h3>Participants</h3> Participants were a convenience sample of 15 community dwelling stroke survivor, median age was 64 years, median time post-stroke was 4.2 years, 9 males and 6 females, mostly White (n=10), and were able to ambulate independently with or without an assistive device. <h3>Interventions</h3> Not Applicable. Semi-structured interview prompts included "What comes to mind when you hear the term ‘physical activity'?" and "Not including exercise, what comes to mind when you hear the term ‘physical activity'?" <h3>Main Outcome Measures</h3> Inductive content analysis was used to identify key themes. <h3>Results</h3> Three key themes emerged. First, exercise-related activities (gym, walking, sports) were identified my most participants (n=13). Second, physical activity necessary for performing basic and instrumental activities of daily living was also identified by most participants (n=12) as an alternative to exercise-related physical activity. Third, being physically active to avoid being sedentary was also identified by 9 participants as being important. <h3>Conclusions</h3> Participants broadly categorized physical activity. For stroke survivors whose stroke-related impairment prevents the ability to exercise, performing daily activities may be a feasible and appropriate alternative. This is important because decreasing sedentary behavior and increasing physical activity of any intensity can improve cardiometabolic health. Health professionals can work with stroke survivors to identify meaningful activities that require physically active to promote post-stroke physical activity, though future research is necessary to identify active ingredients and intervention efficacy. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

How Adults with Stroke Conceptualize Physical Activity: An Exploratory Qualitative Study

<h3>Research Objectives</h3> To explore how adults with stroke conceptualize physical activity as a means of promoting physical activity following stroke. <h3>Design</h3> Qualitative, phenomenological study. Participants completed one 90-minute semi-structured interview. <h3>Setting</h3> Interviews were conducted in participant's homes or in a university conference room. <h3>Participants</h3> Participants were a convenience sample of 15 community dwelling stroke survivor, median age was 64 years, median time post-stroke was 4.2 years, 9 males and 6 females, mostly White (n=10), and were able to ambulate independently with or without an assistive device. <h3>Interventions</h3> Not Applicable. Semi-structured interview prompts included "What comes to mind when you hear the term ‘physical activity'?" and "Not including exercise, what comes to mind when you hear the term ‘physical activity'?" <h3>Main Outcome Measures</h3> Inductive content analysis was used to identify key themes. <h3>Results</h3> Three key themes emerged. First, exercise-related activities (gym, walking, sports) were identified my most participants (n=13). Second, physical activity necessary for performing basic and instrumental activities of daily living was also identified by most participants (n=12) as an alternative to exercise-related physical activity. Third, being physically active to avoid being sedentary was also identified by 9 participants as being important. <h3>Conclusions</h3> Participants broadly categorized physical activity. For stroke survivors whose stroke-related impairment prevents the ability to exercise, performing daily activities may be a feasible and appropriate alternative. This is important because decreasing sedentary behavior and increasing physical activity of any intensity can improve cardiometabolic health. Health professionals can work with stroke survivors to identify meaningful activities that require physically active to promote post-stroke physical activity, though future research is necessary to identify active ingredients and intervention efficacy. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Risk factors for stroke and neurocognitive disorders: the role of pre- and post-stroke physical activity

Risk factors for stroke and neurocognitive disorders: the role of pre- and post-stroke physical activity

Levels of physical activity before and after stroke in relation to early cognitive function

Regular physical activity is widely recommended in the primary and secondary prevention of stroke. Physical activity may enhance cognitive performance after stroke, but cognitive impairments could also hinder a person to take part in physical activity. However, a majority of previous studies have not found any association between post-stroke cognitive impairments and a person’s subsequent level of activity. In this explorative, longitudinal study, we describe the intraindividual change in physical activity from before to 6 months after stroke, in relation to early screening of post-stroke cognitive impairments. Participants were recruited at 2 to 15 days after stroke, and screened for cognitive impairments using the Montreal Cognitive Assessment tool. Information on pre-stroke physical activity was retrospectively collected at hospital admittance by physiotherapists. Post-stroke physical activity was evaluated after 6 months. Of 49 participants included, 44 were followed up. The level of physical activity changed in more than half of all participants after stroke. Participants who were physically active 6 months after stroke presented with significantly less cognitive impairments. These results highlight that many stroke survivors experience a change in their physical activity level following stroke, and that unimpaired cognition may be important for a stroke survivors’ ability to be physically active.

Personal and social factors that influence physical activity levels in community-dwelling stroke survivors: A systematic review of qualitative literature

Objectives: To determine the personal and social factors perceived to influence physical activity levels in stroke survivors. Data sources: Four electronic databases (MEDLINE, CINAHL, PubMed and Embase) were searched from inception to November 2020, including reference and citation list searches. Study selection: The initial search yielded 1499 papers, with 14 included in the review. Included articles were peer-reviewed, qualitative studies, reporting on the perceived factors influencing physical activity levels of independently mobile community-dwelling adults, greater than 3 months post stroke. Data extraction: Data extracted included location, study aim, design, participant and recruitment information and how data were collected and analysed. Data synthesis: Thematic analysis was undertaken to identify meanings and patterns, generate codes and develop themes. Five main themes were identified: (i) Social networks are important influencers of physical activity; (ii) Participation in meaningful activities rather than ‘exercise’ is important; (iii) Self-efficacy promotes physical activity and physical activity enhances self-efficacy; (iv) Pre-stroke identity related to physical activity influences post-stroke physical activity; and (v) Formal programmes are important for those with low self-efficacy or a sedentary pre-stroke identity. Conclusions: Physical activity levels in stroke survivors are influenced by social activities and support, pre-stroke identity, self-efficacy levels and completion of activities that are meaningful to stroke survivors.

How Adults With Stroke Conceptualize Physical Activity: An Exploratory Qualitative Study.

Importance: Physical activity (PA) is recommended for improving physical and cardiovascular function but can be challenging because of stroke-related impairments. A better understanding of how adults with stroke conceptualize PA could assist in developing effective interventions for increasing poststroke PA.Objective: To explore how adults with stroke conceptualize PA.Design: Phenomenological qualitative design.Setting: Participants’ homes.Participants: Community-dwelling adults with chronic (>6 mo) stroke (N = 15).Outcomes and Measures: Semistructured interviews were conducted with participants. Data were analyzed by means of inductive content analysis to identify key themes.Results: Three key themes emerged: (1) moderate to vigorous PA, which includes exercise-related activities (going to the gym, walking, playing sports); (2) PA necessary for performing daily activities and occupations, which includes basic and instrumental activities of daily living; and (3) avoiding sedentary behavior, which includes not wanting to sit for long periods of time, avoiding boredom, and valuing PA over being sedentary.Conclusions and Relevance: Participants broadly categorized PA, encompassing multiple activity types, which is encouraging because reducing sedentary behavior and increasing PA of any intensity can improve cardiometabolic health. Interventions that complement and enhance these conceptualizations, alone or in combination with other mechanisms of action, should be explored for their efficacy in increasing PA in adults with stroke.What This Article Adds: After stroke, perceptions of PA encompass exercise, daily activities and occupations, and avoiding sedentary behavior; these perceptions could be harnessed to promote PA among adults after stroke.

What can virtual reality offer to stroke patients? A narrative review of the literature.

Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients. To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions. An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included. In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included. The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.

Modifiable Factors Associated With Poststroke Physical Activity at Discharge From Rehabilitation: Prospective Cohort Study.

People with stroke are not meeting recommended levels of physical activity. The modifiable factors associated with poststroke physical activity levels need to be identified to develop targeted interventions. The objective of this study was to investigate the factors at discharge from inpatient rehabilitation that are associated with physical activity levels at 3months following discharge. This was a prospective cohort study. Sixty-four people with stroke completed baseline assessments at discharge from inpatient rehabilitation and 55 completed the follow-up 3months later. The candidate factors (ie, gait speed, balance, strength, cognition, mood, and motivation) were measured at discharge. The primary outcome measure at follow-up was walking-related activity (measured by wrist-worn accelerometer). Secondary outcome measures were physical activity participation (Activity Card Sort) and intensity of physical activity (International Physical Activity Questionnaire-Short 7days). Adjusted separate multivariable linear regression models or proportional odds regression models were used to evaluate the associations between candidate factors and physical activity. Gait speed and balance were associated with all aspects of physical activity. Higher level of intrinsic motivation was also associated with higher physical activity participation. Anxiety demonstrated a significant nonlinear relationship with physical activity participation. Inclusion of fatigue and individual muscle strength could have provided further insights into associations with steps per day. The results demonstrated that better physical function at discharge from inpatient rehabilitation was associated with future increased levels of physical activity. Additionally, higher levels of motivation impacted on increased physical activity participation. The influence of anxiety on physical activity participation requires further exploration. Mixed-method study designs can be utilized to further understand the factors associated with poststroke physical activity.