Moving Towards Reducing Prolonged Sedentary Behaviour After Stroke

• Author / Creator

  Ezeugwu, Victor E

• Background: Stroke is a leading cause of adult disability globally. In Canada, about 405,000 individuals are living with the effects of stroke and this number is projected to rise by over 60% in the next two decades. People with stroke are often physically inactive and sedentary which may increase their risk of having secondary health conditions. Due to the mobility deficits associated with stroke, moving fast enough to attain moderate-to-vigorous intensity physical activity targets may be challenging for many people with stroke. Targeting prolonged sedentary behaviour by frequently standing and taking steps throughout waking hours, using the whole-day activity approach, might be feasible and sustainable in improving activity behaviour and mitigating the risks associated with prolonged sedentary behaviours after stroke. Objective: To explore the perspectives of people with stroke about sedentary behaviour, and to develop and test a theory- and home-based sedentary behaviour change intervention for people with stroke. Methods: The Intervention Mapping framework guided the development of a novel sedentary behaviour change intervention for people with stroke. The first step using this framework requires a needs assessment. A qualitative exploratory study (Study I) was conducted with 13 people with stroke on their perspectives about sedentary behaviour and how they can make changes in their day-to-day lives to sit less and move more. The systematic approach to the process of intervention development, including the theoretical basis, content, implementation and evaluation planning, were described in Study II. At the outset of implementing the developed intervention, a cross-sectional study (Study III) using 7-day accelerometry data at baseline was conducted to quantify the volume and pattern of usual activity behaviours. Participants were within 2-4 weeks of discharge from inpatient stroke rehabilitation. Testing of the intervention program was done over an 8-week period in Study IV. Results: The qualitative study showed that there was limited awareness of the health risks of prolonged sedentary behaviour among people with stroke. Misperceptions do exist, as some individuals will rather sit at home if they were not “exercising” while one participant thought that lying was healthier than sitting. Some strategies for behaviour change were identified. It was possible to use Intervention Mapping framework to systematically develop a STand Up Frequently From Stroke (STUFFS) program focused on frequently breaking up prolonged sedentary behaviour as well as reducing overall sedentary time after stroke. The STUFFS program includes a self-monitoring component that empowered people with stroke to self-manage to reduce their sedentary behaviours. The results from the cross-sectional study showed that in addition to the 75% of waking hours (11.2 hours) spent in sedentary behaviour, people with stroke sleep for an average of 9 hours per day, with 50% longer than 9 hours per day. After 8 weeks of the STUFFS intervention, the sedentary time reduced by 54 minutes (P<0.05) and 27 minutes (P=0.05) at post-intervention and follow-up time points, respectively. The health, functional, and patient- reported quality of life outcomes were improved across both time points (P<0.05). However, compared to baseline, participants spent significantly more time in bed immediately after the intervention, but not at follow-up. The improvements in upright behaviours (standing and stepping) were not significant over all time points. Conclusions: Prolonged sedentary behaviour is a problem after stroke. People with stroke living in the community require support to reduce sedentary behaviour after inpatient stroke rehabilitation. This work provides a foundation on which further sedentary behaviour research can build upon to support people with stroke.

• Subjects / Keywords

  • Interventions
  • Stroke
  • Physical Activity
  • Qualitative
  • Sedentary behaviours

• Graduation date

  Spring 2018

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3PV6BN9Z

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.