Adherence to physical activity and cardiovascular recommendations during the 2 years after stroke rehabilitation discharge.

Abstract

Objective measurement is essential to represent habitual physical activity. Only one study objectively measured physical activity for > 12 months after stroke. This study aimed to measure physical activity, cardiovascular risk factors, mobility, mood, fatigue and cognition during the 2 years after rehabilitation discharge and to investigate whether stroke survivors meet physical activity and cardiovascular risk recommendations. This was a longitudinal observational study. Survivors of a first-ever stroke admitted to a large metropolitan rehabilitation hospital were recruited. Outcomes were measured at rehabilitation discharge and 6, 12 and 24 months later. Outcomes were physical activity measured by the SenseWear Armband (e.g., moderate-vigorous physical activity, steps/day) and cardiovascular risk factors (e.g., blood pressure, fasting lipid profile and plasma glucose, waist circumference, body mass index), mobility, mood, fatigue and cognition. Changes over time were evaluated with random effects regression modelling. Participants (n=79, 33% female) had mean (SD) age of 65 (14) years and median gait speed 1.2 m/s (interquartile range 0.8-1.4) at baseline. We found no change in physical activity levels over time. Step count and time spent in bouts of moderate-vigorous physical activity remained low. Many participants achieved the recommended 30 min of daily moderate-vigorous physical activity at baseline, but this was decreased at 2 years (72% [57/79] versus 65% [37/57]). Adherence to cardiovascular recommendations decreased over time, notably for body mass index, plasma glucose and triglyceride levels. Waist circumference and body mass index increased at each time point relative to baseline (by a mean of 3.2 cm and 1.2 kg.m2, respectively, at 2 years, p<0.01). This is the largest longitudinal study of objectively measured physical activity after stroke. Adherence to cardiovascular risk recommendations decreased over time post-stroke, and physical activity levels remained low. Stroke survivors may benefit from annual multi-disciplinary reviews to identify increasing risk and initiate appropriate interventions.