The Feasibility and Longitudinal Effects of a Home-Based Sedentary Behavior Change Intervention After Stroke



      To evaluate the feasibility and preliminary effects of a sedentary behavior change intervention on sedentary behavior, physical activity, function, and quality of life following inpatient stroke rehabilitation.


      Single-group, longitudinal, intervention study with 1-week baseline, 8-week intervention, and 8-week follow-up.




      Individuals (N=34) with subacute stroke recruited within 1 month following discharge home from inpatient stroke rehabilitation.


      STand Up Frequently From Stroke (STUFFS) intervention that involved interrupting and replacing sedentary time with upright activities (standing and walking) at home and in the community. A motivational wrist-worn activity monitor was used throughout the intervention.

      Main Outcome Measures

      Primary outcomes were reach (enrolled/eligible), retention (completed/enrolled), satisfaction, and compliance with the intervention. Secondary outcomes were sedentary behavior, physical activity, lower extremity impairment, self-efficacy, cognitive status, mobility, and quality of life outcomes.


      Forty-four participants were eligible to participate. Of the eligible, 34 (77.3%; time since stroke onset: 3.5±1.1 months) were enrolled at baseline and 32 (94.1%) of the enrolled had complete data at follow-up. Satisfaction with the program was 89%. Sedentary time decreased by 54.2±13.7 minutes per day (P<.01) at postintervention and 26.8±14.0 minutes per day (P=.07) at follow-up, relative to baseline. There were significant improvements in walking speed, cognition, impairment, and self-reported quality of life over time (P<.05). Self-efficacy was high across all time points. The number of steps and time spent stepping were not statistically different across both time periods.


      The program was feasible to deliver in the home environment with good retention and satisfaction. Further research is required to test the effectiveness of the STUFFS program compared with usual care.


      List of abbreviations:

      CMSA (Chedoke-McMaster Stroke Assessment), MoCA (Montreal Cognitive Assessment), STUFFS (STand Up Frequently from Stroke)
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        • Feigin V.L.
        • Forouzanfar M.H.
        • Krishnamurthi R.
        • et al.
        Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010.
        Lancet. 2014; 383: 245-255
        • Billinger S.A.
        • Arena R.
        • Bernhardt J.
        • et al.
        Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 2532-2553
        • Boysen G.
        • Krarup L.
        Benefits of physical activity for stroke survivors.
        Expert Rev Neurother. 2009; 9: 147-149
        • Fini N.A.
        • Holland A.E.
        • Keating J.
        • Simek J.
        • Bernhardt J.
        How physically active are people following stroke? Systematic review and quantitative synthesis.
        Phys Ther. 2017; 97: 707-717
        • English C.
        • Healy G.N.
        • Coates A.
        • et al.
        Sitting and activity time in people with stroke.
        Phys Ther. 2016; 96: 193-201
        • Tieges Z.
        • Mead G.
        • Allerhand M.
        • et al.
        Sedentary behavior in the first year after stroke: a longitudinal cohort study with objective measures.
        Arch Phys Med Rehabil. 2015; 96: 15-23
        • Matthews C.E.
        • Chen K.Y.
        • Freedson P.S.
        • et al.
        Amount of time spent in sedentary behaviors in the United States, 2003-2004.
        Am J Epidemiol. 2008; 167: 875-881
        • Tremblay M.S.
        • Aubert S.
        • Barnes J.D.
        • et al.
        Sedentary Behavior Research Network (SBRN)—terminology consensus project process and outcome.
        Int J Behav Nutr Phys Act. 2017; 14: 75
        • Biswas A.
        • Oh P.I.
        • Faulkner G.E.
        • et al.
        Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults.
        Ann Intern Med. 2015; 162: 123-132
        • Pandey A.
        • Salahuddin U.
        • Garg S.
        • et al.
        Continuous dose-response association between sedentary time and risk for cardiovascular disease: a meta-analysis.
        JAMA Cardiol. 2016; 1: 575-583
        • Manns P.
        • Ezeugwu V.
        • Armijo-Olivo S.
        • Vallance J.
        • Healy G.N.
        Accelerometer-derived pattern of sedentary and physical activity time in persons with mobility disability: National Health and Nutrition Examination Survey 2003 to 2006.
        J Am Geriatr Soc. 2015; 63: 1314-1323
        • Prince S.A.
        • Saunders T.J.
        • Gresty K.
        • Reid R.D.
        A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials.
        Obes Rev. 2014; 15: 905-919
        • Martin A.
        • Fitzsimons C.
        • Jepson R.
        • et al.
        Interventions with potential to reduce sedentary time in adults: systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 1056-1063
        • Mahendran N.
        • Kuys S.S.
        • Brauer S.G.
        Recovery of ambulation activity across the first six months poststroke.
        Gait Posture. 2016; 49: 271-276
        • Cumming T.B.
        • Packer M.
        • Kramer S.F.
        • English C.
        The prevalence of fatigue after stroke: a systematic review and meta-analysis.
        Int J Stroke. 2016; 11: 968-977
        • Eskes G.A.
        • Lanctôt K.L.
        • Herrmann N.
        • et al.
        Canadian stroke best practice recommendations: mood, cognition and fatigue following stroke practice guidelines, update 2015.
        Int J Stroke. 2015; 10: 1130-1140
        • MacKay-Lyons M.
        • Makrides L.
        Exercise capacity early after stroke.
        Arch Phys Med Rehabil. 2002; 83: 1697-1702
        • Ezeugwu V.E.
        • Garga N.
        • Manns P.J.
        Reducing sedentary behaviour after stroke: perspectives of ambulatory individuals with stroke.
        Disabil Rehabil. 2017; 39: 2551-2558
        • Manns P.J.
        • Dunstan D.W.
        • Owen N.
        • Healy G.N.
        Addressing the nonexercise part of the activity continuum: a more realistic and achievable approach to activity programming for adults with mobility disability?.
        Phys Ther. 2012; 92: 614-625
        • Healy G.N.
        • Wijndaele K.
        • Dunstan D.W.
        • et al.
        Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle study (AusDiab).
        Diabetes Care. 2008; 31: 369-371
        • Pescatello L.S.
        • Murphy D.
        • Costanzo D.
        Low-intensity physical activity benefits blood lipids and lipoproteins in older adults living at home.
        Age Ageing. 2000; 29: 433-439
        • Fitzgerald J.D.
        • Johnson L.
        • Hire D.G.
        • et al.
        Association of objectively measured physical activity with cardiovascular risk in mobility-limited older adults.
        J Am Heart Assoc. 2015; 4: e001288
        • Mankowski R.T.
        • Anton S.D.
        • Axtell R.
        • et al.
        Device-measured physical activity as a predictor of disability in mobility-limited older adults.
        J Am Geriatr Soc. 2017; 65: 2251-2256
        • English C.
        • Healy G.N.
        • Olds T.
        • et al.
        Reducing sitting time after stroke: a phase II safety and feasibility randomized controlled trial.
        Arch Phys Med Rehabil. 2016; 97: 273-280
        • Dobkin B.H.
        • Dorsch A.
        The promise of mHealth: daily activity monitoring and outcome assessments by wearable sensors.
        Neurorehabil Neural Repair. 2011; 25: 788-798
        • Dobkin B.H.
        • Dorsch A.K.
        The evolution of personalized behavioral intervention technology: will it change how we measure or deliver rehabilitation?.
        Stroke. 2017; 48: 2329-2334
        • Mattlage A.E.
        • Redlin S.A.
        • Rippee M.A.
        • Abraham M.G.
        • Rymer M.M.
        • Billinger S.A.
        Use of accelerometers to examine sedentary time on an acute stroke unit.
        J Neurol Phys Ther. 2015; 39: 166-171
        • Bandura A.
        Health promotion by social cognitive means.
        Health Educ Behav. 2004; 31: 143-164
        • Kono Y.
        • Kawajiri H.
        • Kamisaka K.
        • et al.
        Predictive impact of daily physical activity on new vascular events in patients with mild ischemic stroke.
        Int J Stroke. 2015; 10: 219-223
        • Taraldsen K.
        • Askim T.
        • Sletvold O.
        • et al.
        Evaluation of a body-worn sensor system to measure physical activity in older people with impaired function.
        Phys Ther. 2011; 91: 277-285
        • Sanders J.P.
        • Loveday A.
        • Pearson N.
        • et al.
        Devices for self-monitoring sedentary time or physical activity: a scoping review.
        J Med Internet Res. 2016; 18: e90
        • CDC (Centers for Disease Control and Prevention)
        National Health and Nutrition Examination Survey (NHANES) anthropometry procedures manual.
        (Available at:) (Accsseed May 18, 2018)
        • Pickering T.G.
        • Hall J.E.
        • Appel L.J.
        • et al.
        Recommendations for blood pressure measurement in humans and experimental animals. 1. Blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research.
        Circulation. 2005; 111: 697-716
        • Gowland C.
        • Stratford P.
        • Ward M.
        • et al.
        Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.
        Stroke. 1993; 24: 58-63
        • Fulk G.D.
        • Echternach J.L.
        Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke.
        J Neurol Phys Ther. 2008; 32: 8-13
        • Podsiadlo D.
        • Richardson S.
        The timed Up and Go—a test of basic functional mobility for frail elderly persons.
        J Am Geriatr Soc. 1991; 39: 142-148
        • Dong Y.
        • Lee W.
        • Basri N.
        • et al.
        The Montreal Cognitive Assessment is superior to the Mini-Mental State Examination in detecting patients at higher risk of dementia.
        Int Psychogeriatr. 2012; 24: 1749-1755
        • Lai S.M.
        • Studenski S.
        • Duncan P.W.
        • Perera S.
        Persisting consequences of stroke measured by the stroke impact scale.
        Stroke. 2002; 33: 1840-1844
        • Rodgers W.M.
        • Wilson P.M.
        • Hall C.R.
        • Fraser S.N.
        • Murray T.C.
        Evidence for a multidimensional self-efficacy for exercise scale.
        Res Q Exerc Sport. 2008; 79: 222-234
        • Winkler E.A.
        • Bodicoat D.H.
        • Healy G.N.
        • et al.
        Identifying adults' valid waking wear time by automated estimation in activPAL data collected with a 24 h wear protocol.
        Physiol Meas. 2016; 37: 1653-1668
        • Tudor-Locke C.
        • Camhi S.M.
        • Leonardi C.
        • et al.
        Patterns of adult stepping cadence in the 2005-2006 NHANES.
        Prev Med. 2011; 53: 178-181
        • Twisk J.
        Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide.
        Cambridge University Press, New York2013
        • Hallal P.C.
        • Andersen L.B.
        • Bull F.C.
        • Guthold R.
        • Haskell W.
        • Ekelund U.
        Global physical activity levels: surveillance progress, pitfalls, and prospects.
        Lancet. 2012; 380: 247-257
        • Teasell R.W.
        • Foley N.C.
        • Salter K.L.
        • Jutai J.W.
        A blueprint for transforming stroke rehabilitation care in Canada: the case for change.
        Arch Phys Med Rehabil. 2008; 89: 575-578
        • Ezeugwu V.E.
        • Manns P.J.
        Sleep duration, sedentary behavior, physical activity, and quality of life after inpatient stroke rehabilitation.
        J Stroke Cerebrovasc Dis. 2017; 26: 2004-2012
        • Kerr A.
        • Rowe P.
        • Esson D.
        • Barber M.
        Changes in the physical activity of acute stroke survivors between inpatient and community living with early supported discharge: an observational cohort study.
        Physiotherapy. 2016; 102: 327-331
        • Healy G.N.
        • Winkler E.A.
        • Owen N.
        • Anuradha S.
        • Dunstan D.W.
        Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers.
        Eur Heart J. 2015; 36: 2643-2649
        • Fanning J.
        • Porter G.
        • Awick E.A.
        • et al.
        Replacing sedentary time with sleep, light, or moderate-to-vigorous physical activity: effects on self-regulation and executive functioning.
        J Behav Med. 2017; 40: 332-342