Advertisement

Approaches to Promote Reduction in Sedentary Behavior in Patients With Minor Ischemic Stroke: A Randomized Controlled Trial

Published:September 22, 2021DOI:https://doi.org/10.1016/j.apmr.2021.08.019

      Highlights

      • Randomized controlled trial on approach to promote a reduction in sedentary behavior.
      • An approach that reduces sedentary behavior in patients with minor ischemic stroke.
      • An approach from the time of admission to hospital until after hospital discharge.
      • Reduced sedentary behavior group showed a significantly reduced sedentary behavior.
      • Reduced sedentary behavior group showed increased physical activity levels.

      Abstract

      Objective

      The purpose of this study was to determine whether an approach that promotes reduction in sedentary behavior (SB) during hospitalization and after hospital discharge reduces SB in patients with minor ischemic stroke (MIS) compared with an approach that promotes an increase in physical activity levels.

      Design

      Randomized controlled trial design.

      Setting

      During hospitalization and after hospital discharge.

      Participants

      We randomly assigned patients (N=61) with MIS (average age, 71.3±8.3y; 65.6% men) admitted to an acute hospital to either the intervention group (reduced SB, n=31) or the control group (increased physical activity levels, n=30).

      Interventions

      During hospitalization, the intervention group received education on reducing SB, goal setting for SB after hospital discharge, and self-monitoring of SB and step count. In contrast, the control group received education on increasing physical activity levels and self-monitoring of step count. Patients in both groups wore an accelerometer during hospitalization until 3 months after hospital discharge. The intervention group received self-monitoring of SB and step count, stickers including information about reducing their SB, and phone calls once every 2 weeks for encouragement and feedback. The control group only wore the accelerometer.

      Main Outcome Measures

      The primary outcome was SB (in percentage) at 3 months after hospital discharge.

      Results

      There was an interaction between the 2 groups for SB. Compared with the control group, the intervention group showed a significantly reduced SB (intervention group: baseline, 70.5%; 3 months after hospital discharge, 48.6%; control group: baseline, 71.5%; 3 months after hospital discharge, 57.5%; F value=5.981; P=.018).

      Conclusions

      The results suggested that an approach that promotes SB reduction during hospitalization and after hospital discharge is effective in reducing SB in patients with MIS 3 months after hospital discharge.

      Keywords

      List of abbreviations:

      GDS15 (Geriatric Depression Scale 15), LPA (low-intensity physical activity), MET (metabolic equivalent of task), MIS (minor ischemic stroke), MMSE (Mini-Mental State Examination), MVPA (moderate-to-vigorous-intensity physical activity), SB (sedentary behavior)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chen Y
        • Wright N
        • Guo Y
        • et al.
        Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0·5 million Chinese adults.
        Lancet Glob Health. 2020; 8: e580-e590
        • Stahmeyer JT
        • Stubenrauch S
        • Geyer S
        • et al.
        The frequency and timing of recurrent stroke: an analysis of routine health insurance data.
        Dtsch Arztebl Int. 2019; 116: 711-717
        • Khanevski AN
        • Bjerkreim AT
        • Novotny V
        • et al.
        Recurrent ischemic stroke: incidence, predictors, and impact on mortality.
        Acta Neurol Scand. 2019; 140: 3-8
        • Brown DL
        • Shafie-Khorassani F
        • Kim S
        • et al.
        Sleep-disordered breathing is associated with recurrent ischemic stroke.
        Stroke. 2019; 50: 571-576
        • Takashima N
        • Arima H
        • Kita Y
        • et al.
        Incidence, management and short-term outcome of stroke in a general population of 1. 4 million Japanese: Shiga Stroke Registry.
        Circ J. 2017; 81: 1636-1646
        • Kaufman BG
        • Shah S
        • Hellkamp AS
        • et al.
        Disease burden following non-cardioembolic minor ischemic stroke or high-risk TIA: a GWTG-stroke study.
        J Stroke Cerebrovasc Dis. 2020; 29105399
        • Amarenco P
        • Lavallée PC
        • Monteiro Tavares L
        • et al.
        Five-year risk of stroke after TIA or minor ischemic stroke.
        N Engl J Med. 2018; 378: 2182-2190
        • Kono Y
        • Yamada S
        • Kamisaka K
        • et al.
        Recurrence risk after noncardioembolic mild ischemic stroke in a Japanese population.
        Cerebrovasc Dis. 2011; 31: 365-372
        • Billinger SA
        • 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
        • Paterson C
        • Fryer S
        • Zieff G
        • et al.
        The effects of acute exposure to prolonged sitting, with and without interruption, on vascular function among adults: a meta-analysis.
        Sports Med. 2020; 50: 1929-1942
        • Taylor FC
        • Dunstan DW
        • Homer AR
        • et al.
        Acute effects of interrupting prolonged sitting on vascular function in type 2 diabetes.
        Am J Physiol Heart Circ Physiol. 2021; 320: H393-H403
        • Carter SE
        • Draijer R
        • Holder SM
        • et al.
        Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting.
        J Appl Physiol (1985). 2018; 125: 790-798
        • Loh R
        • Stamatakis E
        • Folkerts D
        • et al.
        Effects of interrupting prolonged sitting with physical activity breaks on blood glucose, insulin and triacylglycerol measures: a systematic review and meta-analysis.
        Sports Med. 2020; 50: 295-330
        • Peddie MC
        • Kessell C
        • Bergen T
        • et al.
        The effects of prolonged sitting, prolonged standing, and activity breaks on vascular function, and postprandial glucose and insulin responses: a randomised crossover trial.
        PLoS One. 2021; 16e0244841
        • Lin X
        • Alvim SM
        • Simoes EJ
        • et al.
        Leisure time physical activity and cardio-metabolic health: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
        J Am Heart Assoc. 2016; 5e003337
        • Takahashi M
        • Miyashita M
        • Park JH
        • et al.
        Effects of breaking sitting by standing and acute exercise on postprandial oxidative stress.
        Asian J Sports Med. 2015; 6: e24902
      1. WHO guidelines on physical activity and sedentary behaviour.
        World Health Organization, Geneva, Switzerland2020
        • Schröder H
        • Cárdenas-Fuentes G
        • Martínez-González MA
        • et al.
        Effectiveness of the physical activity intervention program in the PREDIMED-Plus study: a randomized controlled trial.
        Int J Behav Nutr Phys Act. 2018; 15: 110
        • Mascarenhas MN
        • Chan JM
        • Vittinghoff E
        • et al.
        Increasing physical activity in mothers using video exercise groups and exercise mobile apps: randomized controlled trial.
        J Med Internet Res. 2018; 20: e179
        • Barone Gibbs B
        • Brach JS
        • Byard T
        • et al.
        Reducing sedentary behavior versus increasing moderate-to-vigorous intensity physical activity in older adults.
        J Aging Health. 2017; 29: 247-267
        • Núñez de Arenas-Arroyo S
        • Cavero-Redondo I
        • Alvarez-Bueno C
        • et al.
        Effect of health to increase physical activity in healthy adults over 55 years: a systematic review and meta-analysis.
        Scand J Med Sci Sports. 2021; 31: 776-789
        • Chaudhry UAR
        • Wahlich C
        • Fortescue R
        • et al.
        The effects of step-count monitoring interventions on physical activity: systematic review and meta-analysis of community-based randomised controlled trials in adults.
        Int J Behav Nutr Phys Act. 2020; 17: 129
        • Sammut M
        • Fini N
        • Haracz K
        • et al.
        Increasing time spent engaging in moderate-to-vigorous physical activity by community-dwelling adults following a transient ischemic attack or non-disabling stroke: a systematic review.
        Disabil Rehabil. 2020 Jun 1; ([Epub ahead of print])
        • Nguyen P
        • Le LK
        • Nguyen D
        • et al.
        The effectiveness of sedentary behaviour interventions on sitting time and screen time in children and adults: an umbrella review of systematic reviews.
        Int J Behav Nutr Phys Act. 2020; 17: 117
        • Prince SA
        • Saunders TJ
        • Gresty K
        • et al.
        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
        • Shrestha N
        • Grgic J
        • Wiesner G
        • et al.
        Effectiveness of interventions for reducing non-occupational sedentary behaviour in adults and older adults: a systematic review and meta-analysis.
        Br J Sports Med. 2019; 53: 1206-1213
        • Kringle EA
        • Barone Gibbs B
        • Campbell G
        • et al.
        Influence of interventions on daily physical activity and sedentary behavior after stroke: a systematic review.
        PM R. 2020; 12: 186-201
        • Yerrakalva D
        • Yerrakalva D
        • Hajna S
        • et al.
        Effects of mobile health app interventions on sedentary time, physical activity, and fitness in older adults: systematic review and meta-analysis.
        J Med Internet Res. 2019; 21: e14343
        • Aunger JA
        • Doody P
        • Greig CA.
        Interventions targeting sedentary behavior in non-working older adults: a systematic review.
        Maturitas. 2018; 116: 89-99
        • Dunstan DW
        • Howard B
        • Healy GN
        • et al.
        Too much sitting–a health hazard.
        Diabetes Res Clin Pract. 2012; 97: 368-376
        • Healy GN
        • Wijndaele K
        • Dunstan DW
        • 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
        • Ashizawa R
        • Yamashita K
        • Take K
        • et al.
        Nonleisure-time physical activity guidance following minor ischemic stroke: a randomized clinical trial.
        Adapt Phys Activ Q. 2021; 38: 329-347
        • Kanai M
        • Izawa KP
        • Nozoe M
        • et al.
        Long-term effect of promoting in-hospital physical activity on postdischarge patients with mild ischemic stroke.
        J Stroke Cerebrovasc Dis. 2019; 28: 1048-1055
        • Morén C
        • Welmer AK
        • Hagströmer M
        • et al.
        The effects of “physical activity on prescription” in persons with transient ischemic attack: a randomized controlled study.
        J Neurol Phys Ther. 2016; 40: 176-183
        • Lin C
        • Sangha R
        • Lee J
        • et al.
        Infarct location is associated with quality of life after mild ischemic stroke.
        Int J Stroke. 2018; 13: 824-831
        • Sangha RS
        • Caprio FZ
        • Askew R
        • et al.
        Quality of life in patients with TIA and minor ischemic stroke.
        Neurology. 2015; 85: 1957-1963
        • Hildebrand M
        • Brewer M
        • Wolf T.
        The impact of mild stroke on participation in physical fitness activities.
        Stroke Res Treat. 2012; 2021548682
        • Network Sedentary Behaviour Research
        Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours.
        Appl Physiol Nutr Metab. 2012; 37: 540-542
        • Ohkawara K
        • Oshima Y
        • Hikihara Y
        • et al.
        Real-time estimation of daily physical activity intensity by a triaxial accelerometer and a gravity-removal classification algorithm.
        Br J Nutr. 2011; 105: 1681-1691
        • Fitzgerald JD
        • Johnson L
        • Hire DG
        • et al.
        Association of objectively measured physical activity with cardiovascular risk in mobility-limited older adults.
        J Am Heart Assoc. 2015; 4e001288
        • Garber CE
        • Blissmer B
        • Deschenes MR
        • et al.
        American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
        Med Sci Sports Exerc. 2011; 43: 1334-1359
        • Sugiyama T
        • Healy NG
        • Dunstan WD
        • et al.
        Joint associations of multiple leisure-time sedentary behaviours and physical activity with obesity in Australian adults.
        Int J Behav Nutr Phys Act. 2008; 5: 35
        • Salmon J
        • Owen N
        • Crawford D
        • et al.
        Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference.
        Health Psychol. 2003; 22: 178-188
        • Brink TL
        • Yesavage JA
        • Owen L
        • et al.
        Screening tests for geriatric depression.
        Clin Geron. 1982; 1: 37-43
        • Sheikh JI
        • Yesavage JA.
        Geriatic depression scale (GDS). Recent evidence and development of a shorter version.
        Clin Geron. 1986; 5: 165-173
        • Buysse DJ
        • Reynolds 3rd, CF
        • Monk TH
        • et al.
        The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
        Psychiatry Res. 1989; 28: 193-213
        • Doi Y
        • Minowa M
        • Uchiyama M
        • et al.
        Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiatric disordered and control subjects.
        Psychiatry Res. 2000; 97: 165-172
        • Doi Y
        • Minowa M
        • Okawa M
        • et al.
        Development of the Japanese version of the Pittsburgh Sleep Quality Index.
        Jpn J Psychiat Treat. 1998; 13: 755-763
        • Arrogi A
        • Bogaerts A
        • Seghers J
        • et al.
        Evaluation of stAPP: a smartphone-based intervention to reduce prolonged sitting among Belgian adults.
        Health Promot Int. 2019; 34: 16-27
        • Kerr J
        • Takemoto M
        • Bolling K
        • et al.
        Two-arm randomized pilot intervention trial to decrease sitting time and increase sit-to-stand transitions in working and non-working older adults.
        PLoS One. 2016; 11e0145427
        • Batchelor FA
        • Williams SB
        • Wijeratne T
        • et al.
        Balance and gait impairment in transient ischemic attack and minor stroke.
        J Stroke Cerebrovasc Dis. 2015; 24: 2291-2297
        • McEwan D
        • Harden SM
        • Zumbo BD
        • et al.
        The effectiveness of multi-component goal setting interventions for changing physical activity behaviour: a systematic review and meta-analysis.
        Health Psychol Rev. 2016; 10: 67-88
        • Michie S
        • Abraham C
        • Whittington C
        • et al.
        Effective techniques in healthy eating and physical activity interventions: a meta-regression.
        Health Psychol. 2009; 28: 690-701
        • Rollo S
        • Gaston A
        • Prapavessis H.
        Cognitive and motivational factors associated with sedentary behavior: a systematic review.
        AIMS Public Health. 2016; 3: 956-984
        • Swartz AM
        • Cho CC
        • Welch WA
        • et al.
        Pattern analysis of sedentary behavior change after a walking intervention.
        Am J Health Behav. 2018; 42: 90-101
        • Park J
        • Ishikawa-Takata K
        • Tanaka S
        • et al.
        Accuracy of estimating step counts and intensity using accelerometers in older people with or without assistive devices.
        J Aging Phys Act. 2017; 25: 41-50
        • Russell D
        • Chase JD.
        The social context of sedentary behaviors and their relationships with health in later life.
        J Aging Phys Act. 2019; 27: 797-806
        • Wondergem R
        • Pisters MF
        • Heijmans MW
        • et al.
        Movement behavior remains stable in stroke survivors within the first two months after returning home.
        PLoS One. 2020; 15e0229587
        • 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
        • Dunstan DW
        • Howard B
        • Healy GN
        • et al.
        Too much sitting–a health hazard.
        Diabetes Res Clin Pract. 2012; 97: 368-376
        • Meneguci J
        • Sasaki JE
        • da Silva
        • Santos Á
        • et al.
        Socio-demographic, clinical and health behavior correlates of sitting time in older adults.
        BMC Public Health. 2015; 15: 65
        • Asiamah N
        • Kouveliotis K
        • Petersen C
        • et al.
        The association between social capital factors and sedentary behaviour among older adults: does the built environment matter?.
        Adv Gerontol. 2019; 32: 234-242
        • Gaskin CJ
        • Orellana L.
        Factors associated with physical activity and sedentary behavior in older adults from six low- and middle-income countries.
        Int J Environ Res Public Health. 2018; 15: 908