Background and Purpose— Movement behaviors, that is, both physical activity and sedentary behavior, are independently associated with health risks. Although both behaviors have been investigated separately in people after stroke, little is known about the combined movement behavior patterns, differences in these patterns between individuals, or the factors associated with these patterns. Therefore, the objectives of this study are (1) to identify movement behavior patterns in people with first-ever stroke discharged to the home setting and (2) to explore factors associated with the identified patterns. Methods— Cross-sectional design using data from 190 people with first-ever stroke discharged to the home setting. Movement, behavior was measured over 2 weeks using an accelerometer. Ten movement behavior outcomes were calculated and compressed using principal component analysis. Movement behavior patterns were identified using a k-means clustering algorithm. Demographics, stroke, care, physical functioning, and psychological, cognitive and social factors were obtained. Differences between and factors associated with the patterns were investigated. Results— On average, the accelerometer was worn for 13.7 hours per day. The average movement behavior of the participants showed 9.3 sedentary hours, 3.8 hours of light physical activity, and 0.6 hours of moderate-vigorous physical activity. Three patterns and associated factors were identified: (1) sedentary exercisers (22.6%), with a relatively low age, few pack-years, light drinking, and high levels of physical functioning; (2) sedentary movers (45.8%), with less severe stroke symptoms, low physical functioning and high levels of self-efficacy; and (3) sedentary prolongers (31.6%), with more severe stroke symptoms, more pack-years, and low levels of self-efficacy. Conclusions— The majority of people with stroke are inactive and sedentary. Three different movement behavior patterns were identified: sedentary exercisers, sedentary movers, and sedentary prolongers. The identified movement behavior patterns confirm the hypothesis that an individually tailored approach might be warranted with movement behavior coaching by healthcare professionals.
Background Research has shown that sedentary behaviour increases the risk of stroke, cardiovascular disease and mortality. People with stroke are highly sedentary. Therefore, reducing sedentary behaviour might reduce the risk of secondary events and death. Personalized strategies using behavioural change techniques directed at reducing sedentary behaviour in people with stroke are currently lacking. Purpose To systematically determine the behaviour change techniques (BCTs) for a behavioural change intervention, directed at reducing sedentary behaviour in community-dwelling people with stroke, using the Behaviour Change Wheel (BCW). Method To complete the stages of the BCW, information on understanding the behaviour, identifying intervention functions, identifying BCTs and modes of delivery were needed. To acquire this information, per stage a literature search was conducted and nominal group technique (NGT) sessions were conducted to identify BCTs. The NGT sessions were conducted with professionals working with people with stroke and with international researchers working in the stroke or sedentary behaviour field. Participants made their choice by rating the BCTs, starting from most important (eight points) down to zero points. Results In total, 75 eligible BCTs were identified. Five BCTs should always be included: ‘goal setting’, ‘action planning’, ‘social support’, ‘problem solving’ and ‘restructuring of the social environment’. For patients without cognitive impairments, ‘self-monitoring’, ‘feedback on behaviour’, ‘information about health consequences’ and ‘goal setting on outcome’ were advised to be included, while for patients with cognitive impairments, ‘prompts/cues’, ‘graded tasks’, ‘restructuring the physical environment’ and ‘social support practical’ should be considered. Conclusion Behaviour change techniques were identified for a behavioural change intervention aiming to reduce sedentary behaviour in community-dwelling people with first-ever stroke. BCTs recommendations depend on the presence of physical and cognitive impairments, although ‘goal setting’, ‘action planning’, ‘social support’, ‘problem solving’ and ‘restructuring of the social environment’ are recommended in all people with first-ever stroke. The identified BCTs serve as the basis for further development of a personalized blended care intervention to reduce sedentary behaviour in people with stroke.
Background: Research has shown that sedentary behaviour increases the risk of stroke, cardiovascular disease and mortality. People with stroke are highly sedentary. Therefore, reducing sedentary behaviour might reduce the risk of secondary events and death. Personalized strategies using behavioural change techniques (BCTs) directed at reducing sedentary behaviour in people with stroke are currently lacking. Therefore, the aim of this study is to systematically determine the BCTs for a behavioural change intervention, directed at reducing sedentary behaviour in community-dwelling people with stroke,.Method: To complete the stages of the Behaviour Change Wheel , information on understanding the behaviour, identifying intervention functions, identifying BCTs and modes of delivery were needed. Per stage a literature search was conducted and nominal group technique (NGT) sessions were conducted to identify BCTs. The NGT sessions were conducted with professionals working with people with stroke and international researchers working in the stroke or sedentary behaviour field. Four different patients symptom profiles, as frequently seen in clinical practice, were used by participants during the NGT sessions: : 1. no physical or cognitive impairments; profile 2. mainly cognitive impairments; profile 3. mainly physical impairments; and profile 4. both physical and cognitive impairments. Per profile participants made their choice by rating the BCTs.Results: Five BCTs should always be included: ‘goal setting’, ‘action planning’, ‘social support’, ‘problem solving’ and ‘restructuring of the social environment’. For patients without cognitive impairments, ‘self-monitoring’, ‘feedback on behaviour’, ‘information about health consequences’ and ‘goal setting on outcome’ were advised to be included, while for patients with cognitive impairments, ‘prompts/cues’, ‘graded tasks’, ‘restructuring the physical environment’ and ‘social support practical’ should be considered. Conclusion: BCTs were identified for a behavioural change intervention aiming to reduce sedentary behaviour in community-dwelling people with first-ever stroke. BCTs recommendations depend on the presence of physical and cognitive impairments, although ‘goal setting’, ‘action planning’, ‘social support’, ‘problem solving’ and ‘restructuring of the social environment’ are recommended in all people with first-ever stroke. The identified BCTs serve as the basis for further development of a personalized blended care intervention to reduce sedentary behaviour in people with stroke.
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