Association of Barriers, Fear of Falling and Fatigue with Objectively Measured Physical Activity and Sedentary Behavior in Chronic Stroke

Abstract

Understanding the fostering factors of physical activity (PA) and sedentary behavior (SB) in post-stroke chronic survivors is critical to address preventive and health interventions. This cross-sectional study aimed to analyze the association of barriers to PA, fear of falling and severity of fatigue encountered by stroke chronic survivors with device-measured PA and SB. Ambulatory community-dwelling post-stroke subjects (≥six months from stroke onset) were evaluated and answered the Barriers to Physical Activity after Stroke Scale (BAPAS), Short Falls Efficacy Scale-International (Short FES-I) and Fatigue Severity Scale (FSS). SB and PA were measured with an Actigraph GT3X+ accelerometer for ≥seven consecutive days. Stepwise multiple linear regression analysis was employed to identify factors associated with PA and SB. Fifty-seven participants (58.2 ± 11.1 years, 37 men) met the accelerometer wear–time criteria (three days, ≥eight h/day). The physical BAPAS score explained 28.7% of the variance of the prolonged sedentary time (β = 0.547; p < 0.001). Additionally, the walking speed (β = 0.452) together with physical BAPAS (β = −0.319) explained 37.9% of the moderate-to-vigorous PA time (p < 0.001). In chronic post-stroke survivors, not only the walking speed but, also, the perceived physical barriers to PA are accounted for the SB and PA. Interventions to reverse SB and to involve subjects post-stroke in higher levels of PA should consider these factors.

Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis

“…We extracted data for 34 PSF associations, 20 with PA 21 , 23 , 26 – 43 and 14 with fitness. 21 , 24 , 31 , 32 , 44 – 53 Two studies 21 , 31 contributed an association for both outcomes and the rest for only one (n = 30).…”

“… 21 , 24 , 31 , 32 , 44 – 53 Two studies 21 , 31 contributed an association for both outcomes and the rest for only one (n = 30). Three studies became eligible once the authors provided additional information regarding the regression coefficient 39 or direction of association. 40 , 41 The nine-item Fatigue Severity Scale (FSS-9) (19 studies), step-count (six studies), and gait-speed (six studies) were the most frequently used outcome measures for PSF, PA, and fitness, respectively ( Table S4 ).…”

“…We extracted data for 34 PSF associations, 20 with PA 21,23,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and 14 with fitness. 21,24,31,32,[44][45][46][47][48][49][50][51][52][53] Two studies 21,31 contributed an association for both outcomes and the rest for only one (n = 30).…”

“…34 Eight studies used selfreported PA 26,30,31,[35][36][37]40,43 and one used observational methods 29 (Table S4). Twelve studies 26,28,[30][31][32][34][35][36][37]39,40,43 found a negative direction of association (i.e. higher PSF-lower PA) and four studies 23,29,33,42 found a positive association (i.e.…”

“…The majority of studies reporting on the association between PSF and PA could not be pooled due to heterogeneity in the statistics used (17 studies, 2621 participants). 23,[26][27][28][29][30][31][32][33][34][35][36][37]39,40,42,43,55 These studies were synthesized using vote-counting based on direction of association. Table S5 summarizes each study's statistical methods and association estimates.…”