Physical Activity in Hospitalised Stroke Patients

Abstract

The aim of this paper was to examine the amount and type of physical activity engaged in by people hospitalised after stroke. Method. We systematically reviewed the literature for observational studies describing the physical activity of stroke patients. Results. Behavioural mapping, video recording and therapist report are used to monitor activity levels in hospitalised stroke patients in the 24 included studies. Most of the patient day is spent inactive (median 48.1%, IQR 39.6%–69.3%), alone (median 53.7%, IQR 44.2%–60.6%) and in their bedroom (median 56.5%, IQR 45.2%–72.5%). Approximately one hour per day is spent in physiotherapy (median 63.2 minutes, IQR 36.0–79.5) and occupational therapy (median 57.0 minutes, IQR 25.1–58.5). Even in formal therapy sessions limited time is spent in moderate to high level physical activity. Low levels of physical activity appear more common in patients within 14 days post-stroke and those admitted to conventional care. Conclusions. Physical activity levels are low in hospitalised stroke patients. Improving the description and classification of post stroke physical activity would enhance our ability to pool data across observational studies. The importance of increasing activity levels and the effectiveness of interventions to increase physical activity after stroke need to be tested further.

A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial

“…These studies demonstrated that most acute stroke patients were inactive for most of the time 17,18 but that this pattern of inactivity varied between hospitals. 17 She also demonstrated that there was considerable variation of opinion and clinical uncertainty among health-care professionals about the value of very early mobilisation (VEM).…”

“…The biological rationale for EM is based on three principal lines of argument: (1) there is good evidence that bed rest has a harmful impact on cardiovascular, respiratory, muscular, skeletal and immune systems across many conditions 11,12 and is likely to slow recovery; (2) some of the most common and serious complications after stroke are those related to immobility [13][14][15][16] (we know that the routine day of most acute stroke patients is largely inactive; 17,18 therefore, introducing frequent training out of bed may reduce the risk of complications of immobility); and (3) current concepts of biological recovery after brain injury suggest a narrow window of opportunity for brain plasticity and repair. 19 If the brain indeed remodels itself based on experience 20 then early task-specific training may well have an important contribution to improving recovery.…”

Group Circuit Class Therapy for Stroke Survivors – A Review of the Evidence and Clinical Implications

“…www.intechopen.com *personal communication with author A recent systematic review identified 24 studies conducted between 1980 and 2009 which measured activity levels of stroke survivors in hospital (West & Bernhardt 2011). Fifteen of these studies measured patient activity over the whole day and 10 examined the physical activity of people in therapy sessions specifically.…”

“…Participants were observed for the majority of the working day -for example from 7 or 8am in the morning until 5, 6 or even 7pm at night. The authors found that stroke survivors in hospital spent the majority of the day inactive (median 48.1%, inter-quartile range [IQR] 39.6-69.3), and alone (median 53.7%, IQR 44.2%-60.6%) (West & Bernhardt 2011). When only the category of moderate to high physical activity is examined (this includes activities such as standing, walking and using stairs) only a median of 21%(IQR 12.8 to 27.7%) of the day is spent in these activities (West & Bernhardt 2011).…”

“…Of the 10 studies examining physical activity levels in therapy sessions, a variety of techniques were used in including behavioural mapping, video-taping and therapist report (West & Bernhardt 2011). Within these studies, participants were reported to be inactive for between 20% and 58% of therapy sessions.…”