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Background: Movement-related behaviours, including prolonged sedentary behaviour, physical inactivity, and poor sleep, are associated with worse functional outcomes poststroke. Addressing these co-dependent behaviours early after stroke may help to optimize recovery and improve overall quality of life for individuals with stroke., Objective: This study aims to determine the feasibility and effect of a 'sit less, move more, sleep better' program early after stroke on functional mobility and global disability outcomes, while also exploring imaging and behavioural markers that may influence walking recovery., Methods: The study is an assessor-blinded, single-center, parallel-group, randomized controlled trial to be completed within 24 months from July 12, 2023 to June 30, 2025. We will enroll 50 patients with acute ischemic stroke within 7 days from symptom onset, aged 18 years or older, and with ongoing walking goals. Demographic and stroke characteristics, including stroke risk factors, neuroimaging, and acute stroke treatments, will be determined and documented. All participants will wear an accelerometer for one week at three different time-points (baseline, 6, and 12 weeks) to assess movement-related behaviours. Following randomization, participants in the intervention arm will receive a 'sit less, move more, sleep better' program for up to 1 hour/day, 5 days/week, for 6 weeks to enhance self-efficacy for change. Participants in the control arm will receive usual inpatient and early supported stroke discharge care. The feasibility outcomes will include reach (enrolled/eligible), retention (completed/enrolled), adverse events, and program adherence. Other outcomes at 6 and 12 weeks include the modified Rankin Scale, Timed-Up and Go, movement-related behaviours, walking endurance, gait speed, cognition, stroke severity and quality of life. Mixed-effects models will assess changes in outcomes over time. Compositional associations between movement-related behaviours and outcomes will consider covariates such as imaging markers., Discussion: Adopting a whole-day approach to poststroke rehabilitation will provide valuable insights into the relationship between optimizing movement-related behaviours early after stroke and their impact on functional outcomes. Through exploring person-specific behavioural and imaging markers, this study may inform precision rehabilitation strategies, and guide clinical decision making for more tailored interventions., Trial Registration: Clinical Trial registration (ClinicalTrials.gov Identifier: NCT05753761, March 3, 2023)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Okusanya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Prolonged sedentary behavior is a problem immediately following a stroke and it persists from the acute to chronic phases of recovery. Frequently interrupting sedentary time might help to mitigate the associated detrimental health consequences. The purpose of this article was to describe the process followed in the systematic development and implementation of a theory- and home-based sedentary behavior change intervention for people with stroke. The Intervention Mapping protocol was used to design, develop and implement a STand Up Frequently From Stroke (STUFFS) program aimed at reducing prolonged sedentary behavior after stroke. A qualitative inquiry with people with stroke (n = 13) informed the development of the intervention. The systematic approach followed in the development process including the theoretical basis, content development, and evaluation planning were described. Program reception was assessed using thematic content analysis of exit-interview data (n = 25). The 8-weeks STUFFS intervention is a home-based sedentary behavior change program that provides education about the risks of prolonged sedentary behavior and facilitates behavior change, including the use of motivational tools to empower people with stroke to reduce sedentary behavior. The program was well-received and acceptable to people with stroke (89% satisfaction). This article provides information that furthers knowledge about theory-based strategies to reduce sedentary behavior in the home environment after stroke and facilitates implementation of this type of intervention. Trial registration: This study is registered at www.clinicaltrials.gov (No. NCT02980744)., (© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background : High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective : This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods : For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results : The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11-19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion : We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke.

Objective: 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., Design: Single-group, longitudinal, intervention study with 1-week baseline, 8-week intervention, and 8-week follow-up., Setting: Community., Participants: Individuals (N=34) with subacute stroke recruited within 1 month following discharge home from inpatient stroke rehabilitation., Intervention: 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., Results: 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., Conclusions: 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., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Understanding the determinants of sedentary behaviour (sitting or lying with low energy expenditure) in stroke survivors can enhance the development of successful behaviour change strategies. This qualitative study explored the perceptions of stroke survivors about sedentary behaviour and ways in which it can be changed., Methods: An interpretative qualitative inquiry was used with thematic analysis of interview data. Interviews were conducted using a semi-structured guide with 13 stroke survivors. Interview transcripts were analysed using thematic analysis. Self-reported sedentary time was assessed during interviews., Results: Four main themes emerged from the data: meaning of sedentary behaviour, reasons for sedentary behaviour, barriers and facilitators to reducing sedentary behaviour, and strategies to sit less and move more. Only 6 participants knew about sedentary behaviour, and 2 were aware of the associated health risks. Participants encountered barriers in their daily lives that affect engagement in activity including motor impairments, fatigue, cognitive problems, and lack of motivation. Using wearable technologies and action planning to reduce sedentary behaviour hold promise as behaviour change strategies., Conclusions: There is limited awareness of health risks of sedentary behaviour among stroke survivors. Strategies involving self-monitoring and movement throughout the day are potential ways to reduce sedentary behaviour. Implications for Rehabilitation Reducing sedentary behaviour in ambulatory stroke survivors is dependent on a number of modifiable determinants. Planning regular interruptions in sedentary time, such as standing or walking frequently throughout waking hours, during television commercial breaks or while using the phone are some potential strategies for reducing sedentary behaviour in stroke survivors. Availability of social and professional support and self-monitoring using wearable technologies that provide real-time feedback might result in increased motivation to sit less and move more. Using alarms and devices that provide cues to action by reminding participants to sit less and move more were perceived as important.

Objective: The aim of this study was to describe accelerometer-derived sleep duration, sedentary behavior, physical activity, and quality of life and their association with demographic and clinical factors within the first month after inpatient stroke rehabilitation., Materials and Methods: Thirty people with stroke (mean ± standard deviation, age: 63.8 ± 12.3 years, time since stroke: 3.6 ± 1.1 months) wore an activPAL3 Micro accelerometer (PAL Technologies, Glasgow, Scotland) continuously for 7 days to measure whole-day activity behavior. The Stroke Impact Scale and the Functional Independence Measure were used to assess quality of life and function, respectively., Results: Sleep duration ranged from 6.6 to 11.6 hours/day. Fifteen participants engaged in long sleep greater than 9 hours/day. Participants spent 74.8% of waking hours in sedentary behavior, 17.9% standing, and 7.3% stepping. Of stepping time, only a median of 1.1 (interquartile range: .3-5.8) minutes were spent walking at a moderate-to-vigorous intensity (≥100 steps/minute). The time spent sedentary, the stepping time, and the number of steps differed significantly by the hemiparetic side (P < .05), but not by sex or the type of stroke. There were moderate to strong correlations between the stepping time and the number of steps with gait speed (Spearman r = .49 and .61 respectively, P < .01). Correlations between accelerometer-derived variables and age, time since stroke, and cognition were not significant., Conclusions: People with stroke sleep for longer than the normal duration, spend about three quarters of their waking hours in sedentary behaviors, and engage in minimal walking following stroke rehabilitation. Our findings provide a rationale for the development of behavior change strategies after stroke., (Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the associations between the composition of movement-related behaviours (sedentary behaviour, sleep, standing, and stepping) and functional outcomes post-stroke. Methods: This study included 34 adults with stroke (mean age: 64.6 ± 12.5 years; time since stroke: 3.5 ± 1.1 months) who underwent an 8-week sedentary behaviour intervention. Functional outcomes were assessed using the timed up and go (TUG) and gait speed tests. Compositional data analysis was used to investigate the relationships between movement-related behaviours and functional outcomes. Results: The baseline composition of movement-related behaviours showed significant associations with changes in TUG (F = 4.28, p = 0.01) and gait speed (F = 4.63, p = 0.01) after the 8-week reducing sedentary behaviour intervention. Reallocating ≥ 30 min/day to stepping, while proportionally decreasing other movement-related behaviours, was associated with a significant change in TUG. Similarly, a relative reallocation of ≥ 40 min/day to stepping was associated with a clinically meaningful change in gait speed. Conclusions: This study highlights the importance of considering movement-related behaviours in relation to functional outcomes post-stroke. Reallocating at least 30 min per day to stepping, relative to a reduction in other movement-related behaviours, is associated with significant and meaningful change in functional outcomes. IMPLICATIONS FOR REHABILITATION: Reallocating at least 30 minutes/day to stepping, relative to a decrease in other movement-related behaviours, is associated with a positive change in functional mobility after an 8-week post-stroke sedentary behaviour intervention. Relative to a decrease in other movement-behaviours, reallocating ≥ 40 minutes/day to stepping is associated with a meaningful change in gait speed. Reallocating time to standing or sleep at the expense of other movement behaviours is not associated with better functional mobility or gait speed. Finding the optimal balance in movement-related behaviours that favours more stepping may lead to improvements in both functional mobility and gait speed. [ABSTRACT FROM AUTHOR]