Performance of Dietary Behaviors in Chronic Community-Dwelling Stroke Survivors: A Mixed-Methods Study.

In order to gain a better understanding of post-stroke dietary behaviors (e.g., selecting, accessing, and preparing healthy foods) among chronic, community-dwelling stroke survivors, we conducted a mixed-methods study consisting of a quantitative online survey (n = 63) and follow-up focus groups with a subset of participants (n = 7). Perceived performance, assistance required, adaptive equipment and compensatory strategies used, and sources of education and training were examined. Results demonstrated (1) diminished post-stroke performance for most dietary behaviors (e.g., grocery shopping, meal preparation), (2) an increased desire to eat healthily to prevent recurrent stroke, (3) variable use of adaptive equipment and compensatory strategies, and (4) limited healthcare-based dietary behavior education and training. These results suggest that stroke survivors could benefit from increased dietary behavior intervention to improve dietary behavior performance. Findings can be used to guide clinical intervention and design future research studies.

Association of obesity and diabetes with physical activity and fruit and vegetable consumption in stroke survivors.

BACKGROUND: Engaging in unhealthy behaviours [poor diet, insufficient physical activity (PA)] increases risk for recurrent stroke and can be compounded by obesity and diabetes, but the association of obesity and diabetes with poor diet and insufficient PA in stroke survivors is unknown. OBJECTIVE: The purpose of this study was to compare prevalences of low fruit and vegetable consumption (low FV consumption, <1 fruit and <1 vegetable daily) and low physical activity (low PA, <150 minutes of weekly moderate-intensity PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, both conditions). METHODS: Cross-sectional data from 32 876 non-institutionalized, US stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AORs) of the investigated unhealthy behaviours (adjusted for sex, age, race, income, education and marital status) and 95% confidence intervals (CIs) were calculated. RESULTS: Prevalences of low FV consumption and low PA exceeded 50% across all obesity-diabetes categories. Compared with respondents with neither obesity nor diabetes, AORs for low PA were increased for respondents with both obesity and diabetes (2.02, 95% CI: 1.72-2.37) and respondents with obesity only (1.31, 1.13-1.53); AORs for low FV consumption did not differ across obesity-diabetes categories. CONCLUSIONS: Results indicated a joint effect of obesity and diabetes with low PA among stroke survivors. Regardless of obesity-diabetes status, however, prevalence of low FV consumption and low PA exceeded 50%. Targeted interventions that modify these unhealthy behaviours among stroke survivors should be explored.

How Adults With Stroke Conceptualize Physical Activity: An Exploratory Qualitative Study.

IMPORTANCE: Physical activity (PA) is recommended for improving physical and cardiovascular function but can be challenging because of stroke-related impairments. A better understanding of how adults with stroke conceptualize PA could assist in developing effective interventions for increasing poststroke PA. OBJECTIVE: To explore how adults with stroke conceptualize PA. DESIGN: Phenomenological qualitative design. SETTING: Participants' homes. PARTICIPANTS: Community-dwelling adults with chronic (>6 mo) stroke (N = 15). OUTCOMES AND MEASURES: Semistructured interviews were conducted with participants. Data were analyzed by means of inductive content analysis to identify key themes. RESULTS: Three key themes emerged: (1) moderate to vigorous PA, which includes exercise-related activities (going to the gym, walking, playing sports); (2) PA necessary for performing daily activities and occupations, which includes basic and instrumental activities of daily living; and (3) avoiding sedentary behavior, which includes not wanting to sit for long periods of time, avoiding boredom, and valuing PA over being sedentary. CONCLUSIONS AND RELEVANCE: Participants broadly categorized PA, encompassing multiple activity types, which is encouraging because reducing sedentary behavior and increasing PA of any intensity can improve cardiometabolic health. Interventions that complement and enhance these conceptualizations, alone or in combination with other mechanisms of action, should be explored for their efficacy in increasing PA in adults with stroke. WHAT THIS ARTICLE ADDS: After stroke, perceptions of PA encompass exercise, daily activities and occupations, and avoiding sedentary behavior; these perceptions could be harnessed to promote PA among adults after stroke.

Prevalence of 3 Healthy Lifestyle Behaviors Among US Adults With and Without History of Stroke.

INTRODUCTION: Engaging in healthy lifestyle behaviors decreases risk for cardiometabolic complications, which is of particular concern for stroke survivors whose history of stroke (HOS) increases cardiometabolic risk. Population-based estimates of healthy behaviors in adults with HOS are lacking but could be used to inform research, policy, and health care practice. The objective of this study was to calculate and compare population-based estimates of the prevalence of consuming 1 or more fruit and 1 or more vegetable daily, meeting weekly aerobic physical activity recommendations, having a body mass index (BMI) of less than 25 kg/m2, and the number of healthy behaviors among US adults with and without HOS. METHODS: We used data from the 2015 Behavioral Risk Factor Surveillance System. Weighted and age-adjusted (to the 2000 US standard population) prevalence estimates and adjusted odds ratios (AORs, adjusted for demographic variables) were computed for study variables. RESULTS: Adults with HOS were less likely than adults without HOS to consume 1 or more fruit and 1 or more vegetable daily (AOR = 0.85; 95% confidence interval [CI], 0.79-0.91), meet weekly aerobic physical activity recommendations (AOR = 0.72; 95% CI, 0.67-0.78), and engage in 2 (AOR = 0.86; 95% CI, 0.79-0.94) or 3 (AOR = 0.73; 95% CI, 0.64-0.82) healthy behaviors. Adults with HOS were more likely to engage in 0 healthy behaviors (AOR = 1.26; 95% CI, 1.16-1.37). Having a BMI of less than 25 kg/m2 and engaging in 1 healthy behavior were similar between groups. CONCLUSION: Prevalence of individual and total number of healthy behaviors was lower in adults with HOS for several healthy behaviors. Future research, policy, and health care practice is needed to promote healthy behaviors in adults with HOS.

Self-Efficacy, Self-Regulation, Social Support, and Outcomes Expectations for Daily Physical Activity in Adults with Chronic Stroke: A Descriptive, Exploratory Study.

Interventions are needed to increase physical activity throughout the day in adults with chronic stroke, but mechanisms of action for doing so have not been identified. In this descriptive, exploratory study of 36 ambulatory, community-dwelling adults with chronic stroke, participants completed questionnaires investigating self-efficacy, self-regulation, social support, and outcomes expectations for daily physical activity. In the absence of any intervention, participants consistently reported high self-efficacy and outcomes expectations but low use of self-regulation and social support strategies. Discussion of how these results can inform the development of interventions to facilitate daily physical activity in adults with chronic stroke is provided.

Promoting Physical Activity and Nutrition in People With Stroke.

The prevalence of cardiovascular disease, diabetes, and obesity is high in people with stroke. Risk factors for these conditions include hypertension, high cholesterol, and physical inactivity. These risk factors are common in people with stroke and often go unmanaged. Engagement in healthy behaviors is important for managing and preventing these risk factors and comorbid conditions. More specifically, physical activity and nutrition are key health behaviors for the management and maintenance of health in people with stroke. These health behaviors, by their very nature, are also occupations; thus, they are influenced by client factors, performance skills and patterns, and environments and contexts. This article discusses physical activity and nutrition within the context of the Occupational Therapy Practice Framework: Domain and Process and proposes potential roles for occupational therapy practitioners and researchers in developing, testing, and providing physical activity and nutrition interventions for people with stroke.

Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke.

OBJECTIVE: This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke. METHOD: Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge. RESULTS: Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles. CONCLUSION: UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation.

Validity of body-worn sensor acceleration metrics to index upper extremity function in hemiparetic stroke.

BACKGROUND AND PURPOSE: Accelerometers have been used to capture real-world use of the paretic upper extremity in people with stroke. It may be possible to characterize different aspects of the recorded acceleration to gain insight about movement capabilities during task-specific behavior. These measures may be of value for guiding rehabilitation. We undertook a study to identify the acceleration characteristics that have a stable association with upper extremity function and sensitivity to within-participant fluctuations in function over multiple sessions of task-specific training. METHODS: Twenty-seven adults 6 months or more poststroke with upper extremity paresis participated. Signals from wrist-worn accelerometers were sampled at 30 Hz during 7 sessions of task-specific training. Paretic upper extremity function was evaluated with the Action Research Arm Test. We used Spearman correlations to examine within-session associations between acceleration metrics and Action Research Arm Test performance. A mixed model was used to determine which metrics were sensitive to within-participant fluctuations in upper extremity function across the 7 training sessions. RESULTS: Upper extremity function correlated with bilateral acceleration variability and use ratio during 5 and 6 sessions, respectively. Time accelerating between 76% and 100% of peak acceleration correlated with function in 6 sessions. Variability of the paretic upper extremity acceleration and the ratio of acceleration variability between upper extremities were associated with function during all 7 sessions. Variability in both the acceleration of the paretic upper extremity, and acceleration of the paretic and nonparetic extremities combined were sensitive to within-participant fluctuations in function across training sessions. DISCUSSION AND CONCLUSIONS: Multiple features of the acceleration profile track with upper extremity function within and across sessions of task-specific training. It may be possible to monitor these features with accelerometers to index upper extremity function outside of clinical settings.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A91).

Real-world affected upper limb activity in chronic stroke: an examination of potential modifying factors.

BACKGROUND: Despite improvement in motor function after intervention, adults with chronic stroke experience disability in everyday activity. Factors other than motor function may influence affected upper limb (UL) activity. OBJECTIVE: To characterize affected UL activity and examine potential modifying factors of affected UL activity in community-dwelling adults with chronic stroke. METHODS: Forty-six adults with chronic stroke wore accelerometers on both ULs for 25 hours and provided information about potential modifying factors [time spent in sedentary activity, cognitive impairment, depressive symptomatology, number of comorbidities, motor dysfunction of the affected UL, age, activities of daily living (ADL) status, and living arrangement]. Accelerometry was used to quantify duration of affected and unaffected UL activity. The ratio of affected-to-unaffected UL activity was also calculated. Associations within and between accelerometry-derived variables and potential modifying factors were examined. RESULTS: Mean hours of affected and unaffected UL activity were 5.0 ± 2.2 and 7.6 ± 2.1 hours respectively. The ratio of affected-to-unaffected UL activity was 0.64 ± 0.19, and hours of affected and unaffected UL activity were strongly correlated (r = 0.78). Increased severity of motor dysfunction and dependence in ADLs were associated with decreased affected UL activity. No other factors were associated with affected UL activity. CONCLUSIONS: Severity of motor dysfunction and ADL status should be taken into consideration when setting goals for UL activity in people with chronic stroke. Given the strong, positive correlation between affected and unaffected UL activity, encouragement to increase activity of the unaffected UL may increase affected UL activity.

Evidence Surrounding Dietary Behavior Interventions in Community-Dwelling Stroke Survivors: A Scoping Review.

Objective: To identify and summarize studies that have implemented dietary behavior interventions and reported dietary outcomes in community-dwelling adult stroke survivors. Design: Scoping Review; Setting: Not applicable. Participants: Studies eligible for review included peer-reviewed studies describing both a dietary intervention and a dietary outcome among community-dwelling stroke survivors published between January 2000 and June 2022. Results: We identified 14 articles that included both a dietary behavior intervention and a dietary outcome. All studies (5 pilot randomized controlled trials (RCTs), 6 non-pilot RCTs, 3 cohort studies) delivered multimodal health behavior interventions that included a dietary component. Interventions were delivered weekly to every other month and lasted for 1-24 months. Most studies did not use standardized assessments to assess dietary outcomes; however, 8 studies reported improvement in dietary outcomes. Conclusions: This review provides support for the efficacy of dietary behavior interventions in stroke survivors. Variability in intervention format and assessment measures across studies impedes the ability to conduct meta-analyses of outcomes to inform research knowledge and clinical practice. Additional research is needed to determine mechanisms-of-action for dietary behavior change in stroke survivors.

Assessment of upper extremity impairment, function, and activity after stroke: foundations for clinical decision making.

The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common UE impairments and how to assess them are briefly discussed. Although multiple UE impairments are typically present after stroke, the severity of one's impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed to optimize the provision of stroke rehabilitation services.

Differences in health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors aged ≥65 years in the USA.

OBJECTIVES: To examine differences in health characteristics and health behaviors between rural and non-rural stroke survivors in the USA. METHODS: Data were extracted from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) to compare prevalences of health characteristics (i.e., diabetes, disability, poor health, high cholesterol, hypertension, no health care coverage, weight status) and health behaviors (i.e., fruit consumption, vegetable consumption, physical inactivity, high alcohol consumption, smoking) among community-dwelling stroke survivors, stratified by rural status (i.e., rural vs. non-rural). Logistic regression was used to calculate odds ratios (ORs) for health characteristics and health behaviors to examine the association of rural status with each variable of interest (reference group=non-rural). RESULTS: Data from 14,599 respondents (rural: n = 5,039; non-rural: n = 9,560) were available for analysis. The majority of respondents were female (61.4%), non-Hispanic white (83.2%), previously married (56.1%), had at least some college education (55.2%), and had an annual household income ≥USD $25,000 (56.9%). Prevalences of disability, poor health, weekly aerobic exercise, and smoking were higher among rural respondents compared to non-rural respondents. Logistic regression showed increased odds (odds ratio range: 1.1-1.2) for these variables among rural respondents; however, odds ratios were attenuated after controlling for sociodemographic and health characteristics. CONCLUSIONS: We did not find evidence of differences in the investigated health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors in the USA. Additional research is needed to confirm these findings and to identify alternative sociodemographic and health factors that may differ between rural and non-rural community-dwelling stroke survivors.

The Effects of an Acute Bout of Aerobic or Resistance Exercise on Nonexercise Physical Activity.

Introduction/Purpose: A reduction in nonexercise physical activity (NEPA) after exercise may reduce the effectiveness of exercise interventions on weight loss in adults with overweight or obesity. Aerobic exercise (AEx) and resistance exercise (REx) may have different effects on NEPA. The purpose of this secondary analysis was to examine the effect of a single bout of AEx or REx on NEPA and sedentary behavior in inactive adults with overweight or obesity. Methods: Adults with overweight or obesity (n = 24; 50% male; age, 34.5 ± 1.5 yr; body mass index, 28.5 ± 0.9 kg·m-2) not meeting current physical activity guidelines completed a single 45-min bout of AEx, REx, or a sedentary control on different days in random order. After each condition, participants' NEPA was recorded for 84 h by accelerometer. Time spent sedentary and in light, moderate, and vigorous physical activity; steps; metabolic equivalent of task (MET)-hours; and sit-to-stand transitions were calculated using activity count data. Results: No differences were observed in the percent of waking time spent sedentary and in light, moderate, and vigorous activity between conditions (P > 0.05). No differences were observed in steps, MET-hours, or sit-to-stand transitions between conditions (P > 0.05). NEPA responses were variable among individuals, with approximately half of participants reducing and half increasing NEPA over the 84 h after each exercise condition. Conclusion: NEPA was not reduced after an acute bout of AEx or REx in a sample of inactive adults with overweight or obesity.

Diabetes and obesity are associated with disability in community-dwelling stroke survivors: A cross-sectional study of 37,955 Behavioral Risk Factor Surveillance System respondents.

PURPOSE: Stroke increases risk for disability. Obesity and diabetes also increase risk for disability in the general population, but their association with disability in stroke survivors is unknown. We examined disability risk associated with obesity and diabetes in stroke survivors across six disability types: hearing, vision, cognition, mobility, and basic and instrumental activities of daily living (ADLs). MATERIALS AND METHODS: Data from 37,955 community-dwelling US stroke survivors aged ≥18 years were analyzed from the 2017 and 2018 Behavioral Risk Factor Surveillance System. Linear regression was used to calculate prevalence of each disability type. Survivors were stratified by obesity versus normal weight and diabetes vs no diabetes, and logistic regression was used to calculate adjusted odds ratios (AOR) for each disability type, adjusted for demographic information. RESULTS: Prevalences of disability types ranged from 14.2% to 36.0%. Among survivors with obesity, odds were elevated for mobility (AOR: 1.68) and basic ADL (AOR: 1.55) disability. Among survivors with diabetes, odds were elevated for all disability types (AOR range: 1.15-1.71). CONCLUSION: Stroke survivors with obesity or diabetes experience increased risk for disability compared to survivors without these chronic conditions. Interventions for managing disability, obesity, and diabetes concomitantly may be warranted and deserve further consideration.

Facilitators and barriers to performing dietary behaviors among chronic community-dwelling stroke survivors: A qualitative secondary analysis.

BACKGROUND: Following a healthy dietary pattern is recommended for secondary stroke prevention, but stroke-related impairments may hinder the performance of dietary behaviors (i.e., accessing, selecting, and preparing food). OBJECTIVE: The purpose of this study was to characterize facilitators and barriers to performing dietary behaviors in stroke survivors. METHODS: We completed a secondary analysis of focus group data using a qualitative descriptive approach and content analysis to examine how 15 chronic (≥ 6 months) community-dwelling stroke survivors and 10 care-partners perceived dietary behavior facilitators and barriers. RESULTS: We identified three key themes. First, changes in body functions/structures (e.g., hemiparesis, balance) result in dietary behavior activity limitations (e.g., difficulty grocery shopping, meal preparation). Second, environmental supports (e.g., care-partners, adaptive equipment) and activity modification (e.g., using pre-cut foods, dining out) are used to overcome dietary behavior limitations. Third, negative affect (e.g., dissatisfaction, frustration) and activity limitations lead to participation limitations (e.g., not being able to perform dietary behaviors independently, not being able to socialize when dining out). CONCLUSIONS: Dietary behaviors are negatively impacted following stroke, but environmental supports and compensatory strategies may be implemented to overcome activity limitations. More research is needed to develop interventions to facilitate dietary behaviors and participation following stroke.

Health Behavior Change Following Stroke: Recommendations for Adapting the Diabetes Prevention Program-Group Lifestyle Balance Program.

Objective. History of stroke increases risk for recurrent stroke, which is a significant issue faced by survivors. The Diabetes Prevention Program-Group Lifestyle Balance (DPP-GLB) program is an effective lifestyle modification intervention for ameliorating cardiovascular risk factors but has not been adapted to account for common stroke-related deficits. The purpose of this study was to determine appropriate adaptations to the DPP-GLB for adults with stroke. Design and Methods. In this phenomenological qualitative study, a total of 15 community-dwelling adults with stroke and 10 care-partners participated in 4 focus groups to review DPP-GLB curriculum materials and provide recommendations for adaptation. Focus groups were recorded and transcribed. Inductive content analysis was used to identify key themes. Results. Three themes were identified. First, physical, cognitive, sensory, and psychosocial stroke-related deficits could affect DPP-GLB participation. Second, existing DPP-GLB characteristics could facilitate participation by adults with stroke. Third, stroke-specific adaptations were recommended, including modified session content and format, adapted physical activity and dietary recommendations, and inclusion of care-partners. Conclusion. Current DPP-GLB content and structure may be insufficient to meet the unique needs of adults with stroke. The suggested adaptations should be incorporated into a stroke-specific curriculum and tested for preliminary efficacy for reducing recurrent stroke risk.

Obesity and diabetes are jointly associated with functional disability in stroke survivors.

BACKGROUND: Stroke is the most common cause of complex disability. Obesity and diabetes increase risk for functional disability in the general population, but their contribution to functional disability in stroke survivors is unknown. OBJECTIVE: To investigate the joint association of obesity and diabetes with functional disability in stroke survivors. METHODS: Cross-sectional data from 34,376 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions). RESULTS: Prevalence of functional disability increased across obesity-diabetes categories in the total sample: neither condition (45.4%, 95% CI: 43.4%-47.4%), obesity only (55.3%, 95% CI: 52.7%-58.0%), diabetes only (60.8%, 95% CI: 57.5%-64.1%), and both conditions (70.3%, 95% CI: 67.7%-72.9%). Compared to respondents with neither condition, those with both obesity and diabetes had 2.62 (95% CI: 2.23-3.08) higher odds for functional disability; odds were also increased for respondents with obesity only (1.52, 95% CI: 1.32-1.76) and diabetes only (1.71, CI: 1.45-2.01). CONCLUSIONS: Our findings indicated a joint effect of obesity and diabetes on functional disability that exceeded either condition alone, placing stroke survivors with both health conditions at greatest risk for diminished functional capacity. Recognizing obesity and diabetes as modifiable risk factors may be useful for identifying stroke sub-populations that could benefit from lifestyle intervention.

A Narrative Review of Handgrip Strength and Cognitive Functioning: Bringing a New Characteristic to Muscle Memory.

BACKGROUND: Measures of handgrip strength have not only emerged as a clinically viable screening tool for determining risk for morbidity, functional disability, and early mortality, but also for helping to identify cognitive deficits. However, the phenomena that links low handgrip strength with cognitive decline remains unclear. The role of the muscular and neural systems, and their adaptations to muscle strengthening activities over the life course, may provide important information for how age-related changes to muscle mass, strength, and neural capacity influence cognition. Moreover, disentangling how handgrip strength and cognitive function are associated may help to inform healthcare providers working with aging adults and guide targeted interventions aiming to preserve muscle and cognitive functioning. OBJECTIVE: To 1) highlight and summarize evidence examining the associations of handgrip strength and cognitive functioning, and 2) provide directions for future research in this area. METHODS: Articles from the PubMed database were searched from November 2018-May 2019. The search term algorithm, inclusion and exclusion criteria were pre-specified by investigators. RESULTS: Several cross-sectional and longitudinal studies have revealed that measures of handgrip strength were associated with cognitive declines regardless of age demographics and the presence of comorbidities. CONCLUSION: Handgrip strength can be used in clinical and epidemiological settings for helping to determine the onset and progression of cognitive impairment. Future research should continue to examine how handgrip strength and cognitive function are linked.

Goal Setting and Action Planning for Health Behavior Change.

Health behavior change is challenging for most individuals, but there are many strategies that individuals can use to facilitate their behavior change efforts. Goal setting is one such strategy that assists individuals to identify specific behaviors to change and how to go about doing so. For many, however, simply setting a goal seldom leads to actual behavior change. For some, identifying an appropriate goal is difficult, while for others, putting goals into action is the roadblock. Two strategies may be of assistance for setting and achieving goals. First, consideration of key goal characteristics (eg, approach vs avoidance goals, performance vs mastery goals, level of difficulty) may result in selection of more appropriate and feasible goals. Second, action planning can help individuals put goals into action. Clinicians can help patients utilize these strategies to set and achieve goals for health behavior change.

Prevalence of five lifestyle risk factors among U.S. adults with and without stroke.

BACKGROUND: History of stroke increases cardiometabolic risk, which can be exacerbated by the presence of unhealthy lifestyle factors. Population-based estimates of lifestyle risk factors in people with stroke are lacking but could be used to inform research, policy, and healthcare practice. OBJECTIVE: To compare population-based estimates of the prevalence of five lifestyle risk factors-low fruit and vegetable consumption, insufficient physical activity, smoking, heavy alcohol consumption, and overweight/obesity-among U.S. adults with and without stroke. METHODS: Representative data from noninstitutionalized adults aged ≥18 years (stroke, n = 37,225; no stroke, n = 851,607) from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate prevalence of individual and total number of risk factors. Logistic regression models were used to determine the odds of lifestyle risk factors in adults with stroke, adjusting for sex, age, ethnicity, marital status, education, income, and disability. RESULTS: Prevalence and adjusted odds ratios (AOR) were higher in individuals with stroke compared to those without stroke for insufficient physical activity (56.5% vs. 49.5%, AOR: 1.14) and smoking (30.1% vs. 16.6%, AOR: 1.16), but lower for heavy alcohol consumption (5.4% vs. 6.1%, AOR: 0.76). Prevalence for low fruit and vegetable consumption (51.7% vs. 46.0%) and overweight/obesity (70.2% vs. 64.5%) was higher among adults with stroke, but differences were attenuated by demographic characteristics. Additionally, clustering of 4-5 lifestyle risk factors was higher in adults with stroke (9.0% vs. 5.3%, AOR: 1.12). CONCLUSION: Additional research and healthcare interventions are needed to improve lifestyle risk factors in adults with stroke.