Patient experiences of physical activity and inactivity in the stroke unit: an interview study.

OBJECTIVE: Stroke unit care is highly recommended after stroke, but patients in these units are often physically inactive. The aim of this study was to explore patient experiences of physical activity and inactivity in the stroke unit. DESIGN: Qualitative interview study. SUBJECTS: Sixteen participants with stroke; a heterogeneous sample with differences in sex, age, and stroke severity from 8 Swedish stroke units. METHODS: In-depth interviews 1-2 weeks after discharge analysed using thematic analysis. RESULTS: The analysis resulted in three themes: 1: Dealing with the challenges of a changed body while striving to become independent; 2: The stroke unit is crucial for physical activity; and 3: Physical activity is important for interaction with others, autonomy, and feeling seen. Participants described how they coped with a new situation when finding new ways to move and function. In addition, they wanted to be involved in their own stroke rehabilitation. CONCLUSION: The participants expressed the following experiences of being in the stroke unit: movement is more important than physical activity and involves being seen and respected; physical activity and exercise are necessary to achieve independence; process involvement is of importance to regain abilities; physical activity offers the possibility of choosing between community and being alone and influences the ability to connect with others and the outside world.

Sick leave one year after COVID-19 infection: a nationwide cohort study during the first wave in Sweden.

This study aimed to investigate the patterns of sick leave, as well as factors associated with sick leave due to COVID-19 during one year after the COVID-19 diagnosis, and sex-related aspects on sick leave. This nationwide study involved 11,902 individuals who received sickness benefits for COVID-19 during the first wave of the pandemic. Data from three Swedish registries were analyzed for sick leave that commenced between March 1 and August 31, 2020, with a follow-up period of 12 months. Sick leave due to COVID-19 was counted as the number of days with sickness benefits and required to include at least one registered COVID-19 diagnosis. The median duration of sick leave was 35 days, and 347 (2.9%) individuals continued their sick leave during the entire follow-up period. Furthermore, 1 year later, the cumulative incidence of sick leave was slightly higher in males (3.5%) compared to females (2.7%). Older age, being single with no children, diagnosed with the virus, medium income level, history of sick leave, and need for inpatient care were significantly associated with a higher duration of sick leave due to COVID-19, both in the total population and when stratified by sex. These results indicated that three out of 100 (3%) patients were still on sick leave 1 year after their COVID-19 diagnosis. Aspects regarding the importance of sick leave duration differed between males and females and comprised sociodemographic characteristics and need for inpatient care. The results indicated the complexity of sick leave due to COVID-19.

Physical activity, acute severity and long-term consequences of COVID-19: an 18-month follow-up survey based on a Swedish national cohort.

OBJECTIVE: To investigate how changes in levels of physical activity (PA) in regard to acute disease severity relate to perceived difficulties in performing daily life activities 18 months after COVID-19 infection. DESIGN: An observational study with an 18-month follow-up survey based on registry data from a national cohort. PARTICIPANTS: 5464 responders to the 18-month follow-up survey of a Swedish national cohort of 11 955 individuals on sick leave due to COVID-19 during the first wave of the pandemic. OUTCOMES: The follow-up survey included questions on daily life activities, as well as present and retrospective level of PA. Changes in PA level from before COVID-19 to follow-up were assessed by the Saltin-Grimby PA Level Scale and analysed by the Wilcoxon signed-rank test. Comparisons of groups were analysed by the Student's t-test, Mann-Whitney U test and χ2. Multiple binary logistic regression was performed to assess the association of changes in PA with perceived difficulties in performing daily life activities. RESULTS: Among the 5464 responders (45% of national cohort), the PA level decreased. Hospitalised individuals had a lower PA level both prior to COVID-19 (p=0.035) and at the 18-month follow-up (p=0.008) compared with non-hospitalised responders. However, the level of PA decreased in both groups. A decrease in PA level increased the odds (OR 5.58, 95% CI 4.90 to 6.34) of having difficulties performing daily life activities. CONCLUSIONS: PA levels were reduced 18 months after COVID-19 infection. A decrease in PA over that time was associated with perceived difficulties performing daily life activities 18 months after COVID-19. As PA is important in maintaining health and deconditioning takes time to reverse, this decline may have long-term implications for PA and health.

Figuring Out Life After Covid-19: a Qualitative Study From Sweden.

OBJECTIVE: To obtain a deeper understanding of the daily life experiences of working aged people during the year following hospitalization due to SARS-CoV-2 (COVID-19), with a focus on function-ing in daily life and return to work. DESIGN: An explorative qualitative study using individual interviews. SUBJECTS: A purposive sample was selected of persons who had received inpatient hospital care, had been discharged approximately 1 year previously and were of working age. METHODS: Semi-structured interviews were conducted with 11 participants (9 men, 2 women). The interviews were transcribed and analysed with inductive thematic analysis. RESULTS: Four themes were identified. Navigating health, with or without support from healthcare, was described as challenging when managing consequences of COVID-19. Participants struggled with a lack of energy that interfered with daily life. It was a trial-and-error process trying to use familiar strategies in new ways to manage. The return to work process was facilitated by own strategies and support. CONCLUSION: This study contributes increased knowledge of everyday life experiences of people 1 year following hospitalization due to COVID-19. The lack of energy and a struggle to manage health while navigating the healthcare system emphasize the importance of strengthening personal and organizational health literacy to facilitate the recovery process after severe COVID-19.

Understanding concerns after severe COVID-19: A self-imposed lockdown guarded by anxiety?

OBJECTIVE: Many people are struggling to get back to their lives after severe COVID-19. To facilitate their reintegration into everyday life, we need to understand how the process is experienced. We aimed to gain deeper knowledge about this process by interviewing persons one year after hospitalisation due to COVID-19. METHODS: The study is based on a qualitative design, with eleven in-depth interviews conducted one year after discharge for COVID-19. Participants were recruited to form a heterogeneous sample with respect to age, gender and socioeconomic background. All interviews were analysed utilising inductive thematic analysis. RESULTS: From the participants' narratives four themes were identified: 'Concerns and worries in everyday life', 'Supportive and concerned relatives', 'A new way of life-sorrows and advantages' and 'Seize the day-a greater awareness of one´s mortality'. Participants described how they tried to create a functioning everyday life. They were generally afraid of getting COVID-19 again and concerned about future life, where their lack of energy played a major role. Narratives were diverse regarding to what extent the struggle to cope was experienced as emotionally challenging or not. CONCLUSIONS: Participants described an unpredictable recovery after COVID-19, characterised by ups and downs, which created worries concerning their future. In some cases, the worry of getting COVID-19 again was strong enough to keep participants in their homes, as a self-imposed lockdown guarded by anxiety. However, the narratives also revealed gratitude towards being alive and having coped so well. This led to a more positive outlook on life with a greater focus on intrinsic values, close social relations and the deeper meaning of life.

Associations between pre-stroke physical activity levels and health-related quality of life 3 months after stroke: A registry-based study (part of PAPSIGOT).

BACKGROUND: Whether pre-stroke physical activity is associated with health-related quality of life after stroke has been sparsely investigated. AIMS: To explore associations between pre-stroke physical activity and health-related quality of life 3 months after stroke onset. METHODS: A consecutively collected cohort study with data from registries. Included were adult patients with first stroke in the period 2014-2018 who were hospitalized at any one of the three stroke units in Gothenburg, Sweden. Pre-stroke physical activity was assessed with the Saltin-Grimby Physical Activity Level Scale (SGPALS) after hospital admission for acute stroke. Health-related quality of life was assessed with the EuroQoL 5 Dimensions 5 Level Version (EQ-5D-5L) 3 months after stroke. Data were analyzed with the Kruskal-Wallis test and binary logistic regression. RESULTS: Data were included from 2044 patients; 91% had ischemic stroke, 46% were female, and mean age was 73 years, with mild stroke severity median National Institute of Health Stroke Scale (NIHSS) of 2. Patients who were pre-stroke physically active reported better overall health-related quality of life by the EQ-5D-5L index value, all the domains in EQ-5D-5L, and the EuroQoL-Visual Analogue Scale (EQ-VAS) compared with pre-stroke physically inactive patients (all p < 0.001). Better health-related quality of life 3 months after stroke was associated with pre-stroke light and moderate physical activity: adjusted odds ratio (95% confidence interval), 1.9 (1.5-2.3) and 2.3 (1.5-3.4), respectively. CONCLUSION: Pre-stroke physical activity is associated with better health-related quality of life 3 months after stroke. For the domains of mobility, self-care, and pain/discomfort, physical activity with higher intensity is even more beneficial.

Associations of Prestroke Physical Activity With Stroke Severity and Mortality After Intracerebral Hemorrhage Compared With Ischemic Stroke.

BACKGROUND AND OBJECTIVES: Prestroke physical activity may protect the brain from severe consequences of stroke. However, previous studies on this subject included mainly ischemic stroke cases, and the association between prestroke physical activity and outcomes after intracerebral hemorrhage is uncertain. Therefore, we sought to examine the associations between prestroke physical activity, stroke severity, and all-cause mortality after intracerebral hemorrhage in comparison with ischemic stroke. METHODS: This was a longitudinal, register-based cohort study. All adult patients with intracerebral hemorrhage or ischemic stroke admitted to 3 stroke units in Gothenburg, Sweden, between November 1, 2014, and June 30, 2019, were screened for inclusion. Physical activity was defined as light physical activity ≥4 h/wk or moderate physical activity ≥2 h/wk the year before stroke. Stroke severity was assessed on admission using the NIH Stroke Scale. All-cause mortality rates were followed up to 7 years, from the time of incident stroke until death or censoring. Ordinal logit models and Cox proportional hazards models were used to estimate adjusted associations of prestroke physical activity. RESULTS: We included 763 patients with intracerebral hemorrhage and 4,425 with ischemic stroke. Prestroke physical activity was associated with less severe strokes by an adjusted odds ratio of 3.57 (99% CI 2.35-5.47) for intracerebral hemorrhages and 1.92 (99% CI 1.59-2.33) for ischemic strokes. During a median follow-up of 4.7 (interquartile range 3.5-5.9) years, 48.5% of patients with intracerebral hemorrhage died, compared with 37.5% with ischemic stroke. Prestroke physical activity was associated with decreased short-term mortality (0-30 days) by an adjusted hazard ratio of 0.30 (99% CI 0.17-0.54) after intracerebral hemorrhage and 0.22 (99% CI 0.13-0.37) after ischemic stroke. Prestroke physical activity was further associated with decreased long-term mortality (30 days-2 years) by an adjusted hazard ratio of 0.40 (99% CI 0.21-0.77) after intracerebral hemorrhage and 0.49 (99% CI 0.38-0.62) after ischemic stroke. DISCUSSION: Prestroke physical activity was associated with decreased stroke severity and all-cause mortality after intracerebral hemorrhage and ischemic stroke, independent of other risk factors. Based on current knowledge, health care professionals should promote physical activity as part of primary stroke prevention.

Back to life: Is it possible to be myself again? A qualitative study with persons initially hospitalised due to COVID-19.

OBJECTIVE: To gain a deeper understanding of the lived experiences of patients with COVID-19, regarding rehabilitation, work and social life 6 months after hospital discharge. DESIGN: An explorative qualitative study with individual interviews. SUBJECTS: Patients of working age with persistent self-reported symptoms at a 3-month follow-up who had received inpatient hospital care with discharge approximately 6 months previously were purposively sampled. METHODS: Semi-structured interviews were performed with 10 men and 5 women. The interviews were transcribed verbatim and analysed with inductive thematic analysis. RESULTS: Four themes were identified: "Social support - crucial, but decreased over time", "Varying needs of, and access to, rehabilitation", "Returning to work after COVID-19 - crucial for future prospects" and "An overwhelming experience that essentially changed one's personality". CONCLUSION: Rehabilitation provided participants with the valuable tools for recovery, giving them hope for future recovery. Support from next of kin was highly valued, creating stronger family bonds. A new meaning and greater appreciation of life was expressed.

Recovering from COVID-19 - A Process Characterised by Uncertainty: A Qualitative study.

OBJECTIVE: To obtain a deeper understanding of the lived experiences of patients with COVID-19, the recovery process and consequences for everyday life 6 months after hospital discharge. DESIGN: An explorative qualitative study using individual interviews. SUBJECTS: A purposive sampling was applied to recruit persons who had received inpatient hospital care, were discharged approximately 6 months previously, were of working age and had persistent self-reported symptoms at a 3-month follow-up appointment. METHODS: Semi-structured interviews were conducted with 15 participants (10 men, 5 women), which were then transcribed and analysed with inductive thematic analysis. RESULTS: Three themes were identified: "Status of recovery - two steps forward, one step back", "Remaining symptoms caused limitations in everyday life" and "Strategies for recovery". Participants indicated the recovery process through 6 months after discharge was a challenging road, often involving setbacks. A wide range of persistent, fluctuating, or new symptoms negatively impacted many areas of daily life, with fatigue and lack of energy being especially prominent. Participants used a variety of strategies to cope and recover. CONCLUSION: This study increases our knowledge of the lived experiences of COVID-19 based individual experiences. Unexpected symptoms in the recovery process were described and not always possible to forecast.

Self-Assessed Aspects of Health 3 Months after COVID-19 Hospitalization-A Swedish Cross-Sectional Study.

It is not yet fully understood how the patients self-assess their overall health in the early recovery after COVID-19 and if certain patient groups are more prominent in perceived long-time effects of COVID-19. The aim of this study was to describe self-assessed aspects of health in body function, activity and participation 3 months after hospitalization due to COVID-19 and identify difference between groups depending in age, sex and level of hospital care. This cross-sectional study consists of self-assessed aspects of health and recovery in 168 participants (mean age 64 years old, 69% men) previously hospitalized patients due to COVID-19. We have previously published data, from hospital discharge, on this cohort were predominantly the older patients and previous ICU-treated participants were affected. In this study there were differences in between groups. Of the study population 72% perceived fatigue, 64% respiratory difficulties, 37% perceived symptoms of anxiety. Three-months after COVID-19 this cohort was overall still affected. The recovery process is multifaced and the cohort heterogeneous, hence the rehabilitation needs to be highly individualized, and the follow-up of this patient group is of importance regardless of age, sex and previous level of hospital care.

A register-based study on associations between pre-stroke physical activity and cognition early after stroke (part of PAPSIGOT).

The objective was to investigate if pre-stroke physical activity is associated with intact cognition early after stroke. The study design was a cross-sectional, register-based study. The study sample included 1111 adults with first stroke (mild or moderate severity) admitted to three Swedish stroke units. The main outcome was cognition. The associations of pre-stroke physical activity, age, sex, smoking, diabetes, atrial fibrillation, previous TIA, statin treatment, hypertension treatment, reperfusion therapies, stroke severity, and education on the outcome cognition were analyzed using binary logistic regression. Physical activity was assessed within 48 h of admittance, and cognition was screened during stroke unit care. The results were: mean age 70 years, 40% women, 61% pre-stroke physically active, and 53% with post-stroke cognitive impairment. Patients with pre-stroke light or moderate physical activity have higher odds for intact cognition compared to inactive: odds ratio (95% confidence interval) 1.32 (0.97-1.80) and 2.04 (1.18-3.53), respectively. In addition to pre-stroke physical activity, people with younger age, a higher level of education, less severe stroke (more mild than moderate), being non-diabetic, and non-smoking have higher odds for intact cognition. In conclusion physical activity before stroke is associated with intact cognition in patients with mild and moderate stroke.

Pre-stroke physical activity in relation to post-stroke outcomes - linked to the International Classification of Functioning, Disability and Health (ICF): A scoping review.

OBJECTIVE: This scoping review aims to identify how pre-stroke physical activity (PA) has been studied in relation to outcomes after stroke using the ICF framework. METHODS: MEDLINE, CINAHL, Scopus, and grey literature databases were systematically searched from inception to March 15, 2021, with no language restrictions. Risk of bias was evaluated for all included studies. Identified outcome measures were linked to ICF components using linking rules, and the main findings were summarized. RESULTS: Of 3664 records screened, 35 studies were included. The risk of bias was graded as moderate to critical for all studies. There were 60 unique outcome measures studied in relation to pre-stroke PA, covering the hyper acute to chronic phases of stroke recovery. Outcome measures linked to body functions were most common (n=19), followed by activities and participation (n=14), body structures (n=7), environmental factors (n=4) and personal factors (n=2). There were large differences in assessments of pre-stroke PA, and only one study analysed haemorrhagic cases separately. CONCLUSIONS: Pre-stroke PA has been studied in relation to all components in the ICF framework.  However, this review highlights the high risk of bias, heterogeneity in pre-stroke PA assessments, and the lack of information regarding haemorrhagic strokes in the current literature.

Physical Function, Cognitive Function, and Daily Activities in Patients Hospitalized Due to COVID-19: A Descriptive Cross-Sectional Study in Sweden.

An estimated 14-20% of people infected with COVID-19 require medical care. The aim of the present study was to evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU). This prospective descriptive cross-sectional study included a consecutive sample of 211 patients (mean age 65.1 years, 67.3% men) hospitalized due to COVID-19 in Sweden. Data regarding physical function and daily activities were collected in hospital from July 2020 to February 2021. The average length of hospital stay was 33.8 days, and 48.8% of the patients were admitted to the ICU. Physical function (grip- and lower body strength) was reduced in both groups, and significantly more in the older group, ≥65 years old, compared to the younger. Furthermore, the older group also had significantly less ability to perform activities in daily life, and had significantly reduced cognitive function as compared to the younger age group. In patients treated in the ICU, physical impairments as well as the activity level were significantly more pronounced compared to patients not treated in the ICU. Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities. The findings in this study indicate the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially in older patients and patients treated in the ICU.

Recurrent sick leave after COVID-19: investigating the first wave of the pandemic in a comprehensive Swedish registry-based study.

BACKGROUND: Sick-leave due to COVID-19 vary in length and might lead to re-current episodes. The aim was to investigate recurrent sick leave due to COVID-19 during the first wave. METHODS: This is a registry-based cohort study. The study comprises all people with sickness benefit due to COVID-19 in Sweden in March 1-August 31, 2020. Data from the Swedish Social Insurance Agency, the Swedish National Board of Health and Welfare, and Statistics Sweden were merged. RESULTS: Within the follow-up period of 4 months, 11,955 people were subject to sickness benefit due to COVID-19, whereof 242 people (2.0%) took recurrent sick leave due to COVID-19, and of those 136 (56.2%) remained on sick leave at the end of follow-up. People with recurrent sick leave were older, more often women, and more likely to have been on sick leave prior to the COVID-19 pandemic. CONCLUSION: A group of people presented with recurrent sick leave due to COVID-19. For half of them, the second sick leave lasted throughout the follow-up. People with recurrent sick leave differ in several aspects from those with shorter sick leave. To capture long-term sick-leave patterns due to COVID-19, a longer period of follow-up is needed.

Women with Fibromyalgia Prefer Resistance Exercise with Heavy Loads-A Randomized Crossover Pilot Study.

Fibromyalgia (FM) is a chronic pain condition associated with impaired muscle strength and exercise-induced pain. Physical exercise has been highlighted, by international clinical guidelines and stakeholders, as an essential component of rehabilitation in FM. Exposure to pain during exercise is generally correlated with elevated lactate levels and, additionally, is one known reason for persons with FM to avoid physical exercise and activity. A crossover design was used to test and evaluate an approach consisting of resistance exercise with heavy loads and a low number of repetitions among ten women with FM. The participants were consecutively recruited to test and perform exercise with two different resistance levels (A = light/moderate load, and B = heavy load) in a randomized crossover trial using an AB/BA setting. Results showed that the heavy load exercise session was experienced as more positive than the light/moderate load exercise session and that lower lactate levels followed exercise with heavier weight loads. This is promising and indicates that the approach of heavy weight loads and accustomed repetitions is accepted in FM and has the potential to attenuate hesitation to exercise due to exercise-induced pain. However, these effects need to be further investigated in more extensive studies.

Patterns and predictors of sick leave after Covid-19 and long Covid in a national Swedish cohort.

BACKGROUND: The impact of Covid-19 and its long-term consequences is not yet fully understood. Sick leave can be seen as an indicator of health in a working age population, and the present study aimed to investigate sick-leave patterns after Covid-19, and potential factors predicting longer sick leave in hospitalised and non-hospitalised people with Covid-19. METHODS: The present study is a comprehensive national registry-based study in Sweden with a 4-month follow-up. All people who started to receive sickness benefits for Covid-19 during March 1 to August 31, 2020, were included. Predictors of sick leave ≥1 month and long Covid (≥12 weeks) were analysed with logistic regression in the total population and in separate models depending on inpatient care due to Covid-19. RESULTS: A total of 11,955 people started sick leave for Covid-19 within the inclusion period. The median sick leave was 35 days, 13.3% were on sick leave for long Covid, and 9.0% remained on sick leave for the whole follow-up period. There were 2960 people who received inpatient care due to Covid-19, which was the strongest predictor of longer sick leave. Sick leave the year prior to Covid-19 and older age also predicted longer sick leave. No clear pattern of socioeconomic factors was noted. CONCLUSIONS: A substantial number of people are on sick leave due to Covid-19. Sick leave may be protracted, and sick leave for long Covid is quite common. The severity of Covid-19 (needing inpatient care), prior sick leave, and age all seem to predict the likelihood of longer sick leave. However, no socioeconomic factor could clearly predict longer sick leave, indicating the complexity of this condition. The group needing long sick leave after Covid-19 seems to be heterogeneous, indicating a knowledge gap.

Transforming self-reported outcomes from a stroke register to the modified Rankin Scale: a cross-sectional, explorative study.

The aim was to create an algorithm to transform self-reported outcomes from a stroke register to the modified Rankin Scale (mRS). Two stroke registers were used: the Väststroke, a local register in Gothenburg, Sweden, and the Riksstroke, a Swedish national register. The reference variable, mRS (from Väststroke), was mapped with seven self-reported questions from Riksstroke. The transformation algorithm was created as a result of manual mapping performed by healthcare professionals. A supervised machine learning method-decision tree-was used to further evaluate the transformation algorithm. Of 1145 patients, 54% were male, the mean age was 71 y. The mRS grades 0, 1 and 2 could not be distinguished as a result of manual mapping or by using the decision tree analysis. Thus, these grades were merged. With manual mapping, 78% of the patients were correctly classified, and the level of agreement was almost perfect, weighted Kappa (Kw) was 0.81. With the decision tree, 80% of the patients were correctly classified, and substantial agreement was achieved, Kw = 0.67. The self-reported outcomes from a stroke register can be transformed to the mRS. A mRS algorithm based on manual mapping might be useful for researchers using self-reported questionnaire data.

Differences in self-perceived general health, pain, and depression 1 to 5 years post-stroke related to work status at 1 year.

Stroke is one of the most common diseases and has several potential consequences, such as psychological problems and pain. Return to work (RTW) after stroke in working-age individuals is incomplete. The present study aimed to investigate differences in self-perceived general health, pain, and depression between 1 and 5 years post-stroke related to RTW status. The study was nationwide, registry-based and the study population (n = 398) consisted of working-age people who had a stroke in 2011 and participated in 1-year and 5-year follow-up questionnaire surveys. Shift analyses with the Wilcoxon signed rank test and logistic regression were used. RTW within the first year post-stroke was associated with better self-perceived general health, less pain, and less depression both at 1 and 5 years post-stroke, compared with the no-RTW group. However, the RTW group had significant deterioration in general health and pain between 1 and 5 years, while the no-RTW group had no significant change. RTW was a significant predictor of lower odds of improvement in general health and pain between 1 and 5 years. This emphasizes the need for continued follow-up and support to ensure a balance between work and health for RTW individuals after stroke.

Levels of physical activity in acute stroke patients treated at a stroke unit: A prospective, observational study.

OBJECTIVE: A prospective, observational study to describe levels of physical activity in patients with stroke on day 2 and day 5 or 6 after admission to a comprehensive stroke unit in Sweden. METHODS: The study was performed at the stroke unit at Sahlgrenska University Hospital during a period of 4 months between 2017 and 2018. Consecutive patients with stroke were observed for 1 min every 10 min while the multidisciplinary team was at work. The level of physical activity, location and the people present were noted at each time-point. RESULTS: A total of 46 patients were observed on day 2, of whom 29 were observed a second time on day 5 or 6. Patients were in bed half of the time and engaged in upright activity for less than 10% of day 2. Patients spent 73% of day 2 in the bedroom and 56% of this day alone. Over time, there was a significant shift of 10% from "in bed" activity to "sitting" (p §lt;0.001). CONCLUSION: Patients are physically inactive, alone and in their rooms for a majority of the time during the first days at a comprehensive stroke unit. There is some increase in physical activity during the first week after admission.