Physical Activity Behavior and Its Association With Global Cognitive Function Three Months After Stroke: The Nor-COAST Study†.

OBJECTIVE: The purposes of this study were to determine the association between physical activity (PA) behavior and global cognitive function 3 months after stroke and to explore the role of physical capacity as a mediating factor. METHODS: Participants with stroke were successively recruited at 5 different hospitals in Norway. PA was measured using accelerometers, with a follow-up period of 7 consecutive days, and global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). The general pattern of PA and the percentage of participants adhering to World Health Organization PA recommendations (at least 150 minutes of moderate-intensity aerobic PA per week) were investigated using descriptive statistics. Multiple regression and mediator analyses were used to examine the relationship between PA behavior and MoCA scores; physical capacity, measured with the Short Physical Performance Battery, served as the mediating variable. RESULTS: A total of 193 women (42.6%) and 260 men (57.4%) with a median age of 73.7 years (25th and 75th percentiles = 65.8 and 80.4, respectively) and a median MoCA score of 25 points (25th and 75th percentiles = 22 and 27, respectively) were included. Mean total time spent walking at moderate intensity was 251.7 (SD = 164.6) min/wk (mean bout length = 20.9 [SD = 7.3] seconds), which indicated 69.3% adherence to World Health Organization guidelines. With each point decrease in the MoCA score, there was an expected 8.6% increase in the odds of nonadherence to PA recommendations. Physical capacity was identified as an important mediating factor, explaining the strength of the association between cognition and PA behavior. CONCLUSIONS: In contrast to previous research, in the present study, most participants adhered to the updated global PA guidelines. However, people who had survived stroke and had reduced cognitive function were at higher risk of inactivity, an association mediated by physical capacity. IMPACT: A better understanding of the association between cognition and PA behavior after stroke might help for developing more targeted early-onset interventions.

Correction to: Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study.

The original version of this article.

Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study.

BACKGROUND: Early mobilization has been an important part of acute stroke unit treatment. However, early and intense mobilization within the first 24 h post stroke may cause an unfavorable outcome. Recently, objective measurements using body-worn sensors have been applied, enabling continuous monitoring of physical activity in the hospital setting. This study aimed to use body-worn sensors to quantify the amount of physical activity and how activity levels changed over time during hospitalization in patients with acute stroke. We also wanted to investigate which factors were associated with upright and sitting activity. METHODS: This was a prospective study including patients admitted to hospital within seven days after onset of stroke. Physical activity was measured by two sensors (ActivPALs from PAL Technologies Ltd., Glasgow, UK), one attached on sternum and one on the thigh of the unaffected side, monitoring continuously from inclusion until discharge. Data were processed in Matlab R 2015B and provided information about daily time in lying, sitting, and upright positions, and daily average duration of sitting and upright bouts. A linear mixed model was used to analyze changes over time. RESULTS: 58 patients were included (31 women, mean (SD) age; 75.1 (12.0)). Patients were hospitalized for 12.1 (7.6) days and had a mean score on the National Institute of Health Stroke Scale of 6.2 (5.5) points. Time spent sitting and time spent upright increased per day during hospitalization by 22.10 min (95% Confidence interval (CI): 14.96, 29.24) and 3.75 min (95% CI: 1.70, 5.80) respectively. Increased time upright was associated with improved Modified Rankin Scale scores (- 38.09 min, 95% CI: -61.88, - 14.29) and higher Short Physical Performance Battery scores (6.97 min, 95% CI: 1.99, 11.95), while prolonged bouts of sitting were associated with more severe stroke (4.50 min, 95% CI: 0.80, 8.19), and older age (1.72 min, 95% CI: 0.20, 3.26). CONCLUSIONS: Patients increased their daily time spent sitting and upright during the initial hospital stay after stroke. Prolonged bouts of sitting were associated with older age and more severe strokes. Hence future research should investigate the benefit of interventions aimed at breaking up sitting time after stroke.

Exercise patterns in older adults instructed to follow moderate- or high-intensity exercise protocol - the generation 100 study.

BACKGROUND: Making older adults exercise and keeping them in exercise programs is a major challenge. Understanding how older adults prefer to exercise may help developing tailored exercise programs and increase sustained exercise participation in ageing populations. We aimed to describe exercise patterns, including frequency, intensity, type, location and social setting of exercise, in older adults instructed to follow continuous moderate-intensity training (MCT) or high-intensity interval training (HIIT) over a one-year period. METHODS: Frequency, intensity, type, location and social setting (alone vs. together with others) of exercise were assessed using exercise logs from 618 older adults (aged 70-77 years) randomized to MCT or HIIT. All participants completed exercise logs after each exercise session they performed during one year. Pearson Chi-square tests were run to assess the association between intensity, type, location and social setting of exercise with training group. RESULTS: Both groups performed 2.2 ± 1.3 exercise sessions per week during the year. Walking was the most common exercise type in both groups, but MCT had a higher proportion of walking sessions than HIIT (54.2% vs. 41.1%, p < 0.01). Compared to MCT, HIIT had a higher proportion of sessions with cycling (14.2% vs. 9.8%, p < 0.01), combined endurance and resistance training (10.3% vs. 7.5%, p < 0.01), jogging (6.5% vs. 3.2%, p < 0.01) and swimming (2.6% vs. 1.7%, p < 0.01). Outdoors was the most common exercise location in both training groups (67.8 and 59.1% of all sessions in MCT and HIIT, respectively). Compared to MCT, HIIT had a higher proportion of sessions at a gym (21.4% vs. 17.5%, p < 0.01) and sports facility (9.8% vs. 7.6%, p < 0.01). Both groups performed an equal amount of sessions alone and together with others, but women had a higher proportion of sessions together with others compared to men (56% vs. 44%, p < 0.01). CONCLUSION: This is the first study that has followed older adults instructed to perform MCT or HIIT over a one-year period, collected data from each exercise session they performed and provided important knowledge about their exercise patterns. This novel information may help researchers and clinicians to develop tailored exercise programs in an ageing population.

Exergaming in Older Adults: Movement Characteristics While Playing Stepping Games.

Despite frequent use of exergames in intervention studies to improve physical function in older adults, we lack knowledge about the movements performed during exergaming. This causes difficulties for interpreting results of intervention studies and drawing conclusions about the efficacy of exergames to exercise specific functions important for the elderly population. The aim of the current study was to investigate whether game and game level affect older adults' stepping and upper body movements while playing stepping exergames. A 3D-motion capture experiment was performed with 20 elderly (12 women and 8 men; age range 65-90 years), playing two exergames, The Mole from SilverFit and LightRace in YourShape: Fitness Evolved, on two difficulty levels, with five 1-min trials for each game and level. Reflective markers were placed on bases of first toe, heels, and lower back. Movement characteristics were analyzed with a linear mixed model. Results indicated that both game and game level affected movement characteristics. Participants took shorter steps and had lower step velocity when playing The Mole compared to LightRace, while The Mole prompted more variation in step length and step velocity. Compared to LightRace, The Mole elicited larger upper body movements in both ML- and AP-directions and participants' feet and upper body covered a larger area. Increasing difficulty level from Easy to Medium resulted in overall decrease of movement, except for number of steps and step speed when playing LightRace. Even with only two games, two levels, and five trials at each, this study indicates that the choice of exergame is not indifferent when aiming to exercise specific functions in older adults and that exergames need to be chosen and designed carefully based on the goals of the intervention.