Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke |
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| Authors: | Mari Gunnes Bent Indredavik Birgitta Langhammer Stian Lydersen Hege Ihle-Hansen Anne Eitrem Dahl Torunn Askim |
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| Institution: | 1. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway;2. Stroke Unit, Department of Internal Medicine, Trondheim University Hospital, Trondheim, Norway;3. Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway;4. Sunnaas Rehabilitation Hospital, HF, Nesoddtangen, Norway;5. Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway;6. Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Oslo, Norway;7. Department of Medicine, Oslo University Hospital, Oslo, Norway;8. Department of Physiotherapy, Clinical Services, Trondheim University Hospital, Trondheim, Norway |
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| Abstract: | ObjectiveTo investigate the associations between participants’ adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion.DesignSecondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST).SettingPrimary health care services in 3 Norwegian municipalities.ParticipantsOf the participants enrolled (N=380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 ± 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale<8) and 2.7% with moderate (8-16 on the National Institutes of Health Stroke Scale) stroke.InterventionMonthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise.Main Outcome MeasuresThe primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants’ training diaries and physiotherapists’ reports.ResultsThe relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P≤.026).ConclusionsIncreased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research. |
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| Keywords: | on behalf of the Exercise Patient compliance Rehabilitation Stroke rehabilitation 6MWT 6-minute walk test BBS Berg Balance Scale LAST Life After Stroke MAS Motor Assessment Scale MMSE Mini-Mental State Examination mRS modified Rankin Scale SIS Stroke Impact Scale TUG Timed Up and Go test |
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