PHYSICAL INACTIVITY AFTER STROKE: INCIDENCE AND EARLY PREDICTORS BASED ON 190 INDIVIDUALS IN A 1-YEAR FOLLOW-UP OF THE FALL STUDY OF GOTHENBURG

ObjectiveTo determine the incidence of physical inactivity and factors prior to stroke and in acute stroke that are associated with physical inactivity 1 year after strokeDesignProspective longitudinal cohortPatientsA total of 190 consecutively included individuals with acute strokeMethodsA follow-up questionnaire, relating to physical activity level using the Saltin-Grimby Physical Activity Scale, was sent to participants in the Fall Study of Gothenburg 1 year after stroke. Predictors of physical inactivity at baseline were identified using univariable and multivariable logistic regression analyses.ResultsPhysical inactivity 1 year after stroke was reported by 70 (37%) of the 190 patients who answered the questionnaire and was associated with physical inactivity before the stroke, odds ratio (OR) 4.07 (95% confidence interval (95% CI) 1.69–9.80, p = 0.002); stroke severity (assessed by National Institutes of Health Stroke Scale (NIHSS), score 1–4), OR 2.65 (95% CI) 1.04–6.80, p = 0.042) and fear of falling in acute stroke, OR 2.37 (95% CI 1.01–5.60, p = 0.048).ConclusionAlmost 4 in 10 participants reported physical inactivity 1 year after stroke. Physical inactivity before the stroke, stroke severity and fear of falling in acute stroke are the 3 main factors that predict physical inactivity 1 year after stroke.LAY ABSTRACTAfter a stroke, there is a risk of becoming physically inactive, which could affect one’s health. In order to create a rehabilitation plan with individualized preventive actions and interventions against physical inactivity, it is important, early after stroke onset, to identify patients who are at risk of becoming physically inactive. Previous studies of the early prediction of physical inactivity are few in number, with small sample sizes. This research on 190 individuals describes which factors prior to and in acute stroke (which is the first week after stroke) are associated with physical inactivity 1 year after stroke. The results showed that physical inactivity before stroke, stroke severity, and a fear of falling in acute stroke are associated with physical inactivity 1 year after stroke.Key words: stroke, physical activity, rehabilitation

Physical activity has been defined by the World Health Organization (WHO) as ”any bodily movement produced by skeletal muscles that requires energy expenditure” (1). In November 2020, the WHO published updated guidelines for physical activity with the key message that we should become more physically active, regardless of age and function. According to these new guidelines, at least 150–300 min of accumulated physical activity of moderate to vigorous intensity every week are recommended for adults. As physical activity affects our bodies and minds, with a beneficial outcome for all ages and variabilities, these guidelines are important (2). However, 25% of adults worldwide have been reported not to be physically active enough (3). As a result, after a stroke, compliance with the guidelines for physical activity can be even more difficult and the risk of becoming physically inactive can be greater compared with those who have not had a stroke (4–10). A review of 26 studies showed that balance (postural control), degree of physical fitness and walking ability are associated with a higher physical activity level after stroke (4). The sample sizes in the review were generally small, with an age range of 65–75 years. In some studies, the inclusion of the participants was not reported or occurred long after stroke onset (4). In a more recent meta-analysis, physical inactivity was associated with higher age, male sex, low physical function, depression, fatigue, low self-efficacy and poor quality of life (11). However, in only 7 of the 21 studies included, the main aim was to study physical activity level (11). In a small study based on 77 individuals, functional dependence, older age and previous low physical activity level were found to be early determinants of physical inactivity 1 year after stroke (12). The primary driver of this study was to target the knowledge gap related to small sample sizes and few studies based on early prediction, to confirm previous analyses, to increase the confidence in estimates, and to reduce the uncertainty. To enable the early identification of individuals at risk of becoming physically inactive post-stroke and to create individualized rehabilitation plans with preventive actions and interventions against physical inactivity, finding the determinants of physical inactivity is of great clinical interest.The aim of this study was to determine the incidence of physical inactivity and factors prior to stroke and in acute stroke that are associated with the occurrence of physical inactivity 1 year after stroke. Based on previous research on the early prediction of physical inactivity 6 months after stroke, established in parts of the current population, we hypothesized that a low physical activity level prior to the stroke, stroke severity, the number of drugs and impaired postural control in acute stroke are associated with physical inactivity 1 year post-stroke (13).