Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke

Mari Gunnes; Bent Indredavik; Birgitta Langhammer; Stian Lydersen; Hege Ihle-Hansen; Anne Eitrem Dahl; Torunn Askim; LAST Collaboration group

doi:10.1016/j.apmr.2019.04.023

Associations Between Adherence to the Physical Activity and Exercise Program Applied in the LAST Study and Functional Recovery After Stroke

Arch Phys Med Rehabil. 2019 Dec;100(12):2251-2259. doi: 10.1016/j.apmr.2019.04.023. Epub 2019 Jul 30.

Authors

Mari Gunnes¹, Bent Indredavik², Birgitta Langhammer³, Stian Lydersen⁴, Hege Ihle-Hansen⁵, Anne Eitrem Dahl⁶, Torunn Askim⁷; LAST Collaboration group

Affiliations

¹ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, Trondheim University Hospital, Trondheim, Norway. Electronic address: [email protected].
² Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, Trondheim University Hospital, Trondheim, Norway.
³ Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway; Sunnaas Rehabilitation Hospital, HF, Nesoddtangen, Norway.
⁴ Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Oslo, Norway; Department of Medicine, Oslo University Hospital, Oslo, Norway.
⁶ Department of Physiotherapy, Clinical Services, Trondheim University Hospital, Trondheim, Norway.
⁷ Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

PMID: 31374191
DOI: 10.1016/j.apmr.2019.04.023

Abstract

Objective: To investigate the associations between participants' adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion.

Design: Secondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST).

Setting: Primary health care services in 3 Norwegian municipalities.

Participants: Of 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.

Intervention: Monthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise.

Main outcome measures: The 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.

Results: The 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).

Conclusions: Increased 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.

Trial registration: ClinicalTrials.gov NCT01467206.

Keywords: Exercise; Patient compliance; Rehabilitation; Stroke rehabilitation.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Aged, 80 and over
Exercise Therapy / methods*
Female
Humans
Male
Middle Aged
Motor Skills
Patient Compliance / statistics & numerical data*
Physical Functional Performance
Physical Therapy Modalities
Postural Balance
Recovery of Function
Residence Characteristics
Sex Factors
Single-Blind Method
Stroke Rehabilitation / methods*
Trauma Severity Indices

Associated data

ClinicalTrials.gov/NCT01467206