Relationship Between Prolonged Sedentary Bout and Functional Recovery in Patients With Subacute Stroke: A Multicenter Observational Study

OBJECTIVE: To examine the association between the daily count of sedentary bouts ≥60 minutes and activities of daily living (ADL) recovery in nonambulatory patients with subacute stroke. DESIGN: A prospective observational cohort study. SETTING: Convalescent rehabilitation wards in 11 inpatient facilities across Japan. PARTICIPANTS: Patients with subacute stroke admitted between February 2022 and February 2025 who were unable to walk independently at admission but had been independent in ADL before stroke onset (N = 626). A total of 588 participants were analyzed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measurement was the motor subscale of the functional independence measure assessed longitudinally at admission, 1 month after admission, and at discharge. The exposure was the mean daily count of ≥60-minute sedentary bouts measured by triaxial accelerometry during the first week after admission. Linear mixed-effects models were used to examine associations between the mean daily count of ≥60-minute sedentary bouts at admission and the motor subscale of the functional independence measure change over time, adjusting for covariates, including total sedentary time. Exploratory age-stratified analyses (≥65 vs ≤64y) were also conducted. RESULTS: Higher daily count of ≥60-minute sedentary bouts was significantly associated with poorer ADL recovery (β=-1.53; 95% CI]: -2.31 to -0.76; P<.001), independent of total sedentary time. Age-stratified analyses revealed that this association was significant in older adults (β=-1.52; 95% CI: -2.46 to -0.57; P=.002) but not in younger patients (β=-0.73; 95% CI -2.05 to 0.59; P=.278). CONCLUSIONS: In nonambulatory patients with subacute stroke, frequent prolonged sedentary bouts during early rehabilitation were independently associated with poorer ADL recovery, particularly in older adults. Interrupting extended sitting periods may represent a simple, low-cost intervention to support functional recovery in stroke rehabilitation.