How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis

BACKGROUND: Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). PURPOSE: The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). DATA SOURCES: Searches were conducted in 5 databases. STUDY SELECTION: Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. DATA EXTRACTION: One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. DATA SYNTHESIS: Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was >78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). LIMITATIONS: Limitations of this review include not pooling data reported as medians. CONCLUSIONS: Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.