Interventions to Change Movement Behaviors After Stroke: A Systematic Review and Meta-analysis

• Published in: Archives of physical medicine and rehabilitation Vol. 105; no. 2; pp. 381 - 410
• Main Authors: Oliveira, Simone Garcia, Ribeiro, Jean Alex Matos, Silva, Érika Shirley Moreira, Uliam, Nicoly Ribeiro, Silveira, Ana Flávia, Araújo, Paloma Nepomuceno, Camargo, Ana Isabela, Urruchia, Vitoria Regina Rocha, Nogueira, Samuel Lourenço, Russo, Thiago Luiz
• Format: Journal Article
• Language: English
• Published: United States 01.02.2024
• Subjects: Sedentary behavior; Stroke; Exercise; Physical activity; Ambulatory monitoring; Rehabilitation; Activity monitoring
• ISSN: 0003-9993; 1532-821X; 1532-821X
• DOI: 10.1016/j.apmr.2023.07.011

This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in individuals with stroke. The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023. The StArt 3.0.3 BETA software was used to screen titles, abstracts, and full texts for studies with randomized controlled trial designs; individuals with stroke (≥18 years of age); interventions aimed at increasing PA or decreasing SB; and objective measurement instruments. Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed. Twenty-eight studies involving 1855 patients were included. Meta-analyses revealed that in the post-stroke acute/subacute phase, exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P=.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=0.68, P=.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (SMD (low-intensity physical activity)=0.36, P=.02; SMD (MVPA)=0.56, P=.0004) and decreased SB with low-quality evidence (SMD=0.48, P=.03). In the post-stroke chronic phase, there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P=.002). In general, the risk of bias in the included studies was low. In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps.