Many stroke survivors don't follow recommendations for physical activity, study finds
Survey data found that overall rates of adherence to 2011, 2014, and 2021 physical activity guidelines for stroke survivors were 78.1%, 42.1%, and 69.9% among stroke survivors who were independently mobile, with those ages 65 years and older more likely to adhere to recommendations than younger survivors when the 2021 guidelines were used as a benchmark.
Patients who have had a stroke often do not follow recommendations for engaging in physical activity, a recent study found.
Researchers used 2011 to 2019 data from the Behavioral Risk Factor Surveillance System to evaluate adherence to physical activity recommendations among U.S. stroke survivors and compare them to survivors of myocardial infarction (MI) and healthy adults. Activity benchmarks for stroke survivors were taken from the 2011, 2014, and 2021 American Heart Association/American Stroke Association (AHA/ASA) guidelines on secondary stroke prevention, while those for MI survivors and healthy adults were taken from the AHA's 2011 guideline for secondary prevention of coronary vascular diseases and the 2020 World Health Organization's physical activity guidelines, respectively.
For stroke survivors, the 2011 AHA/ASA guidelines recommended at least 30 minutes of moderate to vigorous physical activity one to three times a week; the 2014 guidelines recommended three to four weekly sessions of moderate to vigorous physical activity, each lasting an average of 40 minutes; and the 2021 guidelines recommended 10 minutes of moderate physical activity four times per week or 20 minutes of vigorous activity twice a week.
For MI, the 2011 AHA guideline recommended 30 to 60 minutes of moderate to vigorous physical activity at least five times per week, and for healthy adults, the 2020 World Health Organization guidelines recommended 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity physical activity weekly. Adherence to recommendations was assessed by self-report of intensity, duration, and frequency of physical activity. The results were published Dec. 5 by Stroke.
The study included 48,222 stroke survivors, 49.1% women and 47.5% at least 65 years of age. Sixty-eight percent identified as White, 15.2% identified as Black, and 10% identified as Hispanic. Almost a quarter (23.3%) lived in the “stroke belt” (Alabama, Arkansas, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia), 8.1% had no health insurance, and 18.8% had not graduated from high school.
Overall rates of adherence to the 2011, 2014, and 2021 physical activity guidelines were 75.4%, 40.2%, and 69.2% among all stroke survivors and 78.1%, 42.1%, and 69.9% among stroke survivors who were independently mobile. In comparison, adherence to physical activity recommendations was 42.7% among MI survivors and 72% among healthy adults. Stroke survivors who were ages 65 years and older were more likely to adhere to recommendations than younger survivors when the 2021 activity recommendations were used as a benchmark (71.9% vs. 62.3%; P<0.0001).
When the researchers adjusted for sociodemographic factors and comorbid conditions, non-Hispanic Black stroke survivors were less likely to adhere to recommendations (adjusted odds ratio, 0.81; 95% CI, 0.7 to 0.94) and older stroke survivors and those with more formal education were more likely to adhere. Adherence was also lower in the stroke belt versus in other areas of the U.S. (63.5% vs. 67.9%; P<0.0001) and in nonrural versus rural areas (53.8% vs. 58.7%; P<0.0001). Patients who were stroke or MI survivors were less likely to adhere to physical activity recommendations than healthy adults (adjusted odds ratios, 0.74 [95% CI, 0.69 to 0.8] and 0.24 [95% CI, 0.22 to 0.26], respectively).
The data used in this study were from volunteers, did not include stroke survivors living in institutional settings, and may have included overestimates of physical activity due to self-report, among other limitations. The researchers concluded that based on their results, a substantial number of U.S. patients who have survived a stroke do not meet recommendations for physical activity, underscoring the need for tailored interventions. “Targeting population groups such as non-Hispanic Black stroke survivors with lower levels of education is crucial when designing interventions,” they wrote. “In addition, it is essential to consider how target populations may shift with changing guidelines.”