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

Author(s)

Oliveira, Simone Garcia ; Ribeiro, Jean Alex Matos ; Silva, Erika Shirley Moreira ; Uliam, Nicoly Ribeiro ; Silveira, Ana Flavia ; Araujo, Paloma Nepomuceno ; Camargo, Ana Isabela ; Urruchia, Vitoria Regina Rocha ; Nogueira, Samuel Lourenco ; Russo, Thiago Luiz

• Document type: Journal article
• Source: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION; v. 105, n. 2, p. 30-pg., 2024-02-01.

Abstract

Objective: 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. Data Sources: The PubMed (Medline), EMBASE, Scopus, CINAHL (EBSCO), and Web of Science databases were searched for articles published up to January 3, 2023. Study Selection: 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: Data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed. Data Synthesis: 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 moderatequality 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. Conclusions: 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. Archives of Physical Medicine and Rehabilitation 2024;105:381-410 (c) 2023 by the American Congress of Rehabilitation Medicine. (AU)

• FAPESP's process: 17/25185-4 - The effect of the aerobic exercise associated to the modified constraint-induced movement therapy in chronic hemiparetic individuals: a randomized clinical trial
• Grantee: Erika Shirley Moreira da Silva
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 17/13655-6 - Sedentary behaviour and arterial dysfunction in chronic post-stroke subjects
• Grantee: Thiago Luiz de Russo
• Support Opportunities: Regular Research Grants
• FAPESP's process: 23/00506-3 - MODERADE TO VIGOROUS INTENSITY MULTIMODAL CIRCUIT TRAINING EFFICACY TO INCREASE STEPS PER DAY IN STROKE SURVIVORS: RANDOMIZED CLINICAL TRIAL.
• Grantee: Ana Flávia Silveira
• Support Opportunities: Scholarships in Brazil - Doctorate