Samenvatting

Stroke is the second most common cause of death and the third leading cause of disability worldwide,1,2 with the burden expected to increase during the next 20 years.1 Almost 40% of the people with stroke have a recurrent stroke within 10 years,3 making secondary prevention vital.3,4 High amounts of sedentary time have been found to increase the risk of cardiovascular disease,5–11 particularly when the sedentary time is accumulated in prolonged bouts.12–15 Sedentary behavior, is defined as “any waking behavior characterized by an energy expenditure ≤1.5 Metabolic Equivalent of Task (METs) while in a sitting, reclining or lying posture”.16,17 Studies in healthy people, as well as people with diabetes and obesity, have shown that reducing the total amount of sedentary time and/or breaking up long periods of uninterrupted sedentary time, reduces metabolic risk factors associated with cardiovascular disease.6,9,10,12–15 Recent studies have shown that people living in the community after stroke spend more time each day sedentary, and more time in uninterrupted bouts of sedentary time compared to age-matched healthy peers.18–20 Reducing sedentary time and breaking up long sedentary bouts with short bursts of activity may be a promising intervention to reduce the risk of recurrent stroke and other cardiovascular diseases in people with stroke.

To develop effective interventions, it is important to understand the factors associated with sedentary time in people with stroke. Previous studies have found associations between self-reported physical function after stroke and total sedentary time, but inconsistent results with regards to the relationship of age, stroke severity, and walking speed with sedentary time.20,21 These results are from secondary analyses of single-site observational studies, not powered to address associations, and inconsistent in the methods used to determine waking hours; thus making direct comparisons between studies difficult.20,21 Individual participant data pooling, with consistent processing of wake time data, allows novel exploratory analyses of larger datasets with greater power.

By pooling all available individual participant data internationally, this study aimed to comprehensively explore the factors associated with sedentary time in community-dwelling people with stroke. Specifically, our research questions were: (1) What factors are associated with total sedentary time during waking hours after stroke? (2) What factors are associated with time spent in prolonged sedentary bouts during waking hours?