People sit too much and move too little. Even after a stroke. That increases the risk of another stroke and premature death. Roderick Wondergem, a researcher at UMC Utrecht, researched the health risks and developed a coaching program. “Excessive sitting is habitual behavior. To break it, confidence in one’s own ability is crucial.”
Every year, about 16 million people worldwide suffer a stroke. In the Netherlands, that number is about 45,000. This number is expected to increase in the coming years, in large part due to an aging population. In addition to risk factors such as advanced age and high blood pressure, lifestyle factors play an important role in stroke, including little exercise. “Those who have survived a stroke, sit for more than 9.5 hours a day and exercise moderately or intensively for less than 150 minutes a week are at risk of early death, says Roderick Wondergem. As a physical therapy scientist, he studied the exercise behavior of people after a stroke.
“Because of improved acute care, fewer and fewer people will die of stroke,” Roderick says. “But of the survivors, half die within five years and a quarter suffer a second stroke. Furthermore, a significant proportion of patients – about 40 percent – experience a decline in daily functioning. Therefore, it was expected that people would adjust their exercise behavior after a first stroke, but that hardly happens, if at all. Whether someone moves a lot or a little when they come home from the hospital remains the same. The same goes for sitting: if people sit a lot, they continue to do so.”
For his research, Roderick analyzed data from the RISE cohort study. In this study, 200 people after a first stroke were followed at home for 2 years to map their sitting and exercise behavior. Roderick distinguished three groups: 32 percent sit for more than 12 hours a day and hardly move at all, 45 percent sit for 10 to 12 hours a day and move lightly to moderately (activities in and around the house, biking/walking) and 22 percent move adequately (sports, brisk biking/walking).
The first group, those who sit more than 12 hours a day, is where the most return is to be found. Roderick: “It makes a lot of difference whether people mainly sit and don’t move enough or whether people sit a lot but are sufficiently physically active in a day. After a stroke, both groups initially function at the same level, but after a year and a half, people in the first group deteriorate faster and notice it in their daily lives. Every movement counts for those people; every movement contributes to health. Breaking unhealthy sitting behavior is more effective for this group than trying to encourage physical activity.”
Within stroke rehabilitation, influencing sitting behavior is a new goal. Roderick: “This is not about a conscious decision to exercise more, something you can schedule in your calendar, but about habitual behavior that needs to be broken. That is why we developed a behavioral intervention with the group of ‘sitters’. Crucial to this is self-efficacy, in other words, confidence in one’s own abilities. After a stroke, people are often tired and anxious and wonder whether they can handle certain things. Some then have the reflex: ‘I’ll just sit down, then I’m sure I won’t do anything wrong.’ While it is so important to be able to do things themselves, such as making coffee or running errands. If you take a walk every half hour, your blood pressure already drops by 5 mmHg.”
Participants in the intervention program are coached by a physical therapist for 15 weeks, during which they see each other nine times. In addition, participants can monitor their own sitting and exercise behavior with an app. Roderick: “No one can estimate how much they sit. That feedback is very useful. In addition, with the app we can see over the whole period how someone scores compared to themselves before starting the program.” To test the intervention program in practice, a pilot was planned but the corona crisis threw a spanner in the works. In this pilot, six participants will monitor their sitting and exercise behavior and another six will do so with the support of a buddy. “This way we can see if a buddy adds value, for example as a sounding board and to discuss practical problems.” Roderick hopes the pilot can start in September.
Roderick Wondergem works as a senior researcher at the Academic Workshop on Physical Therapy Utrecht. He received his doctorate from Utrecht University on Tuesday, June 23, for his dissertation Movement behavior in people with a first-ever stroke. Download his dissertation here.
