Go home, sit less. The impact of home versus rehabilitation environment on activity levels of stroke survivors (iREAct)

Ms Dawn Simpson1,2, Dr Monique  Breslin2, Dr Toby  Cumming3, Associate Professor Coralie English4,5, Dr Seana  Gall2, Dr   Matthew Schmidt6, Dr Michele Callisaya1,2

1Physiotherapy Department Tasmanian Health Service South, Hobart, Australia, 2Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, 3Stroke Division, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia, 4School of Health Sciences, University of Newcastle, Newcastle, Australia, 5University of Newcastle Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle, Australia, 6School of Health Sciences, University of Tasmania, Hobart, Australia

Background: Sedentary time is high and physical activity low following stroke. There is limited understanding of factors which promote greater activity, and consequently improve function and reduce cardiovascular risk. We examined whether change in environment (hospital/home) influenced the time spent sitting, upright and walking, as well as factors predicting any change.

Methods: 34 participants with stroke were recruited consecutively from 2 rehabilitation units. An activity monitor (ActivPAL3) was worn for 7 days (24 hours/day) at 2 time points: final week in hospital, and first week home. Other measures included mood (HADS), fatigue (FAS) and physical function (gait speed, 6 min walk). Linear mixed models (adjusted for waking hours) were performed with activity time as the outcome and environment as the exposure.

Results: Activity data was available at both time points for 32 (94%) participants (mean age 68 [SD 13] years, 53% male). At home participants spent 45 fewer minutes sitting (95% CI -84,-6 p=0.023), 45 more minutes upright (95% CI 6 ,85 p=0.024), 12 minutes more walking (95% CI 5-19 p=0.001) and completed 712 additional steps per day (95% CI 188 ,1236 p=0.008), compared to the final week in hospital. Better mood prior to discharge predicted differences for all activity outcomes, with the addition of lower fatigue for better walking outcomes (p≤0.05).

Conclusions: Change in environment from hospital to home reduced sitting time and increased time spent in physical activity and daily step count. The environment may be a modifiable factor which clinicians can target to reduce sitting time and promote increases in physical activity.


Dawn is a physiotherapist with 19 years clinical experience, predominantly working in rehabilitation, with a particular interest in stroke rehab. She is the team leader physiotherapist for rehabilitation at the Royal Hobart Hospital, and this study was conducted by the Rehabilitation Physiotherapy Team. She is a also PhD candidate at the Menzies Institute for Medical research in Hobart, Tasmania. Her PhD project focuses on sedentary behaviour and physical activity after stroke, and what factors may influence these behaviours.

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