The structure of walking activity in people after stroke compared with older adults without disability: a cross-sectional study

Abstract

Background: People with stroke have reduced walking activity. It is not known whether this deficit is due to a reduction in all aspects of walking activity or only in specific areas. Understanding specific walking activity deficits is necessary for the development of interventions that maximize improvements in activity after stroke.

Objective: The purpose of this study was to examine walking activity in people poststroke compared with older adults without disability.

Design: A cross-sectional study was conducted.

Methods: Fifty-four participants poststroke and 18 older adults without disability wore a step activity monitor for 3 days. The descriptors of walking activity calculated included steps per day (SPD), bouts per day (BPD), steps per bout (SPB), total time walking per day (TTW), percentage of time walking per day (PTW), and frequency of short, medium, and long walking bouts.

Results: Individuals classified as household and limited community ambulators (n=29) did not differ on any measure and were grouped (HHA-LCA group) for comparison with unlimited community ambulators (UCA group) (n=22) and with older adults without disability (n=14). The SPD, TTW, PTW, and BPD measurements were greatest in older adults and lowest in the HHA-LCA group. Seventy-two percent to 74% of all walking bouts were short, and this finding did not differ across groups. Walking in all categories (short, medium, and long) was lowest in the HHA-LCA group, greater in the UCA group, and greatest in older adults without disability.

Limitations: Three days of walking activity were captured.

Conclusions: The specific descriptors of walking activity presented provide insight into walking deficits after stroke that cannot be ascertained by looking at steps per day alone. The deficits that were revealed could be addressed through appropriate exercise prescription, underscoring the need to analyze the structure of walking activity.

Figure 1.

Steps per day (A), total time walking (B), and percentage of time walking (C) were not significantly different between participants in the household ambulator (HHA) and limited community ambulator (LCA) groups (left of dashed line). Participants in these groups were combined to form the HHA-LCA group. To the right of the dashed lines, older adults without disability (healthy) were significantly different from all participants poststroke. Individuals poststroke in the HHA-LCA group were significantly different from participants in the unlimited community ambulator (UCA) group. Error bars represent ±1 standard error. Asterisk indicates P<.05 between indicated groups.

Figure 2.

(A) Bouts per day were not significantly different between participants in the household ambulator (HHA) and limited community ambulator (LCA) groups (left of dashed line). Participants in these groups were combined to form the HHA-LCA group. To the right of the dashed lines, older adults without disability (healthy) were significantly different from all participants poststroke. Individuals poststroke in the HHA-LCA group were significantly different from participants in the unlimited community ambulator (UCA) group. (B) Median steps per bout did not differ across groups. Error bars represent ±1 standard error. Asterisk indicates P<.05 between indicated groups.

Figure 3.

The frequency of bouts in the (A) short-distance, (C) medium-distance, and (E) long-distance categories for each group and percentage of the total represented by (B) short-distance, (D) medium-distance, and (F) long-distance bouts. To the left of the dashed line in each figure are the results for the household ambulator (HHA) and limited community ambulator (LCA) groups shown separately. To the right of the dashed lines, the bars represent, from left to right, the results for the combined HHA-LCA group, for the unlimited community ambulator (UCA) group, and for older adults without disability (healthy). Error bars represent ±1 standard error. Asterisk indicates P<.05 between indicated groups.