New research shows that stroke patients should start physical activity while still in the hospital
July 24, 2015
By Greg Peters
New research at the University of Kansas Medical Center suggests that greater emphasis should be placed on increasing physical activity during a patient's hospital stay following an acute stroke.
Associate professor Sandra Billinger, PT, Ph.D., FAHA, and her team at the Research in Exercise and Cardiovascular Health (REACH) Laboratory at the University of Kansas Medical Center, studied 32 stroke patients treated at the University of Kansas Hospital. Their findings were reported in the July issue of the Journal of Neurological Physical Therapy.
"The take-home message is that as physical therapists we need to work with the health care team to find ways safely and effectively increase stroke patients' physical activity early after stroke, especially during the hospital stay," Billinger said.
The purpose of the study was to observe the levels of physical activity during inpatient recovery. Previously, anecdotal studies had been done by researchers working with stroke patients outside of the United States, but Billinger's group wanted to gather quantifiable, objective data from stroke patients in this country. So rather than just noting changes in behavior as previous researchers had done, the KU team gathered data produced by accelerometers to chart their patients' physical activity. An accelerometer is a device used by researchers to measure physical activity.
"As stroke physicians, we are aware of the limited amount of physical activity patients do while hospitalized, but the data from this paper has given us a truly objective idea of how little activity these patients actually get," said Michael G. Abraham, M.D., an assistant professor in the neurology and radiology departments at KU Medical Center and a member of KU Hospital's Acute Stroke Team. "Research like this is what is needed to change the treatment paradigm in post-stroke therapy as this is just as important as the acute treatment. "
During the study, an accelerometer was attached to the stroke-affected ankle to measure the patient's physical activity during a 24-hour time period. Participants wore the accelerometers for four days or until they were discharged. Patients participating in the study were between 20 and 80 years old (56 years old was average) and had been admitted to KU Hospital with a diagnosis of stroke. They also had to consent to being involved in the study within 48 hours of admission.
Researchers found that the stroke patients were sedentary nearly 22.5 hours - or 94 percent - of the day with just more than an hour each day spent in light activity. The study found a significant correlation between the amount of time a patient was sedentary each day in the hospital and the results of physical performance test done at the time of the patient's discharge.
Ben Babaran, a 56-year-old alternative energy electrical engineer from Blue Springs, Mo., was awakened by severe cramping in his calf around 4 a.m. on Jan. 31, 2013. Having played basketball, tennis and soccer, Babaran knew his body well and was confident he could treat his own muscle cramping.
But something was different this time. After an hour of massage and walking, Babaran fell back asleep, but later when he made cappuccino for he and his wife at about 6 a.m., he felt weakness in his right hand. His wife, a nurse at the Marc A. Asher, M.D., Comprehensive Spine Center, immediately gave him baby aspirin, and by 7:15 a.m., they were in the emergency room at KU Hospital.
As the stroke progressed throughout the day, Babaran could hardly pick up a pen let alone walk. By the next morning, Billinger and her team had signed him up to be part of their research. Baraban was motivated to get well, and when he went to the recovery wing he was back doing knee bends, squats and stretches.
"Their conclusion was a big confirmation of what I knew all along," he said. "The biggest hurdle patients have after their stroke is not the activity itself, but having the right frame of mind. Patients have to accept what has happened and then commit to work toward recovery. Activity comes from the will and commitment to be whole again."
Billinger said more research is needed to determine the specific types and duration of physical activity that would be the most beneficial to stroke patients in the hospital. Billinger added that most current recommendations urge physical activity for all hospitalized patients as part of their recovery.
The results of the study can be read here.