Walking Capacity and Daily Movement Behaviours After Ischemic Stroke: A Potential Capacity‐Performance Gap

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Abstract
Background and Purpose: Walking capacity is a common focus of stroke rehabilitation; however, the extent to which walking capacity is associated with daily movement behaviours (primary lying, sedentary time, standing and stepping) during different phases of stroke recovery remains unclear. This study examined the relationship between walking capacity and daily movement behaviours among individuals in the acute and subacute phases of ischemic stroke recovery. Methods: In this cross‐sectional study, adults with ischemic stroke who were ambulatory (able to walk ≥ 5 m with or without a gait aid) were recruited during the acute (≤ 7 days post‐stroke; n = 19) and subacute (2 weeks‐3 months post‐stroke; n = 25) phases of stroke recovery. Movement behaviours were assessed using 24‐h activPAL accelerometry, including primary lying time, sedentary time, standing time, stepping time and daily step count. Walking capacity was assessed using the 6‐Minute Walk Test, 10‐m Walk Test (gait speed) and Timed Up and Go. Between‐group differences were analysed using Welch’s t ‐tests or Mann‐Whitney U tests, as appropriate, and associations were examined using Spearman correlations and exploratory partial correlations adjusted for stroke severity (NIHSS). Results: The subacute group demonstrated faster gait speed than the acute group (0.89 vs. 0.71 m/s; p = 0.03), and shorter Timed Up and Go times (median 15.9 vs. 19.0 seconds; p = 0.03), whereas the 6‐Minute Walk Test and daily movement behaviours were similar. Both groups accumulated high sedentary time (∼12 hours/day). Gait speed was the only walking capacity measure associated with daily movement behaviours. In exploratory analyses adjusted for stroke severity, gait speed remained associated with sedentary time in both groups, whereas associations with stepping and standing time were attenuated in the acute group. Conclusions: In this ambulatory sample of adults in the acute and subacute phases of ischemic stroke recovery, participants accumulated approximately 12 hours of sedentary time per day despite walking speeds approaching thresholds associated with community ambulation. These findings are consistent with a potential capacity‐performance gap and highlight the importance of assessing daily movement behaviours alongside standardized walking capacity measures.
Funding Information
  • Glenrose Rehabilitation Hospital Foundation
  • Heart and Stroke Foundation of Canada
  • Fondation Brain Canada
  • Alberta Innovates

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