More Steps Towards an Active Life - ActForStroke

Stroke is worldwide the second most common cause of long-term disability. In Denmark, stroke affects around 12,000 people each year, and around 110,000 are living with the consequences of a stroke. One in five Danes over 25 will experience a stroke during their lifetime, and 30% of stroke victims are under 65 years old. These numbers imply not only a significant burden for the individual and their caregivers but also for society in general. The costs for treatment and care amount to 2.03 billion DKK annually, not including lost working capacity. People living with the consequences of a stroke are at a high risk of early death, recurrent strokes (around 10-26 % during the first years), and myocardial infarctions, aggravated by risk factors, such as diabetes and overweight, both from prior to stroke and after. A huge amount of evidence supports the preventive effect of physical activity in everybody, including those with stroke and comorbidities or other medical issues. To achieve a sufficient level of physical activity according to official recommendations (>30 min moderate activity per day plus 2 x 20 min vigorous activity per week) is challenging for almost everybody but can be especially challenging for people with stroke due to reduced mobility.

Gait after stroke Around two-thirds of those affected suffer from impaired gait function which limits their independence and participation in valued activities and compromises their physical fitness and psycho-social well-being. Recovery of walking early following neurologic injury is a primary goal of patients and their families. However, many walk at a slow pace and for limited distances. A majority of patients still suffer from reduced walking ability at discharge from the hospital. This can lead to a more homebound life with a reduction of social relations and a less active everyday life. Studies suggest that even small declines in gait speed from baseline (i.e., change of 0.1 m/s) are associated with significant increases in health care utilization (e.g., medical/surgical visits, hospitalization duration).

Inactivity after stroke is a consequence of walking impairment or just co-occurring with it, many people with stroke spend too much of their time sedentary and physically inactive. Studies indicate that people with stroke spend more time sedentary and in long uninterrupted sedentary bouts than age-matched healthy people. Interestingly, physical activity seems not to be directly related to their functional level. As inactivity is directly associated with increased cardiovascular risk, the risk for recurrent strokes increases.

ActForStroke With ActForStroke, the investigators want to address these challenges with the following combined interventions that are intended to start during inpatient rehabilitation and continue in municipality rehabilitation.

High-intensity gait training (HIGT) is based on substantial amounts of stepping practice at 70-85 % maximum heart rate. HIGT has been proven effective in other countries in enabling patients with stroke to achieve better gait and balance and, thus increasing their opportunities for an active and independent life. The effect could be maintained 1 year after stroke. Intensive gait training is now recommended by national guidelines for stroke rehabilitation in the US, UK, and Australia. HIGT is an approach that can be implemented within existing staffing levels and thus constitutes a viable long-term approach. However, it is usual practice in Denmark.