Journal of Korean Physical Therapy Science (대한물리치료과학회지)

Korean Physical Therapy Science (대한물리치료과학회)
권호 표지
DOI QR코드

DOI QR Code

Motor and cognitive function according to level of physical activity in stroke patients

뇌졸중환자의 신체활동수준에 따른 운동기능과 인지기능

  • Jeong Ja Kim (Dept. of Rehabilitation Medicine, Veterans Health Service Medical Center) ;
  • Jong Won Lee (Dept. of Rehabilitation Medicine, Veterans Health Service Medical Center)
  • 김정자 (중앙보훈병원 재활의학과) ;
  • 이종원 (중앙보훈병원 재활의학과)
  • Received : 2022.12.19
  • Accepted : 2023.02.21
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: In the rehabilitation of stroke patients, regular physical activity is very important not only as a treatment for maximal functional recovery but also as a strategy to prevent the recurrence of stroke. The purpose of this study was to objectively measure the amount of physical activity in people with stroke, and to examine the differences in motor and cognitive function according to a level of physical activity. Design: A cross-sectional study. Methods: Physical activity (GENEActiv), motor function (Fugl-Meyer Assessment), cognitive function (Montreal Cognitive Assessment-Korean version), and the Korean version of Modified Barthel Index were evaluated in adult stroke patients with hemiplegia. Results: There was no statistically significant difference in the level of physical activity according to the motor and cognitive function. There was no statistically significant difference in motor and cognitive function according to the level of physical activity, but there was a statistically significant difference in the MBI (p<.01). Conclusion: As a result of the difference in the MBI according to the level of physical activity, it was found that the more moderate to vigorous physical activities are performed, the higher the independence in daily living. These results can be interpreted as that the more often you participate in physical activities such as physical therapy (gait training), the better your independence in ADL. Since regular physical activity participation of adult stroke patients can improve daily living performance, it is considered necessary to participate in physical activities such as continuous physical therapy.

Keywords

Acknowledgement

이 논문은 2022년도 중앙보훈병원 연구개발비 지원을 받아 수행된 연구과제임(VHSMC 22032).

References

  1. 강효민. 지적장애 청소년의 신체활동 참가와 사회적 행동의 변화. 한국체육학회지. 2016;55(4):45-58.
  2. 김완수. 만성질환 예방.관리를 위한 적정 신체활동 및 활성화 방안. 보건교육건강증진학회지. 2014;31(4):73-92.
  3. 김정혜, 김지태. 신체활동 참여 장애인의 정신적 웰빙에 대한 메타분석. 한국체육학회지. 2021;60(4):85-99.
  4. 문화체육관광부. 2020년 장애인 생활체육 실태조사 결과보고서. 문화체육관광부. 2021
  5. 박미서, 김미화, 정진희, 등. 신체활동 프로그램이 지적 장애인의 체력에 미치는 효과. 지역사회간호학회지. 2017;28(1):88-97.
  6. 인태성, 정경심. 가벼운 터치 자극을 이용한 균형훈련이 뇌졸중 환자의 자세동요와 보행속도에 미치는 영향. 대한물리치료과학회지. 2022:29(2):20-27. https://doi.org/10.26862/jkpts.2022.06.29.2.20
  7. 양덕일, 석민화, 임강일, 등. 성인지적장애인과 일반인의 신체활동량, 건강체력 및 심혈관질환 위험요인 비교. 한국특수체육학회지. 2014;22(2):99-117. https://doi.org/10.17006/KJAPA.2014.22.2.99
  8. 정한영, 박병규, 신희석, 등. 한글판 수정바델지수(K-MBI)의 개발: 뇌졸중 환자 대상의 다기관 연구. 대한재활의학회지. 2007;31(3):283-297.
  9. 조창옥, 구교만. 뇌졸중장애인의 유산소 신체활동 실천 여부가 주관적 건강상태 및 건강관련 삶의 질에 미치는 영향. 한국특수체육학회지. 2021;29(3):43-51. https://doi.org/10.17006/KJAPA.2021.29.3.43
  10. Ainsworth B, Cahalin L, Buman M, Ross R. The current state of physical activity assessment tools, Prog Cardiovasc Dis. 2015;57(4):387-395. https://doi.org/10.1016/j.pcad.2014.10.005
  11. Anderson LS, Heyne LA. Physical activity for children and adults with disabilities: An issue of "amplified" importance, Disabil Health J. 2010;3(2):71-73. https://doi.org/10.1016/j.dhjo.2009.11.004
  12. Antczak D, Lonsdale C, Del Pozo Cruz B, et al. Reliability of GENEActiv accelerometers to estimate sleep, physical activity, and sedentary time in children, Int J Behav Nutr Phys Act. 2021;18(1):73. doi: 10.1186/s12966-021-01143-6
  13. Barnay JL, Wauquiez G, Bonnin-Koang HY, Anquetil C, Perennou D, ... & Benaim C. Feasibility of the cognitive assessment scale for stroke patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients, Ann Phys Rehabil Med. 2014;57(6-7):422-435. https://doi.org/10.1016/j.rehab.2014.05.010
  14. Bergeron CD, Tanner AH, Friedman DB, et al. Physical activity communication: A scoping review of the literature, Health Promot Pract. 2019;20(3):344-353. https://doi.org/10.1177/1524839919834272
  15. Berglind D, Yacaman-Mendez D, Lavebratt C, et al. The effect of smartphone apps versus supervised exercise on physical activity, cardiorespiratory fitness, and body composition among individuals with mild-to-moderate mobility disability: Randomized controlled trial, JMIR Mhealth Uhealth. 2020;8(2):e14615. doi: 10.2196/14615
  16. Billinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: A statement for healthcare professionals from the American Heart Association, Stroke. 2014;45:2532-2553. https://doi.org/10.1161/STR.0000000000000022
  17. Blodgett J, Theou O, Kirkland S, et al. The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts, Maturitas. 2015;80(2):187-191. https://doi.org/10.1016/j.maturitas.2014.11.010
  18. Booth FW, Roberts CK, Thyfault JP, et al. Role of inactivity in chronic diseases: Evolutionary insight and pathophysiological mechanisms, Physiol Rev. 2017;97(4):1351-1402. https://doi.org/10.1152/physrev.00019.2016
  19. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research, Public Health Rep. 1985;100(2):126-131.
  20. Cook P, Sunnerhagen KS, Persson HC. Level of physical activity is positively correlated with perceived impact on life 12 months after stroke: A cross-sectional study, J Rehabil Med. 2020;52(5):jrm00056. doi: 10.2340/16501977-2667
  21. Crivelli D, Angelillo MT, Grippa E, Colucci A, Nardulli R, & Balconi M. When is a novel psychometric measure needed? A preliminary analysis regarding the Cognitive Assessment for Stroke Patients (CASP) battery compared with MMSE and MoCA,. Appl Neuropsychol Adult. 2018;25(5):410-416. https://doi.org/10.1080/23279095.2017.1320556
  22. Crooke R, Haseler C, Haseler T, et al. Physical activity and moving more for health, J R Coll Physicians Edinb. 2020;50(2):173-180. https://doi.org/10.4997/jrcpe.2020.223
  23. Cunningham C, O' Sullivan R, Caserotti P, et al. Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 2020;30(5):816-827. https://doi.org/10.1111/sms.13616
  24. Danielsson A, Meirelles C, Willen C, et al. Physical activity in community-dwelling stroke survivors and a healthy population is not explained by motor function only. PM R. 2014;6(2):139-145. https://doi.org/10.1016/j.pmrj.2013.08.593
  25. de Hollander EL, Proper KI. Physical activity levels of adults with various physical disabilities, Prev Med Rep. 2018;10:370-376. https://doi.org/10.1016/j.pmedr.2018.04.017
  26. Dogra S., Stathokostas L. Sedentary behavior and physical activity are independent predictors of successful aging in middle-aged and older adults, J Aging Res. 2012;2012:190654. doi: 10.1155/2012/190654
  27. Duran AT, Pascual CB, Goldsmith J, et al. Objectively measured physical activity and sedentary time among adults with and without stroke: A national cohort study, Stroke. 2021;52(11):e729-e732. doi:10.1161/STROKEAHA.121.034194
  28. English C, Healy GN, Coates A, et al. Sitting and activity time in people with stroke, Phys Ther. 2016;96:193-201. https://doi.org/10.2522/ptj.20140522
  29. Erickson KI, Hillman C, Stillman CM, et al. Physical activity, cognition, and brain outcomes: A review of the 2018 physical activity guidelines, Med Sci Sports Exerc. 2019;51(6):1242-1251. https://doi.org/10.1249/MSS.0000000000001936
  30. Esliger DW, Rowlands AV, Hurst TL, et al. Validation of the GENEA accelerometer, Med Sci Sports Exerc. 2011;43(6):1085-1093. https://doi.org/10.1249/MSS.0b013e31820513be
  31. Fini NA, Holland AE, Keating J, et al. How physically active are people following stroke? systematic review and quantitative synthesis, Phys Ther. 2017;97(7):707-717. https://doi.org/10.1093/ptj/pzx038
  32. Fletcher GF, Landolfo C, Niebauer J, et al. Promoting physical activity and exercise: JACC health promotion series, J Am Coll Cardiol. 2018;72(14):1622-1639. https://doi.org/10.1016/j.jacc.2018.08.2141
  33. Fraysse F, Post D, Eston R, et al. Physical activity intensity cut-points for wrist-worn GENEActiv in older adults, Front Sports Act Living. 2021;2:579278. doi: 10.3389/fspor.2020.579278
  34. Fugl-Meyer AR, Jaasko L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance, Scand J Rehabil Med. 1975;17(1):13-31. https://doi.org/10.2340/1650197771331
  35. Gallanagh S, Quinn TJ, Alexander J, et al. Physical activity in the prevention and treatment of stroke, ISRN Neurol. 2011;953818. doi: 10.5402/2011/953818
  36. Guerra-Carrillo B, Katovich K, & Bunge SA. Does higher education hone cognitive functioning and learning efficacy? Findings from a large and diverse sample, PLoS One. 2017;12(8):e0182276. doi: 10.1371/journal.pone.0182276
  37. Hassett L, Ada L, Hellweg S, et al. Active and sedentary bouts in people after stroke and healthy controls: An observational study, Physiother Res Int. 2020;25(3):e1845. doi: 10.1002/pri.1845
  38. Huberty J, Ehlers DK, Kurka J, Ainsworth B, Buman M. Feasibility of three wearable sensors for 24 hour monitoring in middle-aged women, BMC Womens Health. 2015;15:55. doi: 10.1186/s12905-015-0212-3
  39. Kang JM, Cho YS, Park S, Lee BH, Sohn BK, ... & Lee JY. Montreal cognitive assessment reflects cognitive reserve, BMC Geriatr. 2018;18(1):261. doi: 10.1186/s12877-018-0951-8
  40. Kang SM, Kim SH, Han KD, et al. Physical activity after ischemic stroke and its association with adverse outcomes: A nationwide population-based cohort study, Top Stroke Rehabil. 2021;28(3):170-180. https://doi.org/10.1080/10749357.2020.1799292
  41. Karklina A, Chen E, Berzina G, et al. Patients' physical activity in stroke units in Latvia and Sweden, Brain Behav. 2021;11(5):e02110. doi: 10.1002/brb3.2110.
  42. Kim TL, Hwang SH, Lee WJ, et al. The korean version of the Fugl-Meyer Assessment: Reliability and validity evaluation, Ann Rehabil Med. 2021;45(2):83-98. https://doi.org/10.5535/arm.20225
  43. Koscak Tivadar B. Physical activity improves cognition: Possible explanations, Biogerontology. 2017;18(4):477-483. https://doi.org/10.1007/s10522-017-9708-6
  44. Kramer SF, Hung SH, Brodtmann A. The impact of physical activity before and after stroke on stroke risk and recovery:A narrative review, Curr Neurol Neurosci Rep. 2019;19(6):28. doi: 10.1007/s11910-019-0949-4
  45. Lee HJ, Kim KD. Effect of physical activity on cognition and daily living activities of the elderly with mild dementia, J Phys Ther Sci. 2018;30(3):428-433. https://doi.org/10.1589/jpts.30.428
  46. Lee JY, Lee DW, Cho SJ, et al. Brief screening for mild cognitive impairment in elderly outpatient clinic: Validation of the Korean version of the Montreal Cognitive Assessment, J Geriatr Psychiatry Neurol. 2008;21(2):104-110. https://doi.org/10.1177/0891988708316855
  47. Lobenius-Palmer K, Sjoqvist B, Hurtig-Wennlof A, et al. Accelerometer-assessed physical activity and sedentary time in youth with disabilities, Adapt Phys Activ Q. 2018;35(1):1-19. https://doi.org/10.1123/apaq.2015-0065
  48. Martin JJ. Benefits and barriers to physical activity for individuals with disabilities: A social-relational model of disability perspective, Disabil Rehabil. 2013;35(24):2030-2037. https://doi.org/10.3109/09638288.2013.802377
  49. McDonnell MN. Physical activity following stroke, Arch Phys Med Rehabil. 2010;91(4):665-666. https://doi.org/10.1016/j.apmr.2009.12.007
  50. Mlinac ME, Feng MC. Assessment of activities of daily living, self-care, and independence, Arch Clin Neuropsychol. 2016;31(6):506-516. https://doi.org/10.1093/arclin/acw049
  51. Nasreddine ZS, Phillips NA, Bedirian V, et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment, J Am Geriatr Soc. 2005;53(4):695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
  52. Nightingale TE, Walhin JP, Thompson D, et al. Influence of accelerometer type and placement on physical activity energy expenditure prediction in manual wheelchair users, PLoS One. 2015;10(5):e0126086. doi:10.1371/journal.pone.0126086
  53. Ozemek C, Lavie CJ, Rognmo O. Global physical activity levels - Need for intervention, Prog Cardiovasc Dis. 2019;62(2):102-107. https://doi.org/10.1016/j.pcad.2019.02.004
  54. Ramsey KA, Rojer AGM, D'Andrea L, et al. The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: A systematic review and meta-analysis, Ageing Res Rev. 2021;67:101266. doi: 10.1016/j.arr.2021.101266
  55. Rebar AL, Stanton R, Geard D, et al. A meta-meta-analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations, Health Psychol Rev. 2015;9(3):366-378. https://doi.org/10.1080/17437199.2015.1022901
  56. Rech KD, Salazar AP, Marchese RR, et al. Fugl-Meyer assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke, J Stroke Cerebrovasc Dis. 2020;29(1):104463. doi:10.1016/j.jstrokecerebrovasdis.2019.104463
  57. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation, J Clin Epidemiol. 1989;42(8):703-709. https://doi.org/10.1016/0895-4356(89)90065-6
  58. Suarez-Villadat B, Veiga OL, Villagra A, et al. Changes in body composition and physical fitness in adolescents with down syndrome: The UP&DOWN longitudinal study, Child Obes. 2019;15(6):397-405. https://doi.org/10.1089/chi.2018.0198
  59. Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research, Med Sci Sports Exerc. 2005;37:S531-S543. doi: 10.1249/01.mss.0000185657.86065.98
  60. Vahlberg B, Bring A, Hellstrom K, et al. Level of physical activity in men and women with chronic stroke, Physiother Theory Pract. 2019;35(10):947-955. https://doi.org/10.1080/09593985.2018.1460646
  61. van der Ploeg HP, Hillsdon M. Is sedentary behaviour just physical inactivity by another name? Int J Behav Nutr Phys Act. 2017;14(1):142. doi: 10.1186/s12966-017-0601-0.
  62. Wang B, Wu Y, Zhang T, Han J, Yu L, & Sun W. Effect of physical activity on independent living ability among community-dwelling elderly in urban areas of Liaoning Province in China: A population-based study, BMJ Open. 2019;16:9(10):e023543. doi: 10.1136/bmjopen-2018-023543
  63. Warburton DER, Bredin SSD. Health benefits of physical activity: A systematic review of current systematic reviews, Curr Opin Cardiol. 2017;32(5):541-556. https://doi.org/10.1097/HCO.0000000000000437
  64. World Health Organization. Fact sheet, physical activity, 2022. https://www.who.int/newsroom/fact-sheets/detail/physical-activity.
  65. Yan Z, Xu S, Wei D, He X, Li C, ... & Jia J. Comparison of three cognitive assessment methods in post-stroke aphasia patients, Front Psychol. 2022;13:896095. doi: 10.3389/fpsyg.2022.896095
  66. Zamarian L, Lenhart L, Nagele M, Steiger R, Gizewski ER, ... & Delazer M. Effects of cognitive functioning and education on later-life health numeracy, Gerontology. 2020;66(6):582-592. doi: 10.1159/000510092
  67. Zwinkels M, Verschuren O, Balemans A, et al. Effects of a school-based sports program on physical fitness, physical activity, and cardiometabolic health in youth with physical disabilities: Data from the sport-2-stay-fit study, Front Pediatr. 2018;6:75. doi: 10.3389/fped.2018.00075.