Izawa Shinichi

Izawa Shinichi
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Objectively measured physical activity was not associated with neighborhood walkability attributes in community-dwelling patients with stroke

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Lifestyle modification Public health Stroke

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Scientific Reports

volume 12 , Article number: 3475 ( 2022 )
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Although the built environment may affect physical activity, there is little evidence on how neighborhood walkability attributes influence post-stroke physical activity. This study aimed to explore associations between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke. This cross-sectional study recruited patients who could ambulate outside free of assistance. We assessed objectively measured physical activity comprising the number of steps taken and time spent in moderate-to-vigorous physical activity (MVPA) with an accelerometer. Neighborhood walkability attributes were evaluated using the Walk Score. Multiple linear regression analyses were used to determine whether the Walk Score was independently associated with the number of steps taken or MVPA. Eighty participants with a mean age of 65.9 ± 11.1 years were included. The participants took an average of 5900.6 ± 2947.3 steps/day and spent an average of 19.7 ± 21.7 min/day in MVPA. The mean Walk Score was 71.4 ± 17.2. Multiple linear regression analyses showed that no significant associations were found between the Walk Score and the number of steps taken or MVPA. No associations were found between objectively measured physical activity and neighborhood walkability attributes in community-dwelling patients with stroke in an Asian area.
It is well known that physical activity after stroke is a major target to prevent not only stroke recurrence 1 , 2 but also all-cause mortality 3 . In a randomized controlled trial, Kono et al. reported that lifestyle interventions, including the promotion of physical activity, in patients with mild stroke led to a reduction in new vascular events, including recurrent stroke 1 . They also showed that at least approximately 6000 steps per day were appropriate to prevent the occurrence of a new vascular event after stroke 2 . Loprinzi and Addoh indicated in a national prospective cohort study of adults with post-acute stroke that physical activity among stroke survivors is inversely associated with all-cause mortality 3 . For these reasons, studies focusing on the promotion of physical activity itself and studies of the comprehensive prevention of recurrence that include the promotion of physical activity are being conducted 4 , 5 .
Exercise and physical activity influence, or have the potential to influence, the process of post-stroke disablement at various points 6 . Once a stroke occurs or is recurrent, the cycle of “detraining post-stroke” begins, which means that impairments to physical fitness occur that lead to activity limitations, physical inactivity, and the occurrence of additional impairments to physical fitness 6 . To break this negative loop, it may be necessary to focus on instruction beyond that related to physical functions. Thilarajah et al. reported that physical function only accounted for half of the variance in post-stroke physical activity levels in their systematic review and that several modifiable and non-modifiable factors are associated with post-stroke physical activity 7 .
Although the determination of physical activity is multifaceted and complex, ecological models emphasize the role played by the built environment in supporting an active lifestyle 8 . We previously reported that the average number of steps was significantly associated with perceived built environment attributes such as the presence of a sidewalk and access to recreational facilities in community-dwelling ambulatory patients with stroke 9 . However, because this study evaluated built environment attributes by questionnaire, each individual patient might have perceived the neighborhood environment differently. It seems that individuals who regularly engage in physical activity in their neighborhood ma
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