Evaluation of a Physical Activity Intervention for Adults With Brain Impairment

Background. Individuals with brain impairment (BI) are less active than the general population and have increased risk of chronic disease. Objective. This controlled trial evaluated the efficacy of a physical activity (PA) intervention for community-dwelling adults with BI. Methods. A total of 43 adults with BI (27 male, 16 female; age 38.1 ± 11.9 years; stage of change 1-3) who walked as their primary means of locomotion were allocated to an intervention (n = 23) or control (n = 20) condition. The intervention comprised 10 face-to-face home visits over 12 weeks, including a tailored combination of stage-matched behavior change activities, exercise prescription, community access facilitation, and relapse prevention strategies. The control group received 10 face-to-face visits over 12 weeks to promote sun safety, healthy sleep, and oral health. Primary outcomes were daily activity counts and minutes of moderate-to-vigorous-intensity PA (MVPA) measured with the ActiGraph GT1M at baseline (0 weeks), postintervention (12 weeks) and follow-up (24 weeks). Between-group differences were evaluated for statistical significance using repeated-measures ANOVA. Results. MVPA for the intervention group increased significantly from baseline to 12 weeks (20.8 ± 3.1 to 31.2 ± 3.1 min/d; P = .01), but differences between baseline and 24 weeks were nonsignificant (20.8 ± 3.1 to 25.3 ± 3.2 min/d; P = .28). MVPA changes for the control group were negligible and nonsignificant. Between-group differences for change in MVPA were significant at 12 weeks (P = .03) but not at 24 weeks (P = .49). Conclusion. The 12-week intervention effectively increased adoption of PA in a sample of community-dwelling adults with BI immediately after the intervention but not at follow-up. Future studies should explore strategies to foster maintenance of PA participation.

[1]  W. Miller,et al.  Motivational interviewing: preparing people for change. , 2002 .

[2]  S. Trost,et al.  Validity of accelerometry for measurement of activity in people with brain injury. , 2005, Medicine and science in sports and exercise.

[3]  Susan Armijo-Olivo,et al.  Intention to treat analysis, compliance, drop-outs and how to deal with missing data in clinical research: a review , 2009 .

[4]  K. Aho,et al.  Cerebrovascular disease in the community: results of a WHO collaborative study. , 1980, Bulletin of the World Health Organization.

[5]  E. McAuley,et al.  Testing the requirements of stages of physical activity among adults: The comparative effectiveness of stage-matched, mismatched, standard care, and control interventions , 2002, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[6]  Predictors of Physical Activity Stage of Change among Adults with Physical Disabilities , 2004, American journal of health promotion : AJHP.

[7]  B H Marcus,et al.  Assessing motivational readiness and decision making for exercise. , 1992, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[8]  J. Rimmer,et al.  Exercise Intervention Research on Persons with Disabilities: What We Know and Where We Need to Go , 2010, American journal of physical medicine & rehabilitation.

[9]  B. Cardinal,et al.  The mediating role of intention and stages of change in physical activity among adults with physical disabilities: an integrative framework. , 2007, Journal of sport & exercise psychology.

[10]  Charles C. Bonnett,et al.  Functional ambulation in patients with myelomeningocele. , 1973, The Journal of bone and joint surgery. American volume.

[11]  Jacqui H Morris,et al.  Interventions to promote long-term participation in physical activity after stroke: a systematic review of the literature. , 2014, Archives of physical medicine and rehabilitation.

[12]  J. Rimmer,et al.  Determinants of exercise in adults with cerebral palsy. , 2002, Public health nursing.

[13]  G. White,et al.  Promoting physical activity among women with mobility impairments: a randomized controlled trial to assess a home- and community-based intervention. , 2004, Archives of physical medicine and rehabilitation.

[14]  E. Kendall,et al.  Community-based Service Delivery in Rehabilitation: The Promise and the Paradox , 2000, Disability and rehabilitation.

[15]  G. Kolt,et al.  The Physical Activity and Disability Survey (PADS): reliability, validity and acceptability in people with multiple sclerosis , 2007, Clinical rehabilitation.

[16]  T. Patterson,et al.  The development of scales to measure social support for diet and exercise behaviors. , 1987, Preventive medicine.

[17]  Robert W Motl,et al.  Internet intervention for increasing physical activity in persons with multiple sclerosis , 2011, Multiple sclerosis.

[18]  David W Wright,et al.  Position statement: definition of traumatic brain injury. , 2010, Archives of physical medicine and rehabilitation.

[19]  S. Blair,et al.  Physical activity for health: What kind? How much? How intense? On top of what? , 2011, Annual review of public health.

[20]  D. Streiner,et al.  Implementation, Process, and Preliminary Outcome Evaluation of Two Community Programs for Persons with Stroke and Their Care Partners , 2008, Topics in stroke rehabilitation.

[21]  S. Blair,et al.  Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy , 2012, BDJ.

[22]  K. Dodd,et al.  Adults with cerebral palsy benefit from participating in a strength training programme at a community gymnasium , 2004, Disability and rehabilitation.

[23]  B. Dan,et al.  A report: the definition and classification of cerebral palsy April 2006 , 2007, Developmental medicine and child neurology. Supplement.

[24]  C. Abraham,et al.  A taxonomy of behavior change techniques used in interventions. , 2008, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[25]  Bonnie G. Berger,et al.  Motivating People to Be Physically Active , 2002 .

[26]  R. Niaura,et al.  Self-efficacy and the stages of exercise behavior change. , 1992, Research quarterly for exercise and sport.

[27]  M. Sliwinski,et al.  The Benefits of Exercise in Individuals with Traumatic Brain Injury: A Retrospective Study , 1998, The Journal of head trauma rehabilitation.

[28]  R. Endacott,et al.  Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial , 2010, Clinical rehabilitation.

[29]  Ting Hong,et al.  The descriptive epidemiology of cerebral palsy. , 2006, Clinics in perinatology.

[30]  B H Marcus,et al.  The stages of exercise behavior. , 1993, The Journal of sports medicine and physical fitness.

[31]  Stewart G Trost,et al.  Conducting accelerometer-based activity assessments in field-based research. , 2005, Medicine and science in sports and exercise.

[32]  G. Davis,et al.  Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise–Controlled Study , 2008, Journal of the American Geriatrics Society.

[33]  J. Rimmer Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities , 2006, Disability and rehabilitation.

[34]  Basia Belza,et al.  Ambulatory Physical Activity Performance in Youth With Cerebral Palsy and Youth Who Are Developing Typically , 2007, Physical Therapy.

[35]  Amy Rauworth,et al.  Physical activity participation among persons with disabilities: barriers and facilitators. , 2004, American journal of preventive medicine.

[36]  J. Rimmer,et al.  Effects of a short-term health promotion intervention for a predominantly African-American group of stroke survivors. , 2000, American journal of preventive medicine.

[37]  V. Feigin,et al.  Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review , 2009, The Lancet Neurology.

[38]  Leena Choi,et al.  Validation of accelerometer wear and nonwear time classification algorithm. , 2011, Medicine and science in sports and exercise.

[39]  J. Powell,et al.  Benefits of exercise maintenance after traumatic brain injury. , 2012, Archives of physical medicine and rehabilitation.

[40]  J. Harrison,et al.  The global burden of traumatic brain injury: preliminary results from the Global Burden of Disease Project , 2010, Injury Prevention.

[41]  M E Bouton A learning theory perspective on lapse, relapse, and the maintenance of behavior change. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[42]  H. Blake,et al.  Determinants of physical activity participation following traumatic brain injury , 2010 .

[43]  Y. Bhambhani,et al.  Effects of circuit training on body composition and peak cardiorespiratory responses in patients with moderate to severe traumatic brain injury. , 2005, Archives of physical medicine and rehabilitation.

[44]  R. Cumming,et al.  Exercise to Enhance Mobility and Prevent Falls After Stroke , 2012, Neurorehabilitation and neural repair.

[45]  D. Menon,et al.  of The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health , 2010 .

[46]  R. Macko,et al.  Testing a Model of Post‐Stroke Exercise Behavior , 2006, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[47]  A. Dunn,et al.  Lifestyle physical activity interventions. History, short- and long-term effects, and recommendations. , 1998, American journal of preventive medicine.

[48]  R. Macko,et al.  Reliability and validity testing of the short self-efficacy and outcome expectation for exercise scales in stroke survivors. , 2004, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[49]  B. Cardinal,et al.  A pilot study of a web-based physical activity motivational program for adults with physical disabilities , 2005, Disability and rehabilitation.

[50]  T. Truelsen,et al.  ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial , 2009, BMJ : British Medical Journal.