Category: Stroke; Lifestyle Medicine
Objective : To assess feasibility (reliability, acceptability, tolerability, and safety) of ABLE through pre-established benchmarks, and to estimate change in sedentary behavior over time.
Design : Non-randomized pre-post-test
Setting : Community
Participants (or Animals, Specimens, Cadavers) : Community-dwelling, ambulatory people with chronic stroke (6 months to 5 years post-stroke) with 6 hours or more self-reported daily sitting time.
Interventions : ABLE is based in behavioral activation (Kanter, 2010). Participants learned to monitor activities, identify times at risk for prolonged sitting periods, and schedule meaningful activities to break up prolonged sitting (twelve 45 minute in-home sessions over 4 weeks). Self-assessment and collaborative problem-solving skills were used to increase participation in meaningful activities.
Main Outcome Measure(s) : Feasibility was assessed using intervention fidelity procedures (Hildebrand, 2012), the Client Satisfaction Questionnaire-8 (CSQ-8, Attkisson, 1982), and session attendance, duration, and adverse events. Change in sedentary behavior (prolonged sitting in ≥30-minute bouts) was assessed post-intervention and 8-weeks post-intervention using the ActivPAL micro3 (Pal Technologies, Glasgow; Edwardson, 2017).
Results : Participants (n=21) were female (61.9%), white (81.0%), and reported low physical activity relative to pre-stroke (76.2%). Benchmarks for reliability (≥90% fidelity), tolerability (≥90% attendance), and safety (no serious adverse events) were met. The benchmark for acceptability (CSQ-8≥28.80) was not met (M=28.75, SD=3.84). Reduction in sedentary behavior over time (ActivPAL micro3) was moderate to large at post-intervention (M=54.94 minutes, SD=81.10, Cohen's d=0.70, 95% CI=-0.01, 1.24) and small at 8-weeks follow-up (M=19.11 minutes, SD=58.95, Cohen's d=0.18, 95% CI=-0.47, 0.84).
Conclusions : The ABLE intervention may be feasible and was associated with change in sedentary behavior over time. Future pilot testing should explore the role of social environment and levels of sedentary behavior indicating need for intervention.
Emily Kringle– Graduate Student Researcher, University of Pittsburgh, Allison Park, Pennsylvania
Lauren Terhorst– Associate Professor and Biostatistician, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
Grace Campbell– Assistant Professor, University of Pittsburgh, Pittsburgh, Pennsylvania
Bethany Barone Gibbs– Asssociate Professor, University of Pittsburgh, Pittsburgh, Pennsylvania
Michael McCue– Professor, University of Pittsburgh, Pittsburgh, Pennsylvania
Elizabeth Skidmore– Professor and Chair of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania