Promoção de atividade física em indivíduos pós-AVE

Abstract

Stroke has a heterogeneous and complex consequence on the functionality, affecting the structure and function of the body, social participation and activities of daily living. Thus, it increased the interest in research that enable the understanding of the better intervention strategies for this health condition. Nowadays, one of the lines of research has focused on trying to raise strategies and understand the sedentary behavior presented by this population, thus seeking to increase the practice of physical activity in stroke survivors. Several benefits on the continuous practice of physical activity are pointed out in the literature, such as increased cardiorespiratory conditioning, improved mobility and reduced stroke recurrence. To increase the scope of studies in this area, two studies were carried out in this thesis to contribute to the gap in the literature on factors related to the increase in the level of physical activity. The first study aimed to investigate the consequences of pilot or the feasibility studies of interventions to improve mobility after a stroke that became Randomized Controlled Trials (RCT), in addition to the barriers encounter by researchers to follow up the studies. The search was carried out in the Embase, Medline, PEDro, Lilacs and Cochrane Library databases, without data restriction. The inclusion criteria were: (1) pilot or feasibility studies, (2) stroke survivors with more than 18 years, acute or chronic phases after stroke, and (3) physical exercise interventions with outcome measures in mobility (gait). Two trained reviewers performed study selection and data extraction independently. The search strategy resulted in 2515 article, 112 studies were eligible and included in the review. These were published between 1988 to 2019. Seventyfive (67%) studies declared to be a pilot study. The main reason for carrying out the study analyze the feasibility of implementing the intervention proposal (83.9%); content analysis, frequency and intensity of the intervention (47.3%). Fifty percent of the articles concluded that it was feasible to be continue the study, but only seven (14%) studies reported that they became a RCT. Lack of funding for continuity of the studies were reported as the main barrier. The second study aimed to investigate the feasibility of a self-management program to increase the level of physical activity after acute stroke, in a developing country like Brazil. Thus, a phase 1, pre- and postintervention study was conducted with 20 acute stroke survivors. The selfmanagement program was delivered in six home-based sessions over three months. Twenty (16%) of eligible participants were recruited. Eighteen (90%) completed the program and were measured at 3 months, and thirteen (65%) at 6 months. 92% of sessions were delivered for 59 (SD 23) min per session. Participants didn’t increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) nor at 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more than the non-sedentary ones. In conclusion, the self-management program to increase the level of physical activity in ambulators after acute stroke appears to be feasible in a developing country and has the potential to increase the level of physical activity in sedentary individuals with mild disability after a stroke.