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Influencing Sedentary Behavior Through Participation After Stroke

Kringle, Emily A (2019) Influencing Sedentary Behavior Through Participation After Stroke. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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People with stroke have persistent high levels of sedentary behavior. Sedentary behavior, or prolonged sitting, has been associated with the exacerbation of chronic health conditions that elevate the risk for recurrent stroke (e.g., diabetes, obesity, depression). Studies examining sedentary behavior and inactivity physiology suggest that reductions in sedentary behavior are associated with improvements in chronic health conditions. Participation in daily activities requires movement out of a seated position to an upright position, thereby reducing sedentary behavior. This may lead to improvements in chronic health conditions and reduced risk for recurrent stroke.

The overarching goal of this dissertation is to identify intervention elements that hold promise for reducing sedentary behavior among people with chronic stroke. A scoping review revealed that current stroke rehabilitation interventions are associated with small reductions in sedentary behavior over time. Few interventions were clearly specified, and few outcomes were clearly defined. This led to the development of the Activating Behavior for Lasting Engagement (ABLE) intervention. The ABLE intervention uses behavioral activation to promote frequent participation in daily activities to reduce post-stroke sedentary behavior. A descriptive case series (n=5) was conducted to specify the intervention protocol. A single group pre-post-test study (n=21) was conducted to assess the feasibility (safety, participant acceptability, participant tolerability, reliable intervention delivery) and estimate change in sedentary behavior over time. The intervention was deemed safe, tolerable, and reliably delivered. Participant satisfaction scores did not meet the benchmark for feasibility. Moderate to large effect sizes were detected at post-intervention using an objective measure of sedentary behavior (ActivPAL micro3); small effect sizes were detected at 8-week follow-up.

Future intervention refinement is required to enhance the feasibility and bolster effects of the ABLE intervention. These efforts should incorporate the context of participation and sedentary behavior. In addition, consideration of the role of active and inactive participation, patterns of participation, patterns of sedentary behavior, and aspects of the environment will be critical to develop interventions that reduce sedentary behavior and promote optimal health outcomes.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Kringle, Emily Aeak60@pitt.edueak600000-0003-4958-9568
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSkidmore, Elizabeth Rskidmore@pitt.eduskidmore0000-0002-8287-7193
Committee MemberMcCue, Michaelmmccue@pitt.edummccue0000-0002-0850-6714
Committee MemberTerhorst, Laurenlat15@pitt.edulat150000-0001-6376-1470
Committee MemberBarone Gibbs, Bethanybbarone@pitt.edubbarone0000-0002-0732-6148
Committee MemberCampbell, Gracegbc3@pitt.edugbc30000-0003-3942-0662
Date: 4 June 2019
Date Type: Publication
Defense Date: 27 March 2019
Approval Date: 4 June 2019
Submission Date: 26 March 2019
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 144
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: stroke rehabilitation, behavioral activation, sedentary behavior, lifestyle, intervention, occupational therapy
Date Deposited: 04 Jun 2020 05:00
Last Modified: 04 Jun 2020 05:15


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