Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, ). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, ) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials. 1. Introduction Sedentary behaviour activities with an energy expenditure of ≤1.5 metabolic equivalent units [1, 2], such as lying down or sitting) [3] is associated with a variety of health risks, regardless of physical activity levels and other traditional risk factors such as smoking and high blood pressure. Cardiovascular disease [4, 5], type 2 diabetes [6], metabolic syndrome [7], and breast cancer [8] are a few diseases connected to sedentary behaviour, which further increases all-cause mortality [4, 5, 9, 10]. Each additional hour spent sedentary has been proposed to be associated with a progressive rise in mortality risk [4]. It is, however, not only the total amount of sedentary time which seems to be important, but also the way in which it is accumulated. Prolonged bouts of time in sedentary activities (such as sitting down) have been shown to be particularly harmful, with relative benefits noted from regular brief periods of standing or walking [11]. While it is well established that patients in stroke rehabilitation are very inactive [12], sedentary behaviour, per se, is not commonly investigated [13]. In the hospital setting, a recent review [12] of 24 studies demonstrated that stroke survivors on average are involved in nontherapeutic or low physical activity for as much as 76% of the
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