Energy expenditure during sitting, standing, wheelchair propulsion and walking in stroke survivors

Abstract

Aim The aim of this study is to compare the amount of energy expenditure during lying, sitting, standing, wheelchair propulsion and walking of stroke survivors with the energy expenditure of ≤1.5 Metabolic Equivalent of Task (MET) within the definition of sedentary behavior used in healthy adults.

Methods Energy expenditure of stroke survivors was measured by indirect calorimetry (Metamax II) during lying, supported and unsupported sitting, standing, wheelchair propulsion and walking. Measurements were performed with aids used in daily life. Calculations were done for the total group as well as categorised by the Functional Ambulation Categories (FAC).

Results Supported and unsupported sitting showed a lower MET value than 1.5 for the total group and all FAC levels. Only the group FAC 0 showed a higher MET value during standing (i.e. 1.60 METs). The total group (n=27) showed higher levels than 1.5 METs when propelling a wheelchair and walking, respectively 1.91 and 2.55. These increases were also the case when differentiated by ambulation level.

Conclusion The energy expenditure for individuals with stroke to maintain their balance while sitting is not high enough to classify as non-sedentary. Moreover, also for standing, except for individuals classified at FAC 0, there is currently no evidence that qualifies standing as true non-sedentary time. Because standing is not a part of the definition of sedentary behavior for healthy adults, the definition seems only partly applicable to stroke survivors.

Clinical Relevance This study gives insight concerning the amount of energy expenditure of stroke survivors during postures and activities, which may lead to better tailored care and advises during and after rehabilitation in terms of sedentary behavior and low intensity activities. Independent wheelchair propulsion seems to be a light activity which can be used in the clinical practise to encourage stroke survivors to be more active.