Effect of mixed and collective physical activity in chronic stroke rehabilitation: A randomized cross-over trial in low-income settings.

BACKGROUND: The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings. OBJECTIVE: To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke. METHODS: Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety. RESULTS: ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively. CONCLUSION: CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion. PROTOCOL REGISTRATION NUMBER: PACTR202001714888482.

Relationships between walking speed, activities and participation in people with chronic stroke in Burundi.

Background: Reduced walking speed because of a stroke may limit activities of daily living (ADLs) and restrict social participation. Objectives: To describe the level of balance impairment, activity limitations, and participation restrictions and to investigate their relationship with walking speed in Burundians with chronic stroke. Methods: This cross-sectional study involved adult stroke survivors. Walking speed, balance, ADLs and social participation were assessed with the 10-meter walk test (10 mWT), the Berg balance scale (BBS), the activity limitation stroke scale and the participation measurement scale, respectively. In order to determine ambulatory independence status, participants were stratified into three walking speed groups (household ambulation, limited ambulation and full-community ambulation), based on the Perry classification. Results: Fifty-eight adults (mean age 52.1 ± 11.4 years) with chronic stroke were included in our study. Most participants had severe balance impairments (median BBS score, 27). Their mean (± standard deviation [SD]) walking speeds, ADL levels and social participation levels were 0.68 ± 0.34 m/s, 50.8% ± 9.3% and 52.8% ± 8.6%, respectively. Walking speed correlated moderately with balance (rho = 0.5, p < 0.001) and strongly with ADL level (r = 0.7, p < 0.001) but not with participation level (r = 0.2, p = 0.25). Conclusion: Using socio-culturally suitable tools, our study showed that walking speed correlates robustly with balance and ADL ability, but not with social participation, in Burundi, a low-income country. Clinical implications: Exercises targeting walking speed would be very useful for people with chronic stroke living in low-resource countries, in order to promote their functional independence.

Biopsychosocial factors associated with chronic low back pain-related activity limitations in Burundi.

Background: Chronic low back pain (CLBP) is an increasing burden worldwide. The biopsychosocial factors associated with CLBP-related activity limitations have not yet been investigated in Burundi. Objective: The aim of our study was to investigate the biopsychosocial factors that influence the CLBP-related activity limitations in a Burundian sample population. Method: We carried out a cross-sectional study of 58 adults with nonspecific CLBP from Bujumbura city. Univariate and bivariate analyses were used to investigate the association between biopsychosocial factors and CLBP activity limitations. Sequential multiple regression analyses were subsequently used to predict CLBP activity limitations. Results: Fifty-eight individuals with a mean age of 41.3 ± 10.20, 58.6% of female gender, were recruited. The univariate and bivariate analyses demonstrated that educational level, gender, healthcare coverage, profession, height, pain intensity, depression and physical fitness were significantly associated with CLBP-related activity limitations (p range, < 0.001 to < 0.05). The multivariate regression analysis showed that the significant biopsychosocial factors accounted for 49% of the variance in self-reported activity limitations. Predictors of activity limitations were education level (ß = -0.369; p = 0.001), abdominal muscle endurance (ß = -0.339; p = 0.002) and depression (ß = 0.289; p = 0.011). Conclusions: Our study provides evidence of biopsychosocial factor associations with CLBP-related activity limitations in Burundi. Evidence-based management and prevention of CLBP in Burundi should incorporate a biopsychosocial model. Clinical implications: Biopsychosocial factors should be regularly evaluated in people with chronic low back pain and efforts to improve the burden of chronic low back pain in Burundi should take these factors into account.

Global and Leisure-Time Physical Activity Levels Among People Living With HIV on Antiretroviral Therapy in Burundi: A Cross-sectional Study.

ABSTRACT: The latest recommendations for HIV therapeutic management emphasize the importance of regular physical activity (PA). This cross-sectional study assessed the self-reported level of PA, amount of leisure time PA (LTPA), and the predictors of PA practiced in 257 people living with HIV (PLWH) in Burundi. The World Health Organization recommends 150 min of PA per week. In our study, 80.2% of the participants met this recommendation. Participants were more engaged in PA at work (436.8 ± 682.1 min/week) compared with leisure time (231.7 ± 383.8 min/week) and transportation (235.9 ± 496.5 min/week). Multivariate analysis revealed that men (ß = -101.65; p = .01) who were white-collar workers (ß = 67.21; p < .03) with higher education level (ß = 274.21; p < .001) reported higher levels of LTPA than other groups. Integrating PA counseling into the routine care and implementing community-based exercise programs could enhance participation in PA in PLWH.