Strategies for Promoting Physical Activity Maintenance Among Individuals with Stroke

Abstract

Physical activity can have beneficial effects on post-stroke recovery, but only if it is maintained. Current evidence shows that physical activity levels of individuals with stroke do not meet recommended guidelines. This thesis investigated current programs and proposed a novel trial design to aid stroke survivors with maintaining their activity levels in free-living environments. The first study was a systematic review of the effects of current interventions in post-stroke recovery. The review reported no differences between intervention and control groups for steps walked/day at 3-month (standardized mean difference (SMD) 0.19; 95% CI -0.30 to 0.69; I2 = 47%; GRADE rating: Very Low), time spent in moderate-vigorous physical activity at 3-month (SMD -0.03; 95% CI -0.73 to 0.68; I2 = 52%; GRADE rating: Very Low), or self-reported physical activity at the 6-month follow-up (SMD 0.40; 95% CI -0.02 to 0.82; I2 = 0%; GRADE rating: Very Low). However, the pooled estimate of the self-reported physical activity at the 3-month follow-up was above the line of no-effect (SMD 0.22; 95% confidence intervals, 0.01 to 0.42; I2 = 0%; GRADE rating: Very Low). Intervention characteristics associated with physical activity maintenance could not be explored due to the low number of trials. Insights from this review were used to design an Adaptive Treatment Strategy where high-intensity interventions are sequentially tailored to participants following the identification of increased needs. A protocol of a proof-of-concept pilot Sequential Multiple Assignment Randomized Trial was outlined to assess trial feasibility, participants’ acceptability with changes in interventions, participants’ and staffs’ satisfaction with the treatment strategy, and to provide preliminary estimates of effect of physical activity and self-efficacy for physical activity. Together, these two studies provide direction about intervention design, physical activity maintenance assessment, and proposes the design of a novel pilot SMART trial.