Abstract
BackgroundDespite the benefits of physical activity for walking ability, balance, and mood, less than 30% of stroke survivors engage in recommended levels of physical activity with high levels of sedentary behaviour observed. This study aims to assess the feasibility, acceptability and fidelity of a theory- and evidence-based multifaceted behaviour change intervention targeting free-living physical activity and sedentary behaviour after stroke.MethodsThis study will be set in community stroke services in the North East of England and will assess the feasibility of a behaviour change intervention targeting free-living physical activity and sedentary behaviour of stroke survivors and consultation behaviour of the healthcare professionals to support stroke survivors to make these lifestyle changes. Up to 35 stroke survivors currently receiving stroke rehabilitation within the study catchment area with capacity and no contraindications to increasing physical activity/reducing sedentary behaviour will be recruited. Stroke survivors will receive a supported self-management physical activity/sedentary behaviour programme incorporating provision of information, goal setting, action planning, barrier identification, coping planning, self-monitoring and feedback on physical activity and sedentary behaviour. The programme will be supported by up to 12 healthcare professionals (HCPs) recruited from the community stroke services taking part in the study. The HCPs will deliver at least two face-to-face sessions (baseline, review and subsequent reviews if necessary) and provide a range of personalised tools to support each individual stroke survivor (e.g. workbook, self-monitoring tools, information on local resources). The consultation behaviour of the HCPs will be targeted via a training programme incorporating face-to-face training, a training manual and individual feedback on intervention programme delivery from the study research team. The feasibility, acceptability and fidelity of the study protocol will be assessed.DiscussionThe most effective methods of supporting stroke survivors to alter physical activity and sedentary behaviour have yet to be established. This study will establish the feasibility of delivering a complex theory- and evidence-based intervention targeting the behaviour of both stroke survivors and HCPs and assess whether it is acceptable to the target populations. Findings will inform the iterative development of the intervention before a larger scale evaluation.Trial registrationTrial register: Trial identifier: ISRCTN35516780, date of registration: 24/10/2018
Highlights
Despite the benefits of physical activity for walking ability, balance, and mood, less than 30% of stroke survivors engage in recommended levels of physical activity with high levels of sedentary behaviour observed
This study will establish the feasibility of delivering a complex theory- and evidence-based intervention targeting the behaviour of both stroke survivors and healthcare professionals (HCPs) and assess whether it is acceptable to the target populations
Home and community physical activity levels are consistently low after stroke, with stroke survivors spending the majority of their day either sitting or lying down [3, 4]
Summary
Despite the benefits of physical activity for walking ability, balance, and mood, less than 30% of stroke survivors engage in recommended levels of physical activity with high levels of sedentary behaviour observed. Structured exercise is one method of increasing physical activity and has been shown to lead to short-term improvements in walking performance [7], physical fitness [8], metabolic risk factors [9] and mood and quality of life [10] These short-term benefits do not appear to be sustained, and the predominant mode of delivery of structured exercise (face-to-face group work) presents with numerous barriers to engagement including access, cost, sustainability and transport. The lack of long-term benefit of structured exercise is due to a lack of emphasis on ‘free-living’ behaviour and self-management during this mode of delivery This argument is supported by previous research findings indicating structured exercise sessions may only improve free-living physical activity levels if delivered alongside tailored counselling (e.g. group/individual counselling strategies including goal setting, monitoring and review) [11]. A number of small feasibility studies have demonstrated that supported selfmanagement is feasible for targeting physical activity/ sedentary behaviour after stroke [13, 14]
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