Abstract
BackgroundIncreasing physical activity (PA) levels (regular movement such as walking and activities of daily living) and reducing time spent sedentary improves cardiovascular health and reduces morbidity and mortality. Fewer than 30% of independently mobile stroke survivors undertake recommended levels of PA. Sedentary behaviour is also high in this population. We aimed to systematically review the study characteristics and the promise of interventions targeting free-living PA and/or sedentary behaviour in adult stroke survivors.MethodsSeven electronic databases were searched to identify randomised controlled trials (≥3-months follow-up) targeting PA and/or sedentary behaviour in adults with first or recurrent stroke or transient ischaemic attack. The quality assessment framework for RCTs was used to assess risk of bias within and across studies. Interventions were rated as “very”, “quite” or “non-promising” based on within- or between-group outcome differences. Intervention descriptions were captured using the TIDieR (Template for Intervention Description and Replication) Checklist. Behaviour change techniques (BCTs) within interventions were coded using the BCT Taxonomy v1, and compared between studies by calculating a promise ratio.ResultsNine studies fulfilled the review criteria (N = 717 randomised stroke patients) with a high or unclear risk of bias. None of the studies targeted sedentary behaviour. Six studies were very/quite promising (reported increases in PA post-intervention). Studies were heterogeneous in their reporting of participant age, time since stroke, stroke type, and stroke location. Sub-optimal intervention descriptions, treatment fidelity and a lack of standardisation of outcome measures were identified. Face to face and telephone-based self-management programmes were identified as having promise to engage stroke survivors in PA behaviour change. Optimal intensity of contact, interventionist type and time after stroke to deliver interventions was unclear. Nine promising BCTs (ratios ≥2) were identified: information about health consequences; information about social and environmental consequences; goal setting-behaviour; problem-solving; action planning; feedback on behaviour; biofeedback; social support unspecified; and credible source.ConclusionsFuture research would benefit from establishing stroke survivor preferences for mode of delivery, setting and intensity, including measurement of physical activity. Interventions need to justify and utilise a theory/model of behaviour change and explore the optimal combination of promising BCTs within interventions.
Highlights
Increasing physical activity (PA) levels and reducing time spent sedentary improves cardiovascular health and reduces morbidity and mortality
Fewer than 30% of independently mobile stroke survivors undertake recommended levels of physical activity [3, 4]
Increasing physical activity and reducing sedentary behaviour after stroke can improve walking ability and balance [6], control risk factors associated with further cardiovascular disease [7] and attenuate low mood and social isolation frequently observed after stroke [8, 9]
Summary
Increasing physical activity (PA) levels (regular movement such as walking and activities of daily living) and reducing time spent sedentary improves cardiovascular health and reduces morbidity and mortality. Increasing physical activity and reducing sedentary behaviour after stroke can improve walking ability and balance [6], control risk factors associated with further cardiovascular disease [7] and attenuate low mood and social isolation frequently observed after stroke [8, 9]. Structured exercise programmes targeting physical fitness after stroke have been shown to improve short-term physical function [6], cardiorespiratory fitness [12] and metabolic risk factors [7, 13], the impact of these interventions on free-living physical activity and sedentary behaviour over time has not been established. Structured supervised exercise sessions often have little or no emphasis on free-living physical activity or sedentary behaviour outside of the clinical setting. They do not equip individuals with the knowledge, skills and confidence for maintaining increased physical activity over time
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