Promoting physical activity after stroke via self-management: a feasibility study Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial Impact of Treadmill Exercise on Efficacy Expectations, Physical Activity, and Stroke Recovery A randomised controlled trial evaluating family mediated exercise (FAME) therapy following stroke A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial Physical fitness training in Subacute Stroke (PHYS-STROKE) - study protocol for a randomised controlled trial ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial A lifestyle intervention as supplement to a physical activity programme in rehabilitation after stroke: a randomized controlled trial Physical activity early after stroke and its association to functional outcome 3 months later. Enhancing activities of daily living of chronic stroke patients in primary health care by modified constraint-induced movement therapy (HOMECIMT): study protocol for a cluster randomized controlled trial An evaluation of two different exercise regimes during the first year following stroke: A randomised controlled trial Mapping patients’ experiences after stroke onto a patient-focused intervention framework Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial Factors Influencing Stroke Survivors' Quality of Life During Subacute Recovery Feasibility and effects of adapted cardiac rehabilitation after stroke: a prospective trial
Abstract Background : Many people with mild disability after stroke are physically inactive despite the risk of recurrent stroke . A self-management program may be one strategy to increase physical activity in stroke survivors . Objectives : To investigate the feasibility of a self-management program , and determine whether self-management can increase daily physical activity levels and self-efficacy for exercise , decrease cardiovascular risk , and improve walking ability , participation , and quality of life in people with mild disability after stroke . Method : A Phase I , single-group , pre-post intervention study was carried out with twenty stroke survivors who had mild disability and were discharged directly home from acute stroke units . A self-management program was delivered via five home-based sessions over 3 months , incorporating : education , goal setting , barrier identification , self-monitoring , and feedback .  Feasibility of the intervention was determined by examining adherence , duration , usefulness , and safety . Clinical outcomes were amount of physical activity ( duration of moderate physical activity in min/day and counts of physical activity in steps/day ) , self-efficacy , cardiovascular risk , walking ability , participation , and quality of life . Results : The intervention was feasible with 96 % of sessions being delivered , each taking less than an hour ( 41 min , SD 12 ) . Participants perceived the self-management program to be useful and there were few adverse events . At 3 months , participants completed 27 min/day ( 95 % CI 4–49 ) more moderate physical activity than at baseline and 16 min/day ( 95 % CI −10 to 42 ) at 6 months . Conclusion : Self-management appears to be feasible and has the potential to increase physical activity in people with mild disability after stroke . A Phase II r and omized trial is warranted Background In New Zeal and , around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained . Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities . However , on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of re sources and geographical location . Currently most people receive no treatment beyond three months post stroke . The study aims to determine if the Augmented Community Telerehabilitation Intervention ( ACTIV ) results in better physical function for people with stroke than usual care , as measured by the Stroke Impact Scale , physical subcomponent . Methods / design This study will use a multi-site , two-arm , assessor blinded , parallel r and omised controlled trial design . People will be eligible if they have had their first ever stroke , are over 20 and have some physical impairment in either arm or leg , or both . Following discharge from formal physiotherapy services ( inpatient , outpatient or community ) , participants will be r and omised into ACTIV or usual care . ACTIV uses readily available technology , telephone and mobile phones , combined with face-to-face visits from a physiotherapist over a six-month period , to help people with stroke resume activities they enjoyed before the stroke . The impact of stroke on physical function and quality of life will be assessed , measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options . These outcomes will be collected at baseline , six months and 12 months . In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study . Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation . Best practice guidelines recommend a prolonged period of rehabilitation , however this is expensive and therefore not undertaken in most publicly funded centres . An effective , cost-effective , and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home . Trial registration Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Background Stroke is the most common disabling neurological condition in adults . Falls and poor mobility are major contributors to stroke-related disability . Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population . Currently there is good evidence that exercise can enhance mobility after stroke , yet ongoing exercise programs for general community-based stroke survivors are not routinely available . This r and omised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors . Methods and design Three hundred and fifty community dwelling stroke survivors will be recruited . Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessment s and exercise program .  After the completion of the pre-test assessment , participants will be r and omly allocated to one of two intervention groups . Both intervention groups will participate in weekly group-based exercises and a home program for twelve months . In the lower limb intervention group , individualised programs of weight-bearing balance and strengthening exercises will be prescribed . The upper limb/cognition group will receive exercises aim ed at management and improvement of function of the affected upper limb and cognition carried out in the seated position . The primary outcome measures will be falls ( measured with 12 month calendars ) and mobility . Secondary outcome measures will be risk of falling , physical activity levels , community participation , quality of life , health service utilisation , upper limb function and cognition . Discussion This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors . We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke . This program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12606000479505 ) ABSTRACT Stroke survivors are at high risk for cardiovascular mortality which can be in part mitigated by increasing physical activity . Self-efficacy for exercise is known to play a role in adoption of exercise behaviors . This study examines self-reported psychological outcomes in a group of 64 stroke survivors r and omized to either a 6-month treadmill training program or a stretching program .  Results indicated that , regardless of group , all study participants experienced increased self-efficacy ( F = 2.95 , p = .09 ) and outcome expectations for exercise ( F = 13.23 , p < 0.001 ) and improvements in activities of daily living as reported on the Stroke Impact Scale ( F = 10.97 , p = .002 ) . No statistically significant between-group differences were noted , possibly because of the fact that specific interventions design ed to enhance efficacy beliefs were not part of the study . Theoretically based interventions should be tested to clarify the role of motivation and potential influence on exercise and physical activity in the stroke survivor population Background Stroke is a leading cause of disability among adults worldwide . Evidence suggests that increased duration of exercise therapy following stroke has a positive impact on functional outcome following stroke . The main objective of this r and omised controlled trial is to evaluate the impact of additional family assisted exercise therapy in people with acute stroke . Methods / Design A prospect i ve multi-centre single blind r and omised controlled trial will be conducted . Forty patients with acute stroke will be r and omised into either an experimental or control group . The experimental group will receive routine therapy and additional lower limb exercise therapy in the form of family assisted exercises . The control group will receive routine therapy with no additional formal input from their family members . Participants will be assessed at baseline , post intervention and followed up at three months using a series of st and ardised outcome measures . A secondary aim of the project is to evaluate the impact of the family mediated exercise programme on the person with stroke and the individual(s ) assisting in the delivery of exercises using a qualitative methodology . The study has gained ethical approval from the Research Ethics Committees of each of the clinical sites involved in the study . Discussion This study will evaluate a structured programme of exercises that can be delivered to people with stroke by their ' family members/friends ' . Given that the progressive increase in the population of older people is likely to lead to an increased prevalence of stroke in the future , it is important to reduce the burden of this illness on the individual , the family and society . Family mediated exercises can maximise the carry over outside formal physiotherapy sessions , giving patients the opportunity for informal practice .Trial Registration The protocol for this study is registered with the US NIH Clinical trials registry ( NCT00666744 Objectives : To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural setting s ; to measure the impact of the programme on health-related quality of life and functional performance ; and to determine if any benefits gained are maintained . Design : R and omized , assessor blind , cross-over , controlled trial . Setting : Rural outpatient . Subjects : Twenty-five community-dwelling , chronic stroke survivors and 17 carers of participant stroke survivors . Intervention : The intervention group undertook a once-a-week , seven-week group programme combining physical activity , education , self-management principles and a ‘ healthy options ’ morning tea . At completion , the control group crossed over to receive the intervention . Main measures : Stroke Impact Scale ( stroke survivors ) , Health Impact Scale ( carers ) , Six Minute Walk Test , Timed Up and Go , Caregiver Strain Index . Results : There were insufficient participants for results to reach statistical significance . However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers . The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants . The programme was well attended . Of the seven sessions all participants attended four or more and 88 % attended six or seven sessions . Conclusions : This novel programme incorporating physical activity , education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian setting s. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation Background Given the rising number of strokes worldwide , and the large number of individuals left with disabilities after stroke , novel strategies to reduce disability , increase functions in the motor and the cognitive domains , and improve quality of life are of major importance . Physical activity is a promising intervention to address these challenges but , as yet , there is no study demonstrating definite outcomes . Our objective is to assess whether additional treatment in the form of physical fitness-based training for patients early after stroke will provide benefits in terms of functional outcomes , in particular gait speed and the Barthel Index ( co- primary outcome measures ) reflecting activities of daily living ( ADL ) . We will gather secondary functional outcomes as well as mechanistic parameters in an exploratory approach . Methods / Design Our phase III r and omised controlled trial will recruit 215 adults with moderate to severe limitations of walking and ADL 5 to 45 days after stroke onset . Participants will be stratified for the prognostic variables of “ centre ” , “ age ” , and “ stroke severity ” , and r and omly assigned to one of two groups . The interventional group receives physical fitness training delivered as supported or unsupported treadmill training ( cardiovascular active aerobic training ; five times per week , over 4 weeks ; each session 50 minutes ; total of 20 additional physical fitness training sessions ) in addition to st and ard rehabilitation treatment . The control intervention consists of relaxation sessions ( non-cardiovascular active ; five times per week week , over 4 weeks ; each session 50 minutes ) in addition to st and ard rehabilitation treatment . Co- primary efficacy endpoints will be gait speed ( in m/s , 10 m walk ) and the Barthel Index ( 100 points total ) at 3 months post-stroke , compared to baseline measurements . Secondary outcomes include st and ard measures of quality of life , sleep and mood , cognition , arm function , maximal oxygen uptake , and cardiovascular risk factors including blood pressure , pulse , waist-to-hip ratio , markers of inflammation , immunity and the insulin-glucose pathway , lipid profile , and others . Discussion The goal of this endpoint-blinded , phase III r and omised controlled trial is to provide evidence to guide post-stroke physical fitness-based rehabilitation programmes , and to eluci date the mechanisms underlying this intervention . Trial registration Registered in Clinical Trials.gov with the Identifier NCT01953549 Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity . Design Multicentre , multinational , r and omised clinical trial with masked outcome assessment . Setting Stroke units in Denmark , China , Pol and , and Estonia . Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 ( mean age 69.7 years ) r and omised to the intervention , 157 ( mean age 69.4 years ) in the control group . Interventions Patients r and omised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months . Control patients had follow-up visits with the same frequency but without instructions in physical activity . Main outcome measures Physical activity assessed with the Physical Activity Scale for the Elderly ( PASE ) at each visit . Secondary outcomes were clinical events . Results The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group ( difference 5.0 ( 95 % confidence interval −5.8 to 15.9 ) , P=0.36 . The intervention had no significant effect on mortality , recurrent stroke , myocardial infa rct ion , or falls and fractures . Conclusion Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score . More intensive strategies seem to be needed to promote physical activity after ischaemic stroke . Trial registration Clinical Trials Objective : To evaluate the effectiveness of lifestyle group intervention on well-being , occupation and social participation . Design : A r and omized controlled trial . Setting : Senior centres in the community . Subjects : Of 204 stroke survivors screened , 99 ( 49 % ) were r and omized three months after stroke whereby 86 ( 87 % ) participants ( mean ( SD ) age 77.0 ( 7.1 ) years ) completed all assessment s ( 39 in the intervention group and 47 in the control group ) . Intervention : A lifestyle course in combination with physical activity ( intervention group ) compared with physical activity alone ( control group ) . Both programmes were held once a week for nine months . Main outcome measure : The Short Form Question naire ( SF-36 ) , addressing well-being and social participation . Assessment s were performed at baseline and at nine months follow-up . Results : We found no statistically significant differences between the groups at the nine months follow-up in the SF-36 . Adjusted mean differences in change scores in the eight subscales of SF-36 were ; ‘ mental health ’ ( + 1.8 , 95 % confidence interval ( CI ) –4.0 , + 7.6 ) , ‘ vitality ’ ( −3.0 , 95 % CI −9.6 , + 3.6 ) , ‘ bodily pain ’ ( + 3.3 , 95 % CI −7.8 , + 14.4 ) , ‘ general health ’ ( −1.6 , 95 % CI −8.4 , + 5.1 ) , ‘ social functioning ’ ( −2.5 , 95 % CI −12.8 , + 7.8 ) , ‘ physical functioning ’ ( + 1.0 , 95 % CI −6.7 , + 8.6 ) , ‘ role physical ’ ( −7.1 , 95 % CI −22.7 , + 8.4 ) , ‘ role emotional ’ ( + 11.8 , 95 % CI −4.4 , + 28.0 ) . Conclusions : Improvements were seen in both groups , but no statistically significant differences were found in the intervention group compared to controls . An intervention comprising regular group-based activity with peers may be sufficient in the long-term rehabilitation after stroke BACKGROUND Early rehabilitation that includes early mobilization and increased amount of motor activity is hypothesized to be one of the most important factors contributing to the beneficial effect of comprehensive stroke unit treatment , whereas too much bed rest is hypothesized to be harmful . The purpose of the present study was to assess the association between early activity/bed rest and functional outcome 3 months later . METHODS This was a prospect i ve cohort study including patients with the diagnosis of stroke admitted to Trondheim University Hospital , Norway . Patients were eligible if they were less than 14 days poststroke and did not receive palliative care . Motor activity/bed rest  was recorded in the acute phase using a st and ard method of observation , and the outcome was assessed by the modified Rankin Scale ( mRS ) score 3 months later . A proportional odds model was used to analyze the association between motor activity/bed rest and outcome . All analyses were adjusted for age , gender , stroke severity , time from stroke to observation , and prestroke function . RESULTS A total of 106 patients ( mean age 79.0 years , 56.6 % men ) were included . The odds ratio for a higher mRS score ( poor outcome ) was 1.04 ( 95 % confidence interval [ CI ] 1.02 - 1.07 , P = .001 ) as time in bed increased and .97 ( 95 % CI .93 - 1.02 , P = .283 ) as time in motor activity increased . CONCLUSIONS This study confirms that time in bed in the early phase is associated with poor functional outcome 3 months later , indicating that too much bed rest should be avoided in the early phase after stroke Background Stroke leads to constant rehabilitation needs even at the chronic stage . However , although many stroke patients receive physical or occupational therapy in primary health care , treatment prescriptions do not generally specify therapeutic goals ; in particular , participation is not established as an explicit therapeutic goal in the ambulatory setting . The primary aim of this study is to evaluate the efficacy of a therapy regimen for chronic stroke patients ( modified ‘ constraint-induced movement therapy ( CIMT ) at  home  ’ ) with impaired h and or arm function with regard to the prerequisites of participation in everyday activities : a sufficient arm and h and function . ‘ CIMT at home ’ will be compared with conventional physical and occupational therapy ( ‘ therapy as usual ’ ) . Methods / design The study is a parallel cluster r and omized controlled trial with therapy practice s as clusters ( n = 48 ) . After written consent from the patients ( n = 144 ) , the therapists will be r and omly assigned to treat either the intervention or the control group . Blinded external assessors will evaluate the patients using st and ardized outcome measures before and after the intervention , and six months later . The two co primary endpoint assessment s of arm and h and function as prerequisites for participation ( defined as equal involvement in activities of daily living ) are the motor activity log ( quality of arm and h and use ) and the Wolf motor function test ( arm and h and function ) . These assessment s are made four weeks post-treatment and relativized to baseline performance . Changes in primary outcomes will be analyzed with mixed models , which consider the hierarchical structure of the data and will be adjusted to the baseline measurements and sex . The primary analysis will be the comparison of the two r and omized groups , with respect to the adjusted averages for each of the two co primary endpoints . To keep an overall significance level of 5 % , the two endpoints will be tested at the significance level of 5 % each in hierarchical order . Discussion A modification of the CIMT , feasible in the patients ’ homes ( CIMT at home ) , appears to be a promising therapeutic approach in the ambulatory care of chronic stroke patients . With proven efficacy and practicality , a participation-oriented , stroke-specific treatment would be available in primary care . Trial registration Clinical Trials.gov The purpose of this r and omised controlled trial was to evaluate the effects of two different exercise approaches during the first 12 months post stroke on Instrumental Activities of Daily Living ( IADL ) , motor function , gait performance , balance , grip strength , and muscle tone . This study is a double-blind longitudinal r and omised trial of first-time-ever stroke patients . Seventy-five patients were included : 35 in an intervention group and 40 in a self-initiated exercise group .  After discharge from acute rehabilitation , patients assigned in the intervention group had physiotherapy for a minimum amount of 80 hours during the first year . Patients in the self-initiated exercise group were not recommended any specific therapy besides treatment when needed . Main outcome measures were Instrumental Activities of Daily Living according to Fillenbaum , Motor Assessment Scale , 6-Minute Walk Test , Berg Balance Scale , Timed Up- and -Go Test , grip strength , Modified Ashworth Scale , and pulse monitoring . The patients were tested on admission , at discharge , and after 3 , 6 , and 12 months post stroke by an experienced investigator , blinded to group assignment . Twelve months post stroke showed higher levels of independence in all items of the Instrumental Activities of Daily Living Test and improvements in the results of Motor Assessment Scale , 6-Minute Walk Test , Berg Balance Scale , Timed Up- and -Go , and grip strength in both groups . Only a few significant differences were seen between groups , and they were in favour of the self-initiated exercise group ( e.g. , ability to use the telephone independently ) . Attending examination sessions following each intervention phase appeared to be strong motivators for training , irrespective of group allocation Background : Stroke patients ’ involvement in the rehabilitation process including decision making has made significant advances clinical ly over the past two decades . However , development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research . The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may vali date an already established patient-focused intervention framework – the Quest for quality and improved performance ( QQUIP ) ( 2006 ) that includes seven quality improvement goals . Methods : A r and om purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge . Patients ’ reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis . Results : Explanations given by patients included both positive and negative reports of the stroke experience . Regardless of consequences as a result of physical , psychological and social impairments , there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these , experiencing increasing fatigue , difficulties with social activities and situations and having to make changes in health behaviours and lifestyle . Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy , clinical decision-making , self-care , patient safety , access to health advice , care experience and service development . Discussion : Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred . This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care . Implication s for Rehabilitation Consideration for the use of established patient focused frameworks for improving the design and development of rehabilitation stroke interventions . Identify patients ’ main concerns following the experience of stroke and its result ing consequences in developing stroke rehabilitation interventions Greater need to move from a provider-led model of care towards a more favourably balanced view that includes patient participation and involvement in their self management of the rehabilitation programme Background Stroke is one of the major causes of loss of independence , decreased quality of life and mortality among elderly people . About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke , which can lead to difficulties in picking up and managing their social life . The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients . Methods A two group multicentre r and omised controlled trial is used to evaluate the effects of the rehabilitation programme . The programme consists of three care modules : 1 ) neurorehabilitation treatment for elderly stroke patients ; 2 ) empowerment training for patient and informal caregiver ; and 3 ) stroke education for patient and informal caregiver . The total programme has a duration of between two and six months , depending on the individual problems of the patient and informal caregiver . The control group receives usual care in the nursing home and after discharge .  Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge . Data are gathered by face-to-face interviews , self-administered question naires , focus groups and registration forms . Primary outcomes for patients are activity level after stroke , functional dependence , perceived quality of life and social participation . Outcomes for informal caregivers are perceived care burden , objective care burden , quality of life and perceived health . Outcome measures of the process evaluation are implementation fidelity , programme deliverance and the opinion of the stroke professionals , patients and informal caregivers about the programme . Outcome measures of the economic evaluation are the healthcare utilisation and associated costs . Data are collected at baseline , and after six and 12 months . The first results of the study will be expected in 2014.Trial registration International St and ard R and omised Controlled Trial Register Number IS RCT N62286281 , The Dutch Trial Register Background and Purpose — Health-related quality of life ( HRQOL ) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery . This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery . Methods — Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial ( Extremity Constraint-Induced Therapy Evaluation ) . HRQOL was assessed using the  Stroke Impact Scale ( SIS ) , Version 3.0 . The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity . Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains . Results — Age , gender , education level , stroke type , concordance ( paretic arm = dominant h and ) , upper extremity motor function ( Wolf Motor Function Test ) , and comorbidities were associated across SIS domains . Poorer HRQOL in the physical domain was associated with age , nonwhite race , more comorbidities , and reduced upper-extremity function . Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking , and those with an ischemic stroke and concordance reported poorer communication . Conclusions — Although results may not generalize to lower functioning stroke survivors , individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive , targeted interventions design ed to maximize recovery and improve HRQOL Background Despite the cardiovascular etiology of stroke , exercise and risk factor modification programs akin to cardiac rehabilitation ( CR ) are not available . This study aim ed to establish the feasibility of adapting a CR model for individuals with mild to moderate stroke disability . A secondary objective was to determine the program 's effects on aerobic and walking capacity , and stroke risk factors . Methods A repeated measures design was used with a 3-month baseline period and 6-month adapted CR intervention  ( n = 43 , mean ± SD age 65 ± 12 years , 30 ± 28 months post stroke ) . Feasibility was determined by the number of participants who completed the study , occurrence of adverse events and frequency , duration and intensity of exercise performed . To determine effectiveness of the program , outcomes measured included aerobic capacity ( VO2peak , ventilatory threshold ) , 6-Minute Walk Test ( 6MWT ) distance , and risk factors . Descriptive statistics characterized the classes attended and number and intensity of exercise sessions . Paired t-tests , one-factor repeated measures analyses of variance contrasts and chi-square analyses were used to compare changes over time . Results Two participants withdrew during the baseline period . Of the remaining 41 participants who commenced the program , 38 ( 93 % ) completed all aspects . No serious adverse effects occurred . Post-intervention , VO2peak improved relative to the stable baseline period ( P = 0.046 ) and the increase in ventilatory threshold approached significance ( P = 0.062 ) . Conclusions CR is feasible after stroke and may be adapted to accommo date for those with a range of post-stroke disability . It is effective in increasing aerobic capacity . CR may be an untapped opportunity for stroke survivors to access programs of exercise and risk factor modification to lower future event risk . Trial registration Clinical Trials.gov registration number :
DISCUSSION This systematic review will provide information on which interventions are effective for increasing physical activity levels of stroke survivors .
INTRODUCTION Stroke is a leading health problem worldwide and an important cause of disability .
Stroke survivors show low levels of physical activity , and increases in physical activity levels may improve function and health status .
Therefore , the aims are to identify which interventions that have been employed to increase physical activity levels with stroke survivors , to verify their efficacy and to identify the gaps in the literature .