Primary outcomes

Death¹

Any cause

Recurrent non‐fatal events¹

Cardiovascular

Cerebrovascular

Secondary outcomes

Adverse events¹

Falls

Sedentary behaviour¹

Time

Pattern

Risk factors

Other outcomes

Impairments

Physical fitness

Balance

Activity limitations

Specific

Generic

Participation restriction

Quality of life

Psychosocial

Mood

Fatigue

Cognition

Complications of immobility

English 2016b

Breaking up sitting time with
physical activity

Breaking up sitting time with periods of light intensity physical activity leads to reductions
in cardiovascular disease risk factors and mortality.
Therefore, interventions aimed at reducing daily sitting time
may be a promising new target for reducing recurrent stroke risk

Four counselling sessions with the main message being to sit less
and move more, with encouragement to regularly break up sitting
time with short bursts of light‐intensity activity (standing,
walking at a comfortable pace)
 

Motivational interviewing to elicit behaviour
change.

At the first session, participants were presented
with an individualized written report which provided
feedback regarding daily sedentary time and breaks in sedentary
time based on the baseline hip‐worn accelerometer data. This report was used as the starting point for discussions. The counselling
sessions used key motivational interviewing techniques
(decisional balance sheets, importance and confidence rulers) to
initiate and reinforce change talk. Action plans, goals, and strategies
were elicited from the participants, rather than imposed by the counsellors

The counselling sessions were provided by 2
researchers, both of whom were formally trained in
motivational interviewing techniques through accredited courses

The first session was provided face‐to‐face, follow‐up counselling sessions were delivered by
phone

First face‐to‐face session was delivered at the participant's home

Follow up sessions occurred 1, 3, and 7 weeks after the initial session

Motivational interviewing was used
to strengthen each participant's own motivation and commitment
to change.
At the first session, participants were presented
with an individualized written report which provided
feedback regarding daily sedentary time and breaks in sedentary
time based on the baseline hip‐worn accelerometer data. This
report was used as the starting point for discussions. Action plans, goals, and strategies
were elicited from the participants, rather than imposed by
the counselors

n/a

Feasibility was assessed via adherence to counselling sessions
(actively engaged in all scheduled counselling sessions) and
completion of all assessments at baseline and post intervention,
including activity monitor wear time

There was
100% compliance with counselling sessions (ie, all participants
engaged in all scheduled counselling sessions).

Compliance with wearing the activity monitors was
high. At baseline, 23 and 31 participants had 7 days of valid data
from the activPAL3 and Actigraph monitors, respectively. All
other participants had at least 4 days of wear time for both
monitors, with the exception of 3 participants for whom the
Actigraph monitor did not record any valid data on any days. At
post intervention, 33 and 25 participants had 7 days of valid data
from the activPAL3 and the Actigraph monitors, respectively. All
other participants had at least 4 valid wear days for both the
activPAL3 and Actigraph monitors, with the following exceptions: 2 participants (both in the control group) did not complete the
post intervention assessment for reasons of ill health not related to
the trial, and a further 3 participants did not have any valid wear
days for the Actigraph monitor

Krawcyk 2019
 

Early home‐based high intensity interval training (HIIT)

HIIT offers a low time commitment exercise intervention which could overcome barriers to physical activity, improve fitness and influence risk factors

a) Indoor exercise equipment including  cycle ergometer, rowing machine or stairs

and /or

b) Outdoor exercise access to places in which to walk, run or cycle

c) Exercise catalogue containing various suggested modes of exercise

d) Laminated standardized text passage (cue card) to guide exercise intensity

e) Stop watch to time the exercise intervals

f) Exercise diary to record mode duration and intensity

HIIT was performed 9 minutes per day for 12 weeks at home via a mode(s) of exercise selected from a catalogue.

Participants were encouraged to exercise at a high intensity such that they were unable to speak comfortably

The HIIT programme was unsupervised but the trial coordinator was in regular contact
 

a) Trial coordinator provided a talk at baseline which was an education session about lifestyle changes including exercise

b) Trial coordinator  made one home visit to introduce the exercise programme and the talk test (for exercise intensity)

c) Trial coordinator  made weekly telephone calls to check progress

Home and/or outdoors in the community
 

Each session comprised 3 x 3 minutes exercise with 2 minutes active recovery between

Sessions occurred 5 days per week for 12 weeks.

Exercise intensity 77 to 93% maximum heart rate, 14 to 16 on the Borg scale of perceived exertion, not able to speak comfortably.

Exercise intensity progressed by ensuring that participants were not able to speak comfortably.

a) Participants could choose their mode of exercise from among stationary bicycle, brisk walking, stair stepping, outdoor cycling, running, other rehabilitation and indoor rowing. Mode could be alone or in combination.
 

b) Exercise intensity was tailored for each participant

n/a

a) Participants had a
laminated standardized text passage (cue card) to guide exercise intensity.

b) Participants
wore a stop watch to time the 3 minute exercise intervals.

c) Participants kept an exercise diary to record mode duration and intensity.

d) Trial coordinator  made weekly telephone calls to check progress

Participants exercised for an average of 56 out of 60 planned days (93% adherence)

10 of 31 patients (32%) exercised >5 days per week (>100% adherence)

24 of 31 patients (77%) exercised ≥4 days per week (≥80% adherence)

LAST 2018
 
 

Individualised coaching in exercise and physical activity
 

Tailored counselling is known to improve participation in physical activity after stroke
 

a)  a standardized questionnaire to register individual physical activity preferences and list 1 to 3 individual goals

b) outpatient, private, and community‐based treatment
groups, individual physiotherapy, or home training

c) training diary

a) Based on the preferences and goals, a schedule
for physical activities and exercise was set for the next month.

b) participants offered access to outpatient, private, and community‐based treatment groups, individual physiotherapy, or home training if preferred

c) participants were trained how to complete the
training diary and record the amount and intensity of each day’s
activities.

d) Training diaries were reviewed, and the schedule was
reassessed according to individual needs, including progression for
the next month.

e)  Monthly Meetings Month 1‐6  face‐to‐face in the participants’
home.
Month 7‐12 alternate home/phone meetings
Month 13‐18
4 phone and 2 home meetings

Physiotherapist
 

Monthly coaching and scheduling by physiotherapist  based on preferences and goals established using the Goal Attainment Scaling approach
 

Home including community based groups and exercise classes
 
 

Exercise; 45–60 minutes per session, 1 day per week for 18 months at an intensity between 15 and 17 on Borg scale of perceived exertion

Physical activity; 30 minutes per day, every day for 18 months
 
 
 
 
 

Individualised coaching involved identification of individual exercise/activity modes and identification of individual goals.

Intensity of exercise was tailored using the Borg scale of perceived exertion

Exercise/physical activity reviewed and reassessed for the next month

n/a
 

Clear RPE guidelines given

Training diary to monitor progress and advise on next phase

> 60% of participants complied with 150 min/week physical activity

50 ‐ 57% of participants complied with 45min/week exercise

Average exercise RPE achieved 14.0 ‐ 14.3

Attendance at more than 50% of coaching meetings; 38 ‐ 58% of participants

SPRITE I (arm 1) 2017

Home‐based
cardiac rehabilitation programme modified for stroke

Cardiac rehabilitation benefits mortality and morbidity and home delivery improves adherence. Shared common risk factors mean this intervention may also be beneficial for stroke and TIA

a) 'The Healthy Brain Rehabilitation Manual' containing
information about stroke, setting lifestyle change goals and cardiovascular risk. Content included (smoking, physical and
sexual activity, mental health, community resources (e.g. smoking
cessation support; exercise classes), diet and secondary
prevention medication.

b) Telephone follow‐up involving motivational interviewing based on the  theory of planned behaviour and adopting the ‘5
As’ approach to behaviour change.

c) Guidance on how to achieve moderate
intensity physical activity using the ‘talk/sing test’

Participants were informed of the UK national physical
activity guidelines as well as how to achieve moderate
and vigorous physical activity intensity.

This was explained to participants at baseline assessments, in the manual and during telephone follow‐up
 

Health professional (General
Practitioner)

Healthy Brain Manual and telephone follow‐up support carried out by health professional

Home

'The Healthy Brain Rehabilitation Manual' was provided for 6 weeks

Telephone follow‐up took place in week 1 and week 4

Participants were able to set their own goals

n/a

Strategies to improve fidelity:

Participants provided 'The Healthy Brain Rehabilitation Manual' to refer to

Telephone support provided

100% retention of participants in the study

 SPRITE I (arm 2) 2017
 

Home‐based cardiac rehabilitation programme modified for stroke which is delivered either with pedometer

Cardiac rehabilitation benefits mortality and morbidity and home delivery improves adherence. Shared common risk factors mean this intervention may also be beneficial for stroke and TIA

Use of a pedometer  promotes physical activity by providing feedback and allowing  goal setting and
monitoring of activity levels

a) 'The Healthy Brain Rehabilitation Manual' containing
information about stroke, setting lifestyle change goals and cardiovascular risk. Content included (smoking, physical and
sexual activity, mental health, community resources (e.g. smoking
cessation support; exercise classes), diet and secondary
prevention medication.

b) Telephone follow‐up involving motivational interviewing based on the  theory of planned behaviour and adopting the ‘5
As’ approach to behaviour change.

c) Pedometer device (either Yamax Digi‐Walker CW‐701 or Fitbit Charge) to record daily step count and allow participants to set and monitor
goals to increase their physical activity levels

d) Guidance on how to achieve moderate
intensity physical activity by adopting a cadence of 100 steps/min

Participants were informed of the UK national physical
activity guidelines as well as how to achieve moderate
and vigorous physical activity intensity.

This was explained to participants at baseline assessments, in the manual and during telephone follow‐up.

Encouraged to use pedometers
to set step count targets based on previous week’s self‐reported daily step counts

Health professional (General Practitioner)
 

Healthy Brain Manual and telephone follow‐up support carried out by health professional
 

Home
 

'The Healthy Brain Rehabilitation Manual', with a pedometer, was provided for 6 weeks

Telephone follow‐up took place in week 1 and week 4

Participants were able to set their own goals
 

n/a
 

Strategies to improve fidelity:

Participants provided 'The Healthy Brain Rehabilitation Manual' to refer to

Telephone support provided

Pedometers to keep a daily step count diary

100% retention of participants in the study

Not all participants able to use Fitbit pedometer and changed to the Yamax pedometer instead

SPRITE II (arm 1) 2019
and SPRITE II (arm 2) 2019
 

Home‐based cardiac rehabilitation programme modified for stroke which is delivered either with or without telephone support from either a GP or  stroke nurse

Cardiac rehabilitation benefits mortality and morbidity and home delivery improves adherence. Shared common risk factors mean this intervention may also be beneficial for stroke and TIA
 

a) 'The Healthy Brain Rehabilitation Manual' containing
information about stroke, setting lifestyle change goals and cardiovascular risk. Content included (smoking, physical and
sexual activity, mental health, community resources (e.g. smoking
cessation support; exercise classes), diet and secondary
prevention medication.

b) Telephone follow‐up involving motivational interviewing based on the  theory of planned behaviour and adopting the ‘5
As’ approach to behaviour change.

c) Wrist worn pedometer device (Yamax Digi‐Walker CW‐701) to record daily step count and allow participants to set and monitor
goals to increase their physical activity levels

d) Daily step count and physical activity diary

At baseline participants given 'The Healthy Brain Rehabilitation
Manual', a wrist‐worn pedometer,
 step count and physical activity diary.

At baseline participants were informed about physical activity guidelines and how to achieve moderate and vigorous physical activity intensity, reduce sedentary time, and set and monitor physical activity goals using the pedometer

During weeks 1, 4, and 9 participants were
telephoned to address
any concerns,  report weekly average step
counts and encouraged to set step count targets via
motivational interviewing in standardised format.

Participants were telephoned by either a) GP

b) Stroke Nurse

SPRITE II (arm 1) 2019

Health professional (General Practitioner)

Healthy Brain Manual and telephone follow‐up support carried out by health professional
 
 

Home
 
 

Healthy Brain Rehabilitation Manual, with or without pedometers, was provided for 12 weeks

Telephone follow‐up took place in weeks 1, 4 and 9

Participants were able to set their own goals
 
 

n/a
 

Strategies to improve fidelity:

Participants provided a healthy brain rehabilitation manual to refer to

Participants provided with pedometers and kept a daily step count diary

Telephone support provided

Three participants believed the pedometer under‐counted their steps

Five participants lost their pedometer

One participant discontinued using pedometer due to skin irritation.

1/28 participants dropped out

SPRITE II (arm 2) 2019

Health professional (Stroke Nurse)

STARFISH 2018

Increasing physical activity in stroke survivors using STARFISH, an interactive smartphone application: a randomised controlled trial

Stroke survivors are less physically active and have higher sedentary time than healthy matched controls. Low levels of PA and poor cardiovascular fitness are modifiable risk factors for secondary stroke. Novel methods of supporting PA and exercise programmes following stroke should be developed. Mobile devices can provide real‐time feedback, allow individualised content, and facilitate social support

a) Samsung GalaxyTM smartphone containing the STARFISH application. STARFISH uses the in‐built tri‐axial accelerometer of the phone to record the participant’s step count and data is uploaded to the STARFISH server.

b) Literature on post‐stroke PA

Each member of the intervention group was given a smartphone. For the first week STARFISH recorded the step count of each participant to calculate the individual step count target for the following week.

At the end of the week the four members of intervention group met with the researcher. At this visit, individualised step count target for each participant was determined. Thereafter individual step targets were reviewed from data on the STARFISH server and updated automatically.

During the intervention period if a participant reached their target on five out of seven days in a week, their target was increased by 5% for the following week to a maximum of 3000 steps above their baseline.

The group met again with the researcher two months after baseline, to discuss progress and address any concerns.

Control group participants received one individual session with the research physiotherapist where they were given literature published by Chest Heart and Stroke Scotland on the recommended PA guidelines, advice on how to take part in physical activity after surviving a stroke event, and the health benefits of PA post‐stroke.

At completion of the trial the control group participants  received a summary of their outcome measures and a pedometer

The researcher

a) Phone with app given at the start 

b) after week 1, group of 4 participants meet to set step count target for each individual in the group

c) after 2 months progress discussion with researcher

d) after 4 months researcher collects phones and 2nd assessment by blinded assessor

Home

App was provided for 4 months

Progress discussion after 2 months

‐ Initial step count target set 10% above individual baseline step count

‐if a participant reached their target on 5/7days their step count target was increased by 5% the following week, up to a maximum increase of 3000 steps above baseline.

‐ if a participant did not reach their target then the next week their target remained unchanged.

‐If all four members of the group reached their daily step count target on 5/7 days then a reward was administered (i.e. a creature was added to the group’s virtual fish tank)

n/a

‐ Data uploaded to the server automatically

‐ Meeting at 2 months to discuss progress

‐ Constant feedback via the app

Baseline intervention n= 52 (31 control) 

4 month assessment  n= 49 (21 control)

6 month follow up assessment n= 44 (19 control)

Vanroy 2019

Aerobic cycling plus education, followed by coaching

Improved aerobic fitness should increase activities of daily living and physical activity.
Educational content aimed to stimulate active behaviour
and  compliance with intervention through behaviour change techniques.

Coaching at the end of an aerobic fitness programme should facilitate carry‐over into a more physically active lifestyle. Coaching strategies were
derived from several theoretical backgrounds such as the Trans
theoretical Model of behavior change and the self‐determination
theory
 

Phase 1 of study

a) Stationary cycle ergometer that
enables passive, motor‐assisted or active resistive training (MOTOmed leg trainer)

b) MOTOmed chip card

c) Polar pulse watch and chest strap

d) Educational sessions for patients and relatives or friends

e) Individual 'movement contract' with patient’s
decision about how to continue the training

Phase 1

In addition to usual care the participants performed seated cycle training using the MOTOmed ergometer with the intensity guided by the heart rate monitor and the session recorded on the MOTOmed chip card.

Education sessions were delivered during this phase

Movement contract was set up between researcher and participant

Phase 1

Researcher set up the movement contract

Unclear who delivered the education sessions

Phase 1

The exercise was delivered individually with face‐to‐face supervision by researcher

Education delivered unclear with regard individual/group format

Phase 1

Inpatient rehabilitation centre

Phase 1

a) Exercise; 3 times per week for 12 weeks. Training sessions consisted
of 30 minutes of active cycling, progressing from interval (weeks 1‐8) to
continuous (weeks 9‐12) training.

b) Education; information sessions given 4 times for 60 minutes in weeks  3, 6, 8 and 12

Phase 1

Exercise intensity was tailored as it was individualised based on HRR

Movement contract was individualised

Education component not individualised

n/a

Phase 1

To facilitate compliance the sessions were recorded on the MOTOmed cards and a movement contract was agreed

No data available reporting compliance, attendance, adherence

Phase 2 of study

a) Visits by researcher

b) Choice of exercise mode

c) Movement contract

d) Means of recording training

Phase 2

a) Participant performed their choice of aerobic exercise and recorded what they did

b) Researcher visited participants to review the intervention and the movement contract.

Several behavioral strategies
were included in the coaching approach: goal setting, discussing
barriers, increasing autonomy, self‐monitoring and social
support, and motivational interviewing

Phase 2

A well‐trained and experienced
physiotherapist was appointed as the coach

Phase 2

Freely chosen exercise could involve some group activity; no face to face exercise delivery by researcher

Review of exercise performed face to face

Phase 2

At home

Phase 2

Exercise; dose not standardised but selected by each participant

Review visits; 1 visit per month for 9 months; time unclear

Phase 2

Training was self chosen

Movement contract was individualised

Review visits were individualised

n/a

Phase 2

To facilitate compliance,  the researcher undertook monthly review visits

No data available reporting compliance, attendance, adherence
 

Wellwood 2004

Doubled dose of physiotherapy

a) Additional inpatient physiotherapy should
speed up the recovery including mobility

b) Specific functional objectives included the
establishment of independent dynamic sitting balance,
standing balance, upper limb function and
walking, and other functional mobility tasks

a) Three rehabilitation units delivering representative
physiotherapy representative of normal approaches 
UK practice

b) Pre‐existing model for physiotherapy treatment schedules

c) Mechanism for recording the structure of delivered therapy

Physiotherapy delivered was based on outline treatment schedules described by Edwards 1991

Staff included senior and junior qualified
physiotherapists,  occasionally supervised physiotherapy
students

Face to face inpatient rehabilitation delivered during inpatient care.

Trialists considered it impossible to
designate in advance a standard treatment for all
patients but outline treatment schedules were
discussed (based on Edwards et al. 1991) by the trial
management group to ensure consistency of treatment
categories

Three rehabilitation facilities

Intervention comprised an additional 30‐40 minutes contact per day, five days per week

Unclear; UK physiotherapy model would include tailoring of elements

n/a

a) Pre‐existing model of treatment schedules used as basis for intervention

b) 1:1 Therapist input

c) Delivered during inpatient care

d) Mechanism to record delivered therapy

Augmented physiotherapy target of 2:1 ratio was not met

Augmented physiotherapy delivery was 1.6:1