Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity.Design Multicentre, multinational, randomised clinical trial with masked outcome assessment.Setting Stroke units in Denmark, China, Poland, and Estonia.Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 (mean age 69.7 years) randomised to the intervention, 157 (mean age 69.4 years) in the control group.Interventions Patients randomised 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 infarction, 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 NCT00132483

Plankton dynamics and hydrography were invest~gated in the Dogger Bank area, southern North Sea, In May 1990 after the onset of stratification Greatest phytoplankton biomass and production rates were observed withln a subsurface maximum around the pycnochne. At all 51 stations investigated, fluorescence maxima were found at depths > l 5 m and often at depths >30 m. Small flagellates (5 to 7 pm) dominated the phytoplankton. The vertical distributions of the smaller heterotrophs (bacteria, heterotrophic nanoflagellates and cihates) were closely related to the fluorescence distribution. Carbon budgets established for the southern North Sea suggest that, on and south of the Dogger Bank, ca 15 % of phytoplankton production was channelled directly into the larger zooplankton (copepods), while north of the Dogger Bank, ca 30 % was ingested by copepods. The production of the phytoplankton fraction > l 1 pm (i.e. potential copepod prey items) could not alone account for the daily carbon demand of the copepods. The carbon budgets suggest that ciliates could potentially have been of nutritional importance to the copepod populat~on. Calculations showed that copepods possessed the ability to clear a substantial fraction of ciliate production. The high biomass of bacteria, heterotroph~c flagellates and c~liates, as well as the fact that primary production of the larger (I.e. grazable) phytoplankton did not appear to be sufficient to meet copepod energy requirements, suggest the importance of the microbial loop in carbon cycling in the North Sea during the stratified period.

Background: Most observational studies investigating physical activity as a risk factor for stroke have concentrated on the years preceding a stroke event. In the present case control study we compared the reported level of physical activity performed during the week preceding an ischemic stroke with that of community controls. Furthermore we calculated the odds ratio for stroke based on the level of physical activity. Subjects and Methods: Patients with an ischemic stroke were recruited consecutively from hospitals covering Copenhagen City. Community controls were recruited among participants of the Copenhagen City Heart Study and matched according to age and gender. The level of physical activity was assessed using The Physical Activity Scale for the Elderly (PASE), which quantifies the amount of physical activity done in the last 7 days. Results: A total of 127 cases and 301 control subjects were included in the study. Mean (±SD) PASE scores for cases were 76.0 ± 46.2 and 119.7 ± 69.4 for controls (p < 0.001). For each 1-point increase in PASE score the odds ratio for ischemic stroke was 0.98 (0.98–0.99), equivalent to an odds ratio of 0.86 (95% CI: 0.82–0.90) for each 10-point increase. Conclusion: Stroke patients are less physically active in the week preceding an ischemic stroke when compared to age- and sex-matched controls. Increasing PASE score was inversely, log-linearly and significantly associated with odds ratio for ischemic stroke.

Little is known about stroke survivors' level of physical activity or if physical activity plays a role in preventing recurrent stroke. The Physical Activity Scale for the Elderly (PASE) is a valid measure of self-reported level of physical activity in the previous 1-week period reflecting physical activity in older adults, but has not yet been evaluated for use in stroke survivors. The aim was to examine the correlation between self-reported physical activity as measured by PASE and physical capacity as measured by the Senior Fitness Test (SFT) in persons after an ischemic stroke. A consecutive sample of 49 participants ]40 years of age suffering from mild stroke were included 3Á12 months after stroke onset. PASE was administered by interviewing the participants and a trained physiotherapist blinded for the PASE score tested them with the seven items of the SFT. Correlations between PASE score and those items in the SFT that required strength, endurance and balance were moderate between 0.37 (p 00.03) and 0.50 (p00.0005) for the total group. There was no correlation between PASE score and flexibility items. The findings indicate that PASE reflects overall physical capacity to perform everyday activities that require strength, aerobe endurance and balance in persons suffering from mild stroke.

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