URL: https://www.clinicaltrials.gov. Unique identifier: NCT01467206.

Physical activity may help to keep the brain healthier and preserve cognitive ability and mood years after a stroke. In The Life After STroke (LAST) study, stroke survivors were allocated into 2 groups. A training group was encouraged to perform physical activity for 30 min daily, and 45-60 min of moderate-to-intense physical exercise every week. A control group was followed by their general practitioner as usual. This study aimed to measure the effect on cognitive and emotional function in both groups after 18 months. Of the 362 participants, almost half were in the training group. The mean age was 72 years and 40% were female. There were no differences between the groups regarding effect on cognitive or emotional function. In conclusion, this study did not show an effect of the physical training programme on cognition or mood after stroke. Objective: To examine the effects of individualized regular coaching and exercise on post-stroke cognitive and emotional function. Methods: The Life After STroke (LAST) study investigated the differences between intervention and care-as-usual between 3 and 21 months post-stroke. Outcome measures were the Trail Making Test (TMT) A and B, Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and adherence to the intervention. Results: Of the 362 patients included in the study, 177 were assigned to the intervention. The mean age was 71.7 years (SD 11.3) and 39.5% were female. The adjusted mean difference between groups for TMT A was 8.54 (95% CI 0.7 to 6.3), p = 0.032, for TMT B 8.6 (95% CI-16.5 to 33.6), p = 0.50, for MMSE-0.1 (95% CI-0.8 to 0. 6), p = 0.77, for HADS A-0.2 (95% CI-0.9 to 0.5), p = 0.56 and for HADS D-0.1 (95% CI-0.7 to 0.5), p = 0.76). A higher level of adherence to the intervention was significantly associated with increased MMSE (B = 0.030 (95% CI 0.005-0.055), p = 0.020). Conclusion: No clinically relevant effects on cognitive or emotional function were found of individualized regular coaching for physical activity and exercise. However, increased adherence to the intervention was associated with improved cognitive function.

To investigate the associations between participants' adherence to a physical activity and exercise program after stroke and functional recovery 18 months after inclusion. Design: Secondary analyses of the intervention arm in the multisite randomized controlled trial Life After Stroke (LAST). Setting: Primary health care services in 3 Norwegian municipalities. Participants: Of the participants enrolled (NZ380), 186 (48.9%) were randomized to the intervention. The study sample comprised community dwelling individuals included 3 months after stroke, with mean age of 71.7 AE 11.9 years and 82 (44.1%) women. According to the National Institutes of Health Stroke Scale, 97.3% were diagnosed as having mild (National Institutes of Health Stroke Scale<8) and 2.7% with moderate (8-16 on the National Institutes of Health Stroke Scale) stroke. Intervention: Monthly coaching by physiotherapists encouraging participants to adhere to 30 minutes of daily physical activity and 45-60 minutes of weekly exercise. Main Outcome Measures: The primary outcome was Motor Assessment Scale (MAS). Secondary outcome measures were 6-minute walk test, Timed Up and Go (TUG), Berg Balance Scale (BBS), and the physical domains of the Stroke Impact Scale (SIS). Adherence was assessed by combining participants' training diaries and physiotherapists' reports. Results: The relationship between adherence and functional recovery was analyzed with simple and multiple linear regression models. Adjusted for age, sex, dependency, and cognition, results showed statistically significant associations between adherence and functional outcomes after 18 months, as measured by MAS, TUG, BBS, and SIS (P .026). Conclusions: Increased adherence to physical activity and exercise was associated with improved functional recovery after mild to moderate stroke. This emphasizes the importance of developing adherence-enhancing interventions. Dose-response studies are recommended for future research.

The Berg Balance Scale (BBS) has previously shown good measurement properties. However, its ability to detect important change in patients early after stroke is still unknown. The purpose of the present study was to determine the minimal important change (MIC) and its relation to the minimal detectable change (MDC) for BBS in patients early after stroke. This prospective follow-up study included patients within the first 2 weeks after onset of stroke. The BBS, Barthel Index, and Scandinavian Stroke Scale were obtained at inclusion and 1 month later. At the follow-up assessment, the Patient Global Impression of Change was obtained. A receiver operating characteristic (ROC) curve was used to calculate the cut-off value for the MIC. Fifty-two patients (mean age of 78.7, SD 8.5 years) were included. All measures showed a significant improvement from baseline to follow-up. The ROC analysis identified a MIC of ≥6 BBS points, while the MDC was 5.97 BBS points at the 80% confidence level. This study shows that a change of 6 BBS point or more can be considered an important change for patients in the sub-acute phase after stroke, which also represents an 80% probability of exceeding the measurement error. A total of 80% of unchanged patients would display random fluctuations within the bounds of MDC80, while 20% of unchanged patients would exceed MDC80.