Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.

Physical activity measurement is highly variable following stroke and better definition of physical activity outcomes would enhance the field. Accelerometry and behavioural mapping are most commonly used to measure physical activity following stroke, each have advantages and disadvantages depending on the setting and the outcome of interest. There is no single device ideal for clinical application for people following stroke.

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The aim of this study was to investigate the phenomenon of activity (increased activity in response to monitor wear) and determine the minimum wear time of accelerometers when objectively measuring habitual physical activity levels of community dwelling stroke survivors. Exploratory, secondary analyses of cross-sectional data were carried out. Physical activity variables [sitting, standing and stepping time, step count, light physical activity and moderate-to-vigorous physical activity (MVPA)] were measured with two activity monitors for 7 days. Repeated-measures analysis of variance was used to assess reactivity. Minimum wear time was assessed using regression analyses and median absolute differences. Paired t-tests were used to assess differences between weekend and weekday activity levels. There was no evidence of reactivity. Minimum wear time was 3 days for all activity variables, with the exception of MVPA, for which 7 days of monitoring was required. There were no significant differences in weekend and weekday activity levels. To accurately measure activity levels of individuals with stroke, we recommend 3 days of monitoring for all activity variables, with the exception of MVPA, which requires 7 days.

Only four small RCTs with 274 participants (three in inpatient rehabilitation and one in the community) have examined the efficacy of activity monitors for increasing physical activity after stroke. Although these studies showed activity monitors could be incorporated into practice, there is currently not enough evidence to support the use of activity monitors to increase physical activity after stroke.

Objectives: To determine the personal and social factors perceived to influence physical activity levels in stroke survivors. Data sources: Four electronic databases (MEDLINE, CINAHL, PubMed and Embase) were searched from inception to November 2020, including reference and citation list searches. Study selection: The initial search yielded 1499 papers, with 14 included in the review. Included articles were peer-reviewed, qualitative studies, reporting on the perceived factors influencing physical activity levels of independently mobile community-dwelling adults, greater than 3 months post stroke. Data extraction: Data extracted included location, study aim, design, participant and recruitment information and how data were collected and analysed. Data synthesis: Thematic analysis was undertaken to identify meanings and patterns, generate codes and develop themes. Five main themes were identified: (i) Social networks are important influencers of physical activity; (ii) Participation in meaningful activities rather than ‘exercise’ is important; (iii) Self-efficacy promotes physical activity and physical activity enhances self-efficacy; (iv) Pre-stroke identity related to physical activity influences post-stroke physical activity; and (v) Formal programmes are important for those with low self-efficacy or a sedentary pre-stroke identity. Conclusions: Physical activity levels in stroke survivors are influenced by social activities and support, pre-stroke identity, self-efficacy levels and completion of activities that are meaningful to stroke survivors.

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