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.

Background and Purpose: One systematic review has examined factors that predict walking outcome at one month in initially nonambulatory patients after stroke. The purpose of this systematic review was to examine, in nonambulatory people within a month of stroke, which factors predict independent walking at 3, 6, and 12 months. Methods: Prognostic factors: Any factors measured within one month after stroke with the aim of predicting independent walking. Outcome of interest: Independent walking defined as walking with or without an aid but with no human assistance. Results: Fifteen studies comprising 2344 nonambulatory participants after stroke were included. Risk of bias was low in 7 studies and moderate in 8 studies. Individual meta-analyses of 2 to 4 studies were performed to calculate the pooled estimate of the odds ratio for 12 prognostic factors. Younger age (odds ratio [OR], 3.4, P <0.001), an intact corticospinal tract (OR, 8.3, P <0.001), good leg strength (OR, 5.0, P <0.001), no cognitive impairment (OR, 3.5, P <0.001), no neglect (OR, 2.4, P =0.006), continence (OR, 2.3, P <0.001), good sitting (OR, 7.9, P <0.001), and independence in activities of daily living (OR 10.5, P <0.001) predicted independent walking at 3 months. Younger age (OR, 2.1, P <0.001), continence (OR, 13.8, P <0.001), and good sitting (OR, 19.1, P <0.001) predicted independent walking at 6 months. There were insufficient data at 12 months. Conclusions: Younger age, an intact corticospinal tract, good leg strength, continence, no cognitive impairment, no neglect, good sitting, and independence in activities of daily living in patients who are nonambulatory early after stroke predict independent walking at 3 months. Registration: URL: https://www.crd.york.ac.uk/prospero/ ; Unique identifier: CRD42018108794.

Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in communitydwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and strokerelated factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11-19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke.

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word count: 245 Word count: 2754 Highlights Stroke survivors increase walking activity over the first 6 months post-discharge.  Stroke survivors increase daily sitting time over the first 6-monts post-discahrge.  Stroke survivors spend least time in long duration and high intensity activity.  Interventions to target activity should be considered 3-months post-discharge. AbstractStroke survivors commonly adopt sedentary activity behaviours by the chronic phase of recovery. However, the change in activity behaviours from the subacute to chronic phase of stroke is variable. This study explored the recovery of ambulation activity (volume and bouts) at one, three and six months after hospital discharge post-stroke. A total of 42 stroke survivors were recruited at hospital discharge and followed up one, three and six months later. At follow-up, ambulation activity was measured over four days using the ActivPAL TM accelerometer. Measures included volume of activity and frequency and intensity of ambulation activity bouts per day. Linear mixed effects modelling was used to determine changes over time. There was wide variation in activity. Total step counts across all time points were below required levels for health benefits (mean 4592 SD 3411). Most activity was spread across short bouts. While most number of bouts was of low intensity, most time was spent in moderate intensity ambulation across all time points. Daily step count and time spent walking and sitting/lying increased from one month to three and six months. The number of and time spent in short and medium duration bouts increased from one to six months. Time in long duration bouts increased at three months only. Time spent in moderate intensity ambulation increased over time. No change was observed for any other measures. In future, it would be valuable to identify strategies to increase engagement in activity behaviours to improve health outcomes after stroke.

Purpose: To determine validity, reliability and feasibility of accelerometers (ActivPAL™, Sensewear Pro2 Armband) and portable global positioning systems (GPS) (Garmin Forerunner 405CX) for community ambulation measurement after stroke.Methods: Fifteen community-dwelling stroke survivors attended two sessions; completing a 6-minute walk, treadmill walking, and 200-m outdoor circuit. Feasibility was determined by wearing devices over four days. Measures collected included step count, time spent walking, distance, energy expenditure and location. Intra-class correlation coefficients (ICC), Bland–Altman plots and absolute percentage of error (APE) were used to determine validity and reliability.Results: ActivPAL™ had excellent validity and reliability for most measures (ICC: 0.821–0.999, APE: 0%–11.1%), except for good-excellent findings at speeds < 0.42 m/s (ICC: 0.659–0.894, APE: 1.6%–11.1%). Sensewear had missing values for 23% of recordings and high error for all measures. GPS demonstrated excellent validity and reliability for time spent walking and step count (ICC: 0.805–0.999, APE: 0.9%–10%), and 100% accuracy for location. However, it was not valid or reliable for distance (ICC = −0.139, APE = 23.8%). All devices appeared feasible for community ambulation measurement with assistance for setup and data analysis.Conclusions: ActivPAL™ and Garmin GPS appear valid, reliable and feasible tools for community ambulation measurement after stroke, except for distance. Sensewear demonstrated poor validity and reliability when worn on the paretic arm.

Background Stroke is the third leading cause of disability worldwide. Physical activity is important for secondary stroke prevention and for promoting functional recovery. However, people with stroke are more inactive than healthy age-matched controls. Therefore, interventions to increase activity after stroke are vital to reduce stroke-related disability. Objectives To summarise the available evidence regarding the effectiveness of commercially available, wearable activity monitors and smartphone applications for increasing physical activity levels in people with stroke.

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