Should physical activity programs be tailored when older adults have compromised function? Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial Body-weight-supported treadmill rehabilitation after stroke. The working mechanisms of an environmentally tailored physical activity intervention for older adults: a randomized controlled trial Determinants of depression in chronic stroke: A prospective cohort study Exercise to Enhance Mobility and Prevent Falls After Stroke The Psychosocial Effects of Exercise and Relaxation Classes for Persons Surviving a Stroke A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors. A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population Implementation, Process, and Preliminary Outcome Evaluation of Two Community Programs for Persons with Stroke and Their Care Partners Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Stroke patients and long-term training: is it worthwhile? A randomized comparison of two different training strategies after rehabilitation Building a multiple modality, theory-based physical activity intervention: The development of CardiACTION! Progressive Adaptive Physical Activity in Stroke Improves Balance, Gait, and Fitness: Preliminary Results Stroke: a randomized trial of exercise or relaxation. Successfully Improving Physical Activity Behavior after Rehabilitation
The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function Background and Purpose — Individuals with chronic stroke often demonstrate a “ plateau , ” or deceleration of motor recovery , which may lead to discharge from physical therapy ( PT ) . However , numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks . We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke , and suggest that further gains can be realized if intensive stepping , or locomotor training ( LT ) is provided after discharge . Methods — Twenty subjects with chronic stroke completed a repeated baseline measures , r and omized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau , followed by 4 weeks of intensive LT and 4 weeks of no intervention . Outcome measures included clinical and physiological ( metabolic ) measures of walking overground and on a treadmill , and measures of daily stepping activity in the home and community , including during clinical PT and subsequent LT sessions . Results — Stepping practice was more than 4-fold higher during LT versus clinical PT sessions , with significant improvements in daily stepping and gait efficiency only after LT . Changes in daily stepping after clinical PT and intensive LT were correlated ( P<0.001 ) with the amount of stepping practice received during these interventions . Conclusions — Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function . These improvements may be related to the amount and intensity of stepping practice Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity . Design Multicentre , multinational , r and omised clinical trial with masked outcome assessment . Setting Stroke units in Denmark , China , Pol and , and Estonia . Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 ( mean age 69.7 years ) r and omised to the intervention , 157 ( mean age 69.4 years ) in the control group . Interventions Patients r and omised 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 infa rct ion , 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 BACKGROUND Locomotor training , including the use of body-weight support in treadmill stepping , is a physical therapy intervention used to improve recovery of the ability to walk after stroke . The effectiveness and appropriate timing of this intervention have not been established . METHODS We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment -- moderate ( able to walk 0.4 to < 0.8 m per second ) or severe ( able to walk < 0.4 m per second)-- and r and omly assigned them to one of three training groups . One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred ( early locomotor training ) , the second group received this training 6 months after the stroke had occurred ( late locomotor training ) , and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke ( home-exercise program ) . Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks . The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke . RESULTS At 1 year , 52.0 % of all participants had increased functional walking ability . No significant differences in improvement were found between early locomotor training and home exercise ( adjusted odds ratio for the primary outcome , 0.83 ; 95 % confidence interval [ CI ] , 0.50 to 1.39 ) or between late locomotor training and home exercise ( adjusted odds ratio , 1.19 ; 95 % CI , 0.72 to 1.99 ) . All groups had similar improvements in walking speed , motor recovery , balance , functional status , and quality of life . Neither the delay in initiating the late locomotor training  nor the severity of the initial impairment affected the outcome at 1 year . Ten related serious adverse events were reported ( occurring in 2.2 % of participants undergoing early locomotor training , 3.5 % of those undergoing late locomotor training , and 1.6 % of those engaging in home exercise ) . As compared with the home-exercise group , each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment ( P=0.008 ) . Among patients with severe walking impairment , multiple falls were more common in the group receiving early locomotor training than in the other two groups ( P=0.02 ) . CONCLUSIONS Locomotor training , including the use of body-weight support in stepping on a treadmill , was not shown to be superior to progressive exercise at home managed by a physical therapist . ( Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research ; LEAPS Clinical Trials.gov number , NCT00243919 . ) Background The aim of this study was to explore the working mechanisms of a computer tailored physical activity intervention for older adults with environmental information compared to a basic tailored intervention without environmental information . Method A clustered r and omized controlled trial with two computer tailored interventions and a no-intervention control group was conducted among 1971 adults aged ≥ 50 . The two tailored interventions were developed using Intervention Mapping and consisted of three tailored letters delivered over a four-month period . The basic tailored intervention targeted psychosocial determinants alone , while the environmentally tailored intervention additionally targeted environmental determinants , by providing tailored environmental information . Study outcomes were collected with question naires at baseline , three and six months and comprised total physical activity ( days/week ) , walking ( min/week ) , cycling ( min/week ) , sports ( min/week ) , environmental perceptions and use and appreciation of the interventions . Results Mediation analyses showed that changes in cycling , sports and total physical activity behaviour induced by the environmentally tailored intervention were mediated by changes in environmental perceptions . Changes in environmental perceptions did not mediate the effect of the basic tailored intervention on behaviour . Compared with the basic tailored intervention , the environmentally tailored intervention significantly improved cycling behaviour ( τ = 30.2 ) . Additionally , the tailored letters of the environmentally tailored intervention were better appreciated and used , although these differences did not mediate the intervention effect . Discussion This study gave some first indications of the relevance of environmental perceptions as a determinant of changing physical activity behaviours and the potential effectiveness of providing environmental information as an intervention strategy aim ed at enhancing physical activity behaviour among older adults Purpose . The aim of the study was to identify factors that are significantly related to depression in chronic stroke patients . Methods . Prospect i ve cohort study of stroke patients admitted for rehabilitation . A total of 165 first ever stroke patients over 18 years of age were assessed at one and three years post stroke . Depression was determined by the Centre for Epidemiologic Studies Depression Scale ( CES-D ) . Patients with scores ≥16 were classified as depressed . Bivariate and multivariate logistic regression analyses were used to identify prognostic factors for depression . Results . At three years post stroke , 19 % of the patients were depressed . Bivariate analysis showed significant associations between post-stroke depression and type of stroke , fatigue , motor function of the leg and arm , activities of daily living ( ADL ) independency and instrumental ADL . Multivariate logistic regression analysis showed that depression was predicted by one-year instrumental ADL and fatigue . Sensitivity of the model was 63 % , while specificity was 85 % . Conclusions . The present prospect i ve cohort study showed that depression three years after stroke can be predicted by instrumental ADL and fatigue one year post stroke . Recognition of prognostic factors in patients at risk may help clinicians to apply interventions aim ed at preventing depression in chronic stroke Background . Exercise interventions can enhance mobility after stroke as well as prevent falls in elderly persons . Objective . Investigate whether an exercise intervention can enhance mobility , prevent falls , and increase physical activity among community-dwelling people after stroke . Method . A r and omized trial with blinding of physical outcome assessment was conducted through local stroke clubs . Both groups , on average 5.9 years poststroke , received exercise classes , advice , and a home program for 12 months . The experimental group ( EG ) program ( n = 76 ) aim ed to improve walking , prevent falls and increase physical activity . The control group ( CG ) program ( n = 75 ) aim ed to improve upper-limb and cognitive functions . The primary outcomes were walking capacity , walking speed measured before and after the intervention , and fall rates monitored monthly . Results . At 12 months , the EG walked 34 m further in 6 minutes ( 95 % confidence interval [ CI ] = 19 - 50 ; P < .001 ) and 0.07 m/s faster over 10 m ( 95 % CI = 0.01 - 0.14 ; P = .03 ) than the CG . The EG had 129 falls , and the CG had 133 . There were no differences in proportion of fallers ( relative risk = 1.22 ; 95 % CI = 0.91 - 1.62 ; P = .19 ) or the rate of falls between groups ( incidence rate ratio = 0.96 ; 95 % CI = 0.59 - 1.51 ; P = .88 ) . Conclusion . The experimental intervention delivered through stroke clubs enhanced aspects of mobility but had no effect on falls Background . This study was set up to explore unexpected findings emergent from a r and omized controlled trial of exercise versus relaxation post-stroke . Purpose . Stroke survivors ' experiences of taking part in exercise and relaxation classes were explored . Methods . In-depth , semi-structured interviews carried out with 14 community-dwelling stroke survivors in Edinburgh . The informants previously participated in a r and omized exploratory trial of exercise versus relaxation . Findings . The classes motivated participants to take part in other purpose ful activities , to continue to practice what they had learned , and /or to attend another class in the community . Class participation also led to an improvement of self-perceived quality of life , specifically , improved confidence , physical ability , psychosocial functioning , and a sense of empowerment . Implication s. Taking part in either exercise or relaxation classes after stroke can contribute to improved self-perceived quality of life , improved psychosocial functioning , and improved motivation to take an active role in the recovery process BACKGROUND AND PURPOSE Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors . This study compared the effectiveness of a 10-week supervised strengthening and conditioning program ( supervised ) with a 1-week supervised instruction program followed by a 9-week unsupervised home program ( unsupervised ) and evaluated retention of changes at 6 months and 1 year after program completion . METHODS Seventy-two subjects retained at baseline ( 27 women , 45 men ; mean+/-SD age , 64.6+/-11.8 years ) were r and omly allocated to receive the supervised or unsupervised program . The primary outcome was walking speed over 6 minutes , and secondary outcome measures were Human Activity Profile , Medical Outcome Study 36-Item Short-Form survey ( SF-36 ) , Physiological Cost Index , and lower extremity muscle strength . RESULTS The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year . The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year . The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year ; the unsupervised group showed significant improvement at 1 year . Women made greater gains in supervised programs , but men made greater gains in unsupervised programs . CONCLUSIONS Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year , although supervised programs showed trends to greater improvements in self-reported gains . Gender differences require further research Objective : To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects . Design : Single-blinded r and omized control trial . Setting : Outpatient rehabilitation . Subjects : Forty-eight community-dwelling ischaemic stroke patients ( 38 independently mobile , 9 requiring assistance , 1 non-ambulatory ) were r and omly assigned to intervention or control groups by concealed allocation . Intervention : The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10 . Both groups continued usual care ( excluding aerobic exercise ) ; intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes . Main outcome measures : Cardiac risk score ( CRS ) ; VO2 ( mL O2/kg per minute ) and Borg Rate of Perceived Exertion ( RPE ) assessed during a st and ardized ergometry test ; Hospital Anxiety and Depression Scale ( HADS ) ; Frenchay Activity Index ; Fasting Lipid Profiles and Resting Blood Pressure . Results : Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 ( intervention 10.6 ±1.6 to 12.0 ± 2.2 , control 11.1 ±1.8 to 11.1 ±1.9 t=4.734 , P<0.001 ) and CRS ( intervention 13.4 ±10.1 to 12.4 ±10.5 , control 9.4 ±6.7 to 15.0 ±6.1 t=-2.537 , P<0.05 ) . RPE rating decreased in intervention subjects ( 13.4 ±12.2 to 12.4 ±2.0 ) and increased in controls ( 13.8 ±1.8 to 14.4 ±1.6 ) ; Mann — Whitney U ( U = 173.5 , P<0.05 ) . Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone ( 5.1 ±3.4 to 3.0 ±2.8 ) ( Wilcoxon signed ranks test Z=-3.278 , P<0.001 ) . Conclusion : Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme . The intervention was associated with improvement in self-reported depression Abstract Purpose : This evaluation compared a new self-management program with l and and water exercise ( Moving On after STroke or MOST ) to a st and ard education program ( Living with Stroke or LWS ) . Participants : Of 30 persons with stroke ( average age 68 and 2 years post stroke ) , 18 selected MOST and 12 chose LWS . Sixteen care partners participated . Method : Assessment s at baseline , program completion , and 3-month follow-up included the Reintegration to Normal Living ( RNL ) Index , Activity-specific Balance Confidence ( ABC ) scale , exercise participation , and goal attainment ( for the MOST group ) . Program delivery costs were calculated and focus groups conducted to examine participant expectations and experiences . Results : Social support was an important benefit of both programs , but only MOST participants improved significantly on the RNL ( p < .05 ) and ABC ( p < .001 ) . Seventy-eight percent of all short-term personal goals in MOST were achieved , and overall goal attainment was above the expected level . At follow-up , a higher percentage of MOST participants were enrolled in exercise programs ( p < .05 ) . Conclusion : Although self-management programs with exercise are more costly to deliver than st and ard educational programs , these preliminary results indicate that such programs may be more effective in helping persons with stroke and care partners deal with the challenges of living with stroke Objective : To evaluate whether enhanced secondary prevention more significantly influences readiness to change health behaviour after minor stroke/transient ischaemic attack , compared with conventional stroke secondary prevention . Design : Single-blind r and omized control trial . Setting : Rural district general hospital outpatient clinic . Subjects : Fifteen women and 37 men with a mean age of 68.3 years with first minor stroke or transient ischaemic attack . Interventions : The intervention group received ‘ enhanced secondary prevention ’ ( additional advice , motivational interviewing and telephone support ) to change health behaviour . Both groups received ‘ conventional care ’ which included advice given during routine care . Main measures : The primary outcome was ‘ readiness to change behaviour ’ measured using a vali date d stroke specific score based on the transtheoretical model . Secondary outcomes were the Hospital Anxiety and Depression Scale , and self-reported alcohol consumption , smoking behaviour , exercise frequency , and fruit and vegetable consumption . Results : Analysis of the data for the 52 participants showed no statistical difference in the groups for the primary outcome of readiness to change behaviour . Statistically significant improvements for change in self-reported exercise were demonstrated ( P = 0.007 ) ; to 2—3 times per week in the intervention group compared to 0—1 times per week in the control group , and in fruit and vegetable consumption ( P = 0.033 ) ; to 10 portions of fruit and vegetables consumed per week in the intervention group compared to 1 or 2 portions a week for the control group . No evidence of a difference between groups was seen for alcohol consumption or Hospital Anxiety and Depression Scale . Conclusions : While no difference was demonstrated between the groups for readiness to change behaviour , a clinical ly significant effect in reported exercise behaviour and diet were demonstrated in the intervention group . This interesting finding indicates a dissonance between the behaviour scale and actual behaviour change , potentially indicating a lack of sensitivity of the scale to detect a change in this patient group UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance Objective : To find out if there were any differences in improvement and maintenance of motor function , activity of daily living and grip strength between patients with first-ever stroke receiving two different strategies of physical exercise during the first year after stroke . Design : A longitudinal r and omized controlled stratified trial . Setting : Rehabilitation institutions , community , patients ' homes and nursing homes . Subjects : Seventy-five male and female first-time-ever stroke patients : 35 in an intensive exercise group and 40 in a regular exercise group . Intervention : The intensive exercise group received physiotherapy with focus on intensive exercises in four periods during the first year after stroke . The regular exercise group patients were followed up according to their subjective needs during the corresponding year . Main outcome measures : Motor Assessment Scale , Barthel Index of Activities of Daily Living , and grip strength . Results : Both groups improved significantly up to six months when function stabilized . The groups did not differ significantly on any test occasions . The difference of improvement from admission to discharge was significant in favour of the intensive exercise group , in the Motor Assessment Scale total score ( intensive exercise group 7.5 ; regular exercise group 1.7 , P = 0.01 ) , and in the Barthel Index of Activities of Daily Living total score ( 17.4 versus 8.9 , P = 0.04 ) . Conclusion : Motor function , activities of daily living functions and grip strength improved initially and were maintained during the first year after stroke in all patients irrespective of exercise regime . This indicates the importance of motivation for regular exercise in the first year following stroke , achieved by regular check-ups OBJECTIVES : Despite the widely acknowledged benefits of regular physical activity ( PA ) , specific goals for increased population levels of PA , and strongly recommended strategies to promote PA , there is no evidence suggesting that the prevalence of PA is improving . If PA intervention research is to be improved , theory should be used as the basis for intervention development , participant context or environment should be considered in the process , and intervention characteristics that will heighten the likelihood of translation into practice should be implemented ( e.g. , ease of implementation , low human re source costs ) . The purpose of this paper is to describe the implementation of the aforementioned concepts within the intervention development process associated with CardiACTION an ongoing r and omized 2 × 2 factorial trial . METHODS : The Ecological Model of Physical Activity integrated with Protection Motivation Theory was used to inform the design of the interventions . This integrated model was selected to allow for the development of theory-based individual , environmental , and individually + environmentally targeted physical activity interventions . All intervention strategies were matched to proposed mediators of behavior change . Strategies were then matched to the most appropriate interactive technology ( i.e. , interactive computer session , automated telephone counseling , and tailored mailings ) delivery channel . CONCLUSIONS : The potential implication s of this study include determining the independent and combined influence of individual and environment mechanisms of behavior change on intervention effectiveness . In addition , all intervention models are developed to be scalable and disseminable to a broad audience at a low cost Abstract Purpose : We conducted a noncontrolled pilot intervention study in stroke survivors to examine the efficacy of lowintensity adaptive physical activity to increase balance , improve walking function , and increase cardiovascular fitness and to determine whether improvements were carried over into activity profiles in home and community . Method : Adaptive physical activity sessions were conducted 3 times/week for 6 months . The main outcomes were Berg Balance Scale , Dynamic Gait Index , 6-Minute Walk Test , cardiovascular fitness ( VO2 peak ) , Falls Efficacy Scale , and 5-day Step Activity Monitoring . Results : Seven men and women with chronic ischemic stroke completed the 6-month intervention . The mean Berg Balance baseline score increased from 33.9 ± 8.5 to 46 ± 6.7 at 6 months ( mean ± SD ; p = .006 ) . Dynamic Gait Index increased from 13.7 ± 3.0 to 19.0 ± 3.5 ( p = .01 ) . Six-minute walk distance increased from 840 ± 110 feet to 935 ± 101 feet ( p = 0.02 ) . VO2 peak increased from 15.3 ± 4.1 mL/kg/min to 17.5 ± 4.7 mL/kg/min ( p = .03 ) . There were no significant changes in falls efficacy or free-living ambulatory activity . Conclusion : A structured adaptive physical activity  produces improvements in balance , gait , fitness , and ambulatory performance but not in falls efficacy or free-living daily step activity . R and omized studies are needed to determine the cardiovascular health and functional benefits of structured group physical activity programs and to develop behavioral interventions that promote increased free-living physical activity patterns OBJECTIVES To determine the feasibility and effect of exercise training after stroke . DESIGN R and omized exploratory trial comparing exercise training ( including progressive endurance and resistance training ) with relaxation ( attention control ) . SETTING Interventions were performed in a rehabilitation hospital . PARTICIPANTS Sixty-six independently ambulatory patients ( mean age 72 , 36 men ) without significant dysphasia , confusion , or medical contraindications to exercise training who had completed their usual rehabilitation and had been discharged from hospital . INTERVENTION Both interventions were held three times a week for 12 weeks . Up to seven patients attended each session . MEASUREMENTS The Functional Independence Measure ; Nottingham Extended Activities of Daily Living ; Rivermead Mobility Index ; functional reach ; sit-to-st and ; elderly mobility score ; timed up- and -go ; Medical Outcomes Study 36-Item Short Form Question naire , version 2 ( SF-36 ) ; Hospital Anxiety and Depression Score ; aspects of physical fitness ( comfortable walking speed , walking economy , and explosive leg extensor power ) were measured at baseline , immediately after interventions ( 3 months ) , and 7 months after baseline . RESULTS The median number of intervention sessions attended was 36 ( interquartile range ( IQR ) 30.00 - 36.75 ) for exercise and 36 ( IQR 30.50 - 37.00 ) for relaxation .  Adherence to the individual exercises ranged from 94 % to 99 % . At 3 months , role-physical ( an item in SF-36 ) , timed up- and -go , and walking economy were significantly better in the exercise group ( analysis of covariance ) . At 7 months , role-physical was the only significant difference between groups . CONCLUSION Exercise training for ambulatory stroke patients was feasible and led to significantly greater benefits in aspects of physical function and perceived effect of physical health on daily life Purpose . To determine the effects of the physical activity promotion programs Rehabilitation & Sports ( R&S ) and Active after Rehabilitation ( AaR ) on sport and daily physical activity 1 year after in- or outpatient rehabilitation . Design . Subjects in intervention rehabilitation centers were r and omized into a group receiving R&S only  ( n = 315 ) and a group receiving R&S and AaR ( n = 284 ) . Subjects in six control centers ( n = 603 ) received usual care . Setting . Ten Dutch rehabilitation centers . Subjects . Subjects consisted of 1202 rehabilitation patients . Most frequent diagnoses were stroke , neurological disorders , and back disorders . Intervention . Both the sport stimulation program ( R&S ) and the daily physical activity promotion program ( AaR ) consisted of personalized tailored counseling . Measures . Two sport outcomes and two daily physical activity outcomes were assessed with question naires at baseline and 1 year after rehabilitation . Analysis . Multilevel analyses comparing both intervention groups to the control group . Results . The R&S program showed no significant effects . Intention-to-treat analyses in the R&S + AaR group showed borderline significant improvements in one sport ( odds ratio [ OR ] = 1.66 , p = .02 ) and both physical activity outcomes ( OR = 1.68 , p = .01 and regression coefficient = 10.78 , p = .05 ) . On-treatment analyses in the R&S + AaR group showed similar but stronger effects . Conclusions . The combination of the R&S and AaR programs improved physical activity behavior and sport participation 1 year after in- or outpatient rehabilitation . The R&S program alone did not have any effects
OBJECTIVE To investigate the effects of interventions to promote long-term participation in physical activity ( PA  ) on measures of frequency , duration , or intensity of PA at 3 months or longer in community-dwelling stroke survivors .