Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial Promoting physical activity after stroke via self-management: a feasibility study The ExStroke Pilot Trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke. Improving physical activity after stroke via treadmill training and self management (IMPACT): a protocol for a randomised controlled trial Timecourse of health-related quality of life as determined 3, 6 and 12 months after stroke Long-Term Disability After First-Ever Stroke and Related Prognostic Factors in the Perth Community Stroke Study, 1989–1990 Understanding physical factors associated with participation in community ambulation following stroke A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial Randomized controlled pilot study of a SystemCHANGE™ weight management intervention in stroke survivors: rationale and protocol How Physically Active Are People with Stroke in Physiotherapy Sessions Aimed at Improving Motor Function? A Systematic Review Mental Contrasting With Implementation Intentions (MCII) Improves Physical Activity and Weight Loss Among Stroke Survivors Over One Year Effects of a "test in-train out" walking program versus supervised standard rehabilitation in chronic stroke patients: a feasibility and pilot randomized study. Balance self-efficacy and its relevance to physical function and perceived health status after stroke. Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial. Correlates of physical activity level in breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study Impact of Treadmill Exercise on Efficacy Expectations, Physical Activity, and Stroke Recovery Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke The association between physical activity and health-related quality of life among breast cancer survivors Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Physical fitness training in Subacute Stroke (PHYS-STROKE) - study protocol for a randomised controlled trial Factors Influencing Stroke Survivors' Quality of Life During Subacute Recovery Progressive Adaptive Physical Activity in Stroke Improves Balance, Gait, and Fitness: Preliminary Results Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction
Background Stroke is the most common disabling neurological condition in adults . Falls and poor mobility are major contributors to stroke-related disability . Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population . Currently there is good evidence that exercise can enhance mobility after stroke , yet ongoing exercise programs for general community-based stroke survivors are not routinely available . This r and omised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors . Methods and design Three hundred and fifty community dwelling stroke survivors will be recruited . Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessment s and exercise program .  After the completion of the pre-test assessment , participants will be r and omly allocated to one of two intervention groups . Both intervention groups will participate in weekly group-based exercises and a home program for twelve months . In the lower limb intervention group , individualised programs of weight-bearing balance and strengthening exercises will be prescribed . The upper limb/cognition group will receive exercises aim ed at management and improvement of function of the affected upper limb and cognition carried out in the seated position . The primary outcome measures will be falls ( measured with 12 month calendars ) and mobility . Secondary outcome measures will be risk of falling , physical activity levels , community participation , quality of life , health service utilisation , upper limb function and cognition . Discussion This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors . We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke . This program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12606000479505 ) Abstract Background : Many people with mild disability after stroke are physically inactive despite the risk of recurrent stroke . A self-management program may be one strategy to increase physical activity in stroke survivors . Objectives : To investigate the feasibility of a self-management program , and determine whether self-management can increase daily physical activity levels and self-efficacy for exercise , decrease cardiovascular risk , and improve walking ability , participation , and quality of life in people with mild disability after stroke . Method : A Phase I , single-group , pre-post intervention study was carried out with twenty stroke survivors who had mild disability and were discharged directly home from acute stroke units . A self-management program was delivered via five home-based sessions over 3 months , incorporating : education , goal setting , barrier identification , self-monitoring , and feedback .  Feasibility of the intervention was determined by examining adherence , duration , usefulness , and safety . Clinical outcomes were amount of physical activity ( duration of moderate physical activity in min/day and counts of physical activity in steps/day ) , self-efficacy , cardiovascular risk , walking ability , participation , and quality of life . Results : The intervention was feasible with 96 % of sessions being delivered , each taking less than an hour ( 41 min , SD 12 ) . Participants perceived the self-management program to be useful and there were few adverse events . At 3 months , participants completed 27 min/day ( 95 % CI 4–49 ) more moderate physical activity than at baseline and 16 min/day ( 95 % CI −10 to 42 ) at 6 months . Conclusion : Self-management appears to be feasible and has the potential to increase physical activity in people with mild disability after stroke . A Phase II r and omized trial is warranted INTRODUCTION A high level of physical activity is associated with a decreased risk of first stroke and physical activity modifies recognized stroke risk factors and is recommended for stroke survivors . Available research shows that stroke patients can increase their level of physical performance over a short period . When the intervention period is over , physical performance often declines towards baseline level . Currently , there is no evidence on the association between physical activity and the risk of recurrent stroke . The ExStroke Pilot Trial is a r and omized clinical trial with the aim of increasing stroke patients ' level of physical activity and secondarily to associate the level of physical activity to the risk of recurrent stroke , myocardial infa rct ion , and all-cause mortality in the two groups . We describe the rationale , design , and baseline data of the ExStroke Pilot Trial . METHODS Patients with ischemic stroke above 39 years were r and omized to intervention or control group . The intervention group will , over a 2-year period , receive information on and verbal instruction to exercise by a physiotherapist or a physician . The control group will receive the department 's usual care . Physical activity  is assessed in both groups seven times during follow-up using the  Physical Activity Scale for the Elderly ( PASE ) question naire , which quantifies the amount of physical activity done in the last seven days prior to interview . The PASE score constitutes the primary outcome measure . The secondary outcome is the time from r and omization to recurrent stroke , myocardial infa rct ion , or all-cause mortality . Further outcome measures include : time from r and omization to recurrent stroke , myocardial infa rct ion , and vascular death ; recurrent stroke ; modified Rankin Scale ; quality of life ; occurrence of falls and fractures . TRIAL STATUS From 9 centers in 4 countries , 314 patients were included and follow-up is ongoing . Mean age and st and ard deviation ( SD ) of the study participants was 68.4 ( 11.9 ) years and 56.4 % were male . Mean ( SD ) PASE score was 84.1 ( 55.9 ) and median ( interquartile range ) Sc and inavian Stroke Scale score was 54 ( 51 - 58 ) Background The level of physical activity undertaken by stroke survivors living in the community is generally low . The main objectives of the IMPACT trial are to determine , in individuals undergoing rehabilitation after stroke , if 8 weeks of high-intensity treadmill training embedded in self-management education ( i ) results in more physical activity than usual physiotherapy gait training and ( ii ) is more effective at increasing walking ability , cardiorespiratory fitness , self-efficacy , perception of physical activity , participation , and health-related quality of life as well as decreasing cardiovascular risk , and depression , at 8 and 26 weeks . Methods A prospect i ve , two-arm , parallel-group , r and omised trial with concealed allocation , blinded measurement and intention-to-treat analysis , will be conducted . 128 stroke survivors undergoing rehabilitation who are able to walk independently will be recruited and r and omly allocated to either the experimental or control group , who will both undergo gait training for 30 min , three times a week for 8 weeks under the supervision of a physiotherapist . Outcomes will be measured at baseline ( Week 0 ) , on completion of the intervention ( Week 8) and beyond the intervention ( Week 26 ) . This study has obtained ethical approval from the relevant Human Research Ethics Committees . Discussion Improving stroke survivors ’ walking ability and cardiorespiratory fitness is likely to increase their levels of physical activity . Furthermore , if education in self-management results in sustained high levels of physical activity , this should result in improved participation and quality of life . Trial registration This trial was registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12613000744752 ) on 4th July , 2013 Objective : To study the timecourse of health-related global and domain-specific  quality of life ( QOL ) in patients presenting with stroke or transient ischemic attacks ( TIA ) up to one year after the ischemic event . Variables were identified that may predict poststroke life satisfaction . Patients and Methods : In this prospect i ve study , a cohort of 183 stroke/TIA patients was followed up at 3 , 6 , and 12 months . A total of 144 survivors completed the follow-up ( 65 women , 79 men , mean age 65.3 years ) .  Health-related QOL  was assessed by the Short Form 36 ( SF-36 ) question naire , the  neurological status by the European Stroke Scale ( ESS ) . Disability was evaluated by using the Barthel index and the modified Swedish Stroke Registry Follow-up Form ; depression was scored by the Montgomery-Asberg Depression Rating Scale ( MADRS ) . Results : One year after stroke/TIA , 66 % of patients reported a worsening of life satisfaction compared with the prestroke level . The SF-36 physical component summary was reduced throughout the observation period . The SF-36 mental component summary deteriorated between the 6- and 12-months follow-up from 52.2 ± 7.1 to 50.6 ± 7.1 ( p < 0.05 ) . The SF-36 domains “ physical functioning ” , “ social functioning ” and the MADRS scores both showed a significant deterioration between 6 and 12 months poststroke ( p < 0.05 ) . In contrast , the neurological status and the degree of disability remained stable . Male sex , absence of diabetes , and normal MADRS scores at 3 and 6 months postinsult were identified as predictors of favorable QOL after 1 year ( p < 0.05 ) . Conclusions : Despite stable neurologic function and disability , global as well as domain-specific measures of QOL deteriorated over the 12-months observation period in a cohort of stroke survivors Background and Purpose — Few reliable estimates of the long-term functional outcome after stroke are available . This population -based study aim ed to describe disability , dependency , and related independent prognostic factors at 5 years after a first-ever stroke in patients in Perth , Western Australia . Methods — All individuals with a suspected acute stroke who were resident in a geographically defined region ( population , 138 708 ) of Perth , Western Australia , were registered prospect ively and assessed according to st and ardized diagnostic criteria over a period of 18 months in 1989 to 1990 . Patients were followed up prospect ively at 4 and 12 months and 5 years after the index event . Results — There were 370 cases of first-ever stroke , and 277 patients survived to 30 days . Of these early survivors , 152 ( 55 % ) were alive at 5 years , and among those who were neither institutionalized ( n=146 ) nor disabled ( n=129 ) at the time of their stroke , 21 ( 14 % ) were institutionalized in a nursing home , and 47 ( 36 % ) were disabled . The most important predictors of death or disability at 5 years were increasing age , baseline disability defined by a Barthel Index score of < 20/20 ( odds ratio [ OR ] , 6.3 ; 95 % confidence interval [ CI ] , 2.7 to 14 ) , moderate hemiparesis ( OR , 2.7 ; 95 % CI , 1.1 to 6.2 ) , severe hemiparesis ( OR , 4.5 ; 95 % CI , 1.1 to 19 ) , and recurrent stroke ( OR , 9.4 ; 95 % CI , 3.0 to 30 ) . A low level of activity before the stroke was a significant predictor of institutionalization , and subsequent recurrent stroke was a consistent , independent predictor of institutionalization , disability , and death or institutionalization , increasing the odds of each of these 3 adverse outcomes by 5- to 15-fold . Conclusions — Among 30-day survivors of first-ever stroke , about half survive 5 years ; of survivors , one third remain disabled , and 1 in 7 are in permanent institutional care . The major modifiable predictors of poor long-term outcome are a low level of activity before the stroke and subsequent recurrent stroke . Efforts to increase physical activity among the elderly and to prevent recurrent stroke in survivors of a first stroke are likely to reduce the long-term burden of cerebrovascular disease Purpose . This study examined the association between impaired physical function and participation in  community ambulation  following stroke . We hypothesised that participation would be significantly less following stroke , and that physical impairments would be associated with participation . Method . Using a case – control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation  ( number of trips and walking-related activities ( WRA ) reported prospect ively over a 12-day period ) . The association of physical impairments ( strength , range of motion , sensation , muscle tone , vision , and activity limitations ( gait speed and performance on complex walking tasks ) ) with level of participation was analysed using negative binomial regression and goodness of fit . Results . Participants included 30 individuals with and 30 without stroke , average age 68 years , majority were Caucasian women . Average time  since stroke was 40 months . Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction ( p < 0.001 ) . Usual gait speed , balance , muscle strength and muscle length were impaired ( p < 0.001 ) in stroke vs. controls , and associated with number of trips and WRA ( p < 0.05 ) . However , these factors explained less than very little of the variance in participation . Conclusions . While individual factors were associated with level of participation , results failed to accurately predict participation in community ambulation following stroke . Other factors , such as depression , cognition and self-efficacy may be stronger determinants of participation Objectives : To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural setting s ; to measure the impact of the programme on health-related quality of life and functional performance ; and to determine if any benefits gained are maintained . Design : R and omized , assessor blind , cross-over , controlled trial . Setting : Rural outpatient . Subjects : Twenty-five community-dwelling , chronic stroke survivors and 17 carers of participant stroke survivors . Intervention : The intervention group undertook a once-a-week , seven-week group programme combining physical activity , education , self-management principles and a ‘ healthy options ’ morning tea . At completion , the control group crossed over to receive the intervention . Main measures : Stroke Impact Scale ( stroke survivors ) , Health Impact Scale ( carers ) , Six Minute Walk Test , Timed Up and Go , Caregiver Strain Index . Results : There were insufficient participants for results to reach statistical significance . However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers . The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants . The programme was well attended . Of the seven sessions all participants attended four or more and 88 % attended six or seven sessions . Conclusions : This novel programme incorporating physical activity , education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian setting s. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation Background Over 65 % of stroke survivors are either overweight or obese and have multiple cardiovascular risk factors . However , few studies have examined the effects of comprehensive lifestyle behavior interventions to promote weight loss and control cardiovascular risk factors in stroke survivors . Thus , the purpose of this study is to examine a novel behavior change approach - SystemCHANGE ™ - to promote weight loss and improve health and function in stroke survivors .  SystemCHANGE ™ focuses on re design ing the social environment to achieve a specific goal . Methods We will conduct a r and omized controlled pilot study to examine the efficacy , feasibility , and safety of the SystemCHANGE ™ weight management program in overweight and obese stroke survivors . The central hypothesis of the study is that the SystemCHANGE ™ intervention will help overweight and obese stroke survivors lose 5 % of their body weight , thereby improving health and function . Thirty-five stroke survivors will be r and omized into either the 6-month SystemCHANGE ™ intervention or a contact-control intervention . Outcome measures will be assessed at baseline and again at 3 and 6 months after the interventions . Body composition will be assessed using a Bod Pod . Patient-reported outcomes will be the Stroke Impact Scale and Reintegration to Normal Living Index . Objective outcomes will include the 6-Minute Walking Test and Rivermead Motor Assessment . Discussion This study will be the first r and omized controlled trial to evaluate the efficacy and safety of a weight management intervention in stroke survivors using the SystemCHANGE ™ approach . Furthermore , it will be the first empirically-examined comprehensive lifestyle intervention design ed to target physical activity , nutrition , and sleep to promote weight loss in stroke survivors . Trial registration Clinical Trials.gov Identifier : Background . Targeted physical activity drives functional recovery after stroke . This review aim ed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions . Summary of Review . A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions . Seven studies were included ; six observational and one r and omised controlled trial . People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration . The most common activities practice d in a physiotherapy session were walking , sitting , and st and ing with a mean ( SD ) practice time of 8.7 ( 4.3 ) , 4.5 ( 4.0 ) , and 8.3 ( 2.6 ) minutes , respectively . Conclusion . People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity . In light of dosage studies , practice time may be insufficient to drive optimal motor recovery Objective : Stroke is the most common cause of physical impairment , and having already had a stroke dramatically increases the risk of having another one . Although greater physical activity lowers rates of stroke recurrence , patients often fail to act in line with this recommendation . The present intervention tested whether teaching the self-regulation strategy of mental contrasting ( MC ) with implementation intentions ( II ; MCII ) improves stroke patients ’ physical activity and weight loss over 1 year compared with 2 information-only , control interventions . Research Method : Participants were 183 stroke survivors who were capable of adhering to physical activity recommendations ( age : M = 57 years ; body mass index ( BMI ): M = 30 ) . Patients were r and omized to 3 conditions : unstructured information ( n = 61 ) , structured information ( n = 62 ) , and structured information plus MCII ( n = 60 ) . Patients ’ physical activity was assessed 50 weeks after they had left the rehabilitation hospital using the Baecke Inventory ( Baecke , Burema , & Frijters , 1982 ) , and by diaries provided at 2 consecutive weekends after 0 , 10 , 20 , 30 , 40 , and 50 weeks . Diaries were also used to assess weight change . Results : MCII participants were more physically active after the 50 weeks ( Baecke Inventory : 2.74 vs. 2.59 , p < .05 ; diary : 62.45 vs. 54.11 , p = .03 ) and lost more weight ( 2.15 kg , p = .02 ) compared with participants in the control conditions . Conclusions : Teaching the MCII self-regulation strategy enhanced long-term physical activity in stroke patients relative to health information on its own . MCII thus qualifies as an effective intervention technique to improve secondary stroke prevention BACKGROUND The loss of normal ambulatory function after stroke , besides causing disability , leads to progressive deconditioning and exposes patients to increased risk of cardiovascular diseases and recurrent stroke . Conventional rehabilitation is mainly limited to the subacute period after stroke . Effective , safe and sustainable interventions for patients and healthcare system , including the long-term , should be identified . AIM To verify the feasibility , safety and preliminary efficacy of an original home-based rehabilitation model compared to a st and ard supervised program in chronic hemiplegic stroke survivors . DESIGN Pilot , two-arm , parallel group , r and omized , controlled clinical trial . SETTING Community-dwelling poststroke patient/Hospital . POPULATION Twelve chronic hemiplegic stroke patients ( age=66.5±11.9 years , males , N.=9 ) . METHODS Participants were r and omly assigned for a 10-week period to a structured home-based exercise program ( N.=6 ) and a st and ard supervised group- setting program ( N.=6 ) . The feasibility outcomes included adherence to interventions , retention rate and safety . Satisfaction was also evaluated by the Client Satisfaction Question naire . Efficacy was assessed by the 6-minute walk test , Timed Up and Go and Stair Climb tests . The impact on Quality -of-life was estimated using the physical activity domain of the Short Form-36 question naire . Operators ' time consuming was also calculated . RESULTS Adherence was 91 % in the home-based exercise group and 92 % in the st and ard supervised group . The retention rate was 100 % , with no adverse events reported and high satisfaction scores for both interventions . 6-minute walk test and physical activity domain significantly increased in both groups ( P=0.03 ) . Timed Up and Go improved in both groups , significantly for the home-based exercise group ( P=0.03 ) while Stair Climb remained stable . Time required to operators to implement the home-based exercise program was 15 hours vs. 30 hours for the st and ard supervised one . CONCLUSIONS In a sample of hemiplegic chronic stroke patients , a structured home-based exercise program was feasible , safe and capable of inducing improvements in functional capacity and Quality -of-life comparable to a conventional supervised rehabilitation program A future larger r and omized controlled trial will be needed to confirm such results . CLINICAL REHABILITATION IMPACT With the limitation of a small sample size , the study suggested that a home-based program for chronic stroke might be an effective alternative to traditional supervised programs with the peculiarity of being sustainable for patients and healthcare system OBJECTIVES To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status . DESIGN Secondary analysis of baseline , postintervention , and 6-month follow-up data from a r and omized trial . SETTING General community . PARTICIPANTS Ninety-one subjects with a first or recurrent stroke , discharged from rehabilitation therapy with a residual walking deficit . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The Activities-Specific Balance Confidence ( ABC ) Scale , Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale , and the EQ-5D visual analog scale of perceived health status . RESULTS Average balance self-efficacy was 59 out of 100 points on the ABC scale ( 95 % confidence interval , 55 - 64 ; n=89 ) . After adjusting for age and sex , functional walking capacity explained 32 % and 0 % of the respective variability in physical function and perceived health status scores obtained 6 months later . After adjustment for age , sex , and functional walking capacity , balance self-efficacy explained 3 % and 19 % of variation in 6-month physical function and perceived health status scores , respectively . CONCLUSIONS Subjects living in the community after stroke experience impaired balance self-efficacy . Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement , primarily in perceived health status , but also in physical function , than the enhancement of functional walking capacity alone BACKGROUND Family caregivers provide the foundation for long-term home care of stroke survivors . The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external re sources to cope with this situation , thereby placing their own health at risk . We conducted a r and omised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers . OBJECTIVES To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence , problem-solving coping abilities , caregiver 's depressive symptoms , caregiving burden and re sources ( family functioning , social support ) and physical health ( such as caregiving-related injury ) , as well as potential placement of stroke survivors . DESIGN A prospect i ve multi-centre and single-blinded r and omised controlled trial stratified by survivors ' history of stroke . SETTING AND PARTICIPANTS Adult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong . METHODS The design of the trial was based on the relational/problem-solving model . Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of question naires before r and omisation , immediately , one- and three-months post-intervention . The control group received usual care , whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme ( two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions ) . Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests . RESULTS We recruited 128 caregiver-survivor dyads . The intervention group demonstrated significantly greater improvements throughout the study ( p < 0.01 ) in terms of caregiving competence , problem-solving coping abilities and social support satisfaction . This group also displayed significantly greater improvements in terms of family functioning ( p < 0.05 ) at one-month post-intervention , an increased number of social support ( p < 0.001 ) and a lower level of burden at three-month post-intervention . However , there was no significant effect on enabling stroke survivors to remain in their home . Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities , which suggested its mediating effect on caregiving competence of stroke caregivers . CONCLUSIONS Findings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors Background  Physical activity levels among breast cancer survivors are typically low , and knowledge of the correlates of increased physical activity among cancer survivors is limited . The purpose of this study was to examine factors that are associated with physical activity or inactivity among breast cancer survivors . Methods Data from 3088 women participating in the Women ’s Healthy Eating and Living ( WHEL ) Study , collected prior to r and omization , were the focus of the current analyses . Self-reports of physical activity levels , quality of life , depression , and dietary intakes  were collected . Pearson correlation analyses were employed to examine the associations among these variables , and multiple regression analyses were performed to examine the relationship between selected health behaviors and physical activity levels , after controlling for demographic , breast cancer-related , and psychosocial variables . Results Demographic and psychosocial variables were related to physical activity levels ( P < 0.001 for all ) . Cancer treatment type and cancer stage were correlated with survivors ’ physical activity levels ( P < 0.01 ) , but the associations were no longer significant after controlling for demographic variables . Physical activity levels were strongly associated with other health behaviors , especially dietary intakes ( P < 0.001 ) , even after controlling for demographic , cancer-related , and psychosocial factors . Conclusion Low physical activity  levels in breast cancer survivors are associated with specific behavioral and other factors , which can be considered as indicators of women at higher risk . Findings of significant differences in  physical activity levels based on demographic characteristics suggest the importance of promoting physical activity particularly among breast cancer survivors of ethnic minority or lower education levels ABSTRACT Stroke survivors are at high risk for cardiovascular mortality which can be in part mitigated by increasing physical activity . Self-efficacy for exercise is known to play a role in adoption of exercise behaviors . This study examines self-reported psychological outcomes in a group of 64 stroke survivors r and omized to either a 6-month treadmill training program or a stretching program .  Results indicated that , regardless of group , all study participants experienced increased self-efficacy ( F = 2.95 , p = .09 ) and outcome expectations for exercise ( F = 13.23 , p < 0.001 ) and improvements in activities of daily living as reported on the Stroke Impact Scale ( F = 10.97 , p = .002 ) . No statistically significant between-group differences were noted , possibly because of the fact that specific interventions design ed to enhance efficacy beliefs were not part of the study . Theoretically based interventions should be tested to clarify the role of motivation and potential influence on exercise and physical activity in the stroke survivor population Abstract Purpose : Programmes that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation . The purpose of this study was to explore patterns of perceived needs and skill-building during a  stroke caregiver intervention programme . Method : Descriptive statistics were used to analyse data from 123 stroke caregivers enrolled in the intervention group of a r and omised controlled clinical trial . Caregivers received eight weekly telephone sessions , with a booster session a month later . At each session , the  Caregiver Needs and Concerns Checklist ( CNCC ) was used to identify and prioritise current needs that were then addressed through skill-building strategies . Results : Perceived needs changed over time . Information about stroke was the highest priority need during Session 1 . Managing survivor emotions and behaviours was the highest priority for Sessions 2 through 4 . Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs . Physical and instrumental care needs were relatively low but stable across all nine sessions . Skill-building was consistently high , though it peaked during Sessions 2 and 3 . Conclusions : Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation . Implication s for Rehabilitation Family caregivers of stroke survivors play an essential role in the rehabilitation process of the stroke survivor . Identifying and addressing the priority needs and concerns of stroke caregivers during the early discharge period enables caregivers to provide sustained support for the stroke survivor . Rehabilitation professionals are in a key position to address evolving caregiver needs and concerns as they transition to home setting s with follow-up care Background The quality of life for breast cancer survivors has become increasingly important because of their high survival rate and prolonged life expectancy . The purpose of this study was to examine the association of physical activity following diagnosis and health-related quality of life ( HRQOL ) in breast cancer survivors . Methods We conducted a cross-sectional study of breast cancer survivors . A total of 231 women aged 21–78 years who had been diagnosed with stages I to III breast cancer and had breast cancer surgery at least 6 months prior were recruited from three hospitals between September 2012 and April 2015 and were included in this study . We asked participants about their HRQOL and engagement in physical activity using structured question naires . We examined the association between HRQOL levels and physical activity using a generalized linear model . Results Breast cancer survivors in the high physical activity group ( 3rd tertile ) were more likely to have lower scores for fatigue ( p for trend = 0.001 ) and pain ( p for trend = 0.02 ) and higher scores for sexual function ( p for trend = 0.007 ) than those in the low physical activity group ( 1st tertile ) . When we stratified participants by stage , we found increasing scores for physical functioning ( p for trend = 0.01 ) and decreasing scores for fatigue ( p for trend = 0.02 ) with increasing levels of physical activity in breast cancer survivors with stage I breast cancer . In survivors with stages II and III , we found statistically significant associations with fatigue ( p for trend = 0.02 ) and sexual functioning ( p for trend = 0.001 ) . Conclusions In conclusion , engagement in physical activity was related to better health-related quality of life among breast cancer survivors . Our findings may warrant further prospect i ve and intervention studies to support the benefit of physical activity in improving the quality of life and survival of Korean breast cancer survivors Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov Background Given the rising number of strokes worldwide , and the large number of individuals left with disabilities after stroke , novel strategies to reduce disability , increase functions in the motor and the cognitive domains , and improve quality of life are of major importance . Physical activity is a promising intervention to address these challenges but , as yet , there is no study demonstrating definite outcomes . Our objective is to assess whether additional treatment in the form of physical fitness-based training for patients early after stroke will provide benefits in terms of functional outcomes , in particular gait speed and the Barthel Index ( co- primary outcome measures ) reflecting activities of daily living ( ADL ) . We will gather secondary functional outcomes as well as mechanistic parameters in an exploratory approach . Methods / Design Our phase III r and omised controlled trial will recruit 215 adults with moderate to severe limitations of walking and ADL 5 to 45 days after stroke onset . Participants will be stratified for the prognostic variables of “ centre ” , “ age ” , and “ stroke severity ” , and r and omly assigned to one of two groups . The interventional group receives physical fitness training delivered as supported or unsupported treadmill training ( cardiovascular active aerobic training ; five times per week , over 4 weeks ; each session 50 minutes ; total of 20 additional physical fitness training sessions ) in addition to st and ard rehabilitation treatment . The control intervention consists of relaxation sessions ( non-cardiovascular active ; five times per week week , over 4 weeks ; each session 50 minutes ) in addition to st and ard rehabilitation treatment . Co- primary efficacy endpoints will be gait speed ( in m/s , 10 m walk ) and the Barthel Index ( 100 points total ) at 3 months post-stroke , compared to baseline measurements . Secondary outcomes include st and ard measures of quality of life , sleep and mood , cognition , arm function , maximal oxygen uptake , and cardiovascular risk factors including blood pressure , pulse , waist-to-hip ratio , markers of inflammation , immunity and the insulin-glucose pathway , lipid profile , and others . Discussion The goal of this endpoint-blinded , phase III r and omised controlled trial is to provide evidence to guide post-stroke physical fitness-based rehabilitation programmes , and to eluci date the mechanisms underlying this intervention . Trial registration Registered in Clinical Trials.gov with the Identifier NCT01953549 Background and Purpose — Health-related quality of life ( HRQOL ) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery . This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery . Methods — Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial ( Extremity Constraint-Induced Therapy Evaluation ) . HRQOL was assessed using the  Stroke Impact Scale ( SIS ) , Version 3.0 . The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity . Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains . Results — Age , gender , education level , stroke type , concordance ( paretic arm = dominant h and ) , upper extremity motor function ( Wolf Motor Function Test ) , and comorbidities were associated across SIS domains . Poorer HRQOL in the physical domain was associated with age , nonwhite race , more comorbidities , and reduced upper-extremity function . Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking , and those with an ischemic stroke and concordance reported poorer communication . Conclusions — Although results may not generalize to lower functioning stroke survivors , individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive , targeted interventions design ed to maximize recovery and improve HRQOL 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 Purpose : This study examined the role of anxiety and upper limb dysfunction , amongst other variables , as predictors of health related quality of life ( HRQOL ) 6 months after stroke . Method : Participants : Stroke survivors ( n = 85 ) who had previously participated in a r and omised controlled trial of a physiotherapy intervention .  Dependent variable : HRQOL – Nottingham Health Profile ( NHP ) . Predictor variables : Mood – Hospital Depression and Anxiety Scale ; Upper Limb Functioning - Action Research Arm Test ; Rivermead Motor Assessment ; Activities of Daily Living – Modified Barthel Index ; Clinical and demographic factors . Results : Anxiety and depression significantly predicted 49 % of variance in overall HRQOL ( p < 0.05 ) , but only anxiety significantly predicted NHP pain ( 13 % variance , p < 0.001 ) , emotional reactions ( 41 % variance , p < 0.001 ) , sleep ( 19 % variance , p = 0.02 ) and social isolation ( 23 % variance , p = 0.02 ) . Depression and anxiety together significantly predicted 30 % variance in energy level ( p < 0.001 ) . UL motor impairment and activities of daily living predicted 36 % of variance in NHP physical activity score ( p < 0.001 ) . Conclusions : This study indicates that where anxiety is assessed , it appears more important in determining HRQOL than depression . UL impairment and ADL independence predicted perceived physical activity . Management strategies for anxiety and therapy for UL recovery long after stroke onset are likely to benefit perceived HRQOL . Implication s for Rehabilitation Anxiety is a major predictor of quality of life six months after stroke . Post-stroke anxiety should be routinely assessed in rehabilitation . Appropriate management strategies for anxiety should occur during rehabilitation with follow-up into the chronic post-stroke period . Upper limb impairment is a stronger predictor of perceptions of physical activity than independence in activities daily living six months after stroke . Rehabilitation of the upper limb should continue into the chronic post-stroke period
DISCUSSION This systematic review will provide information on which interventions are effective for increasing physical activity levels of stroke survivors .
INTRODUCTION Stroke is a leading health problem worldwide and an important cause of disability .
Stroke survivors show low levels of physical activity , and increases in physical activity levels may improve function and health status .
Therefore , the aims are to identify which interventions that have been employed to increase physical activity levels with stroke survivors , to verify their efficacy and to identify the gaps in the literature .