## 4 Discussion
Similarly to previous research, this study found that the activity patients performed was of low intensity and primarily comprised sitting (an average 4.5 h sitting per day between 7:00 and 23:00). In previous studies that classified stroke patients' activities by level of functioning, this type of activity was classified as a mild effort [14; 32]. Findings thus indicate that the activities performed by the patients in the current study within the range of activities considered part of early mobility (including, for example, sitting out of bed, standing, walking, and going up/down stairs) were those classified as easy, with almost no performance of activities classified as moderate or high levels of exertion, such as walking. Taking into consideration the limited associations between functional level and actual activity, it seems that patients were not engaged in higher-intensity activities, regardless of their functional ability. A clearer distinction in CPG between activities of mild and moderate intensity may facilitate the implementation of activities with higher motor and metabolic demands. Also needed is an intervention protocol that aligns activity type with the patient's functional level [33; 34]. In the broader perspective of in-hospital physical activity. Several interventions designed to increase in-hospital mobility have proved efficacious [35; 36]. The lesson learned from these experimental interventions is that change in in-hospital activity is facilitated by a multidisciplinary approach, requires collaboration between nurses and health professionals (e.g., physical therapists, occupational therapists), and involves patient and personnel-training modules. In addition, implementation in the \"real-life\" clinical field requires the flexibility to adjust generic action plans to the specific context at hand, including, for example, department type (e.g., intensive care, internal medicine, neurology) and patient characteristics and values [37; 38]. The findings of the current study emphasize the need to consider and modify departmental routines and to better train staff in the required standards presented in CPG. Our study has several limitations. First, the nature of the measurement tool did not distinguish independent active sitting and sitting supported in an armchair. This is important because interventions to facilitate mobility post-stroke were specifically focused on active sitting, contrary to supported out-of-bed sitting. Second, we used MoveMonitor+ activity monitors. While the construct validity of this device to measure body positions was established [13; 24], and the device was used in many research studies, it was not validated in post-stroke patients hospitalized in an acute care setting. The difficulties patients have communicating and the requirement that they are able to provide consent may have biased the recruitment of patients, which limits the generalizability of the findings. Finally, we excluded several shifts from the data analysis due to long periods of not wearing the activity monitors, mainly because of device malfunction or because the device was not returned to its place after it was removed for showering or for medical exams.