A physiotherapist facilitated walking intervention using an activity tracker to improve daily step counts in people with stroke

Abstract

Background Globally, stroke is a leading cause of long-term disability in adults. Participating in regular physical activity such as walking has multiple health benefits for stroke survivors and can reduce the risk of recurrent stroke. Despite this, physical activity levels are known to be low in people living with stroke. Activity trackers are increasingly being used to motivate individuals to increase physical activity and may be an effective strategy to increase participation in physical activity for people living with stroke. Objectives The objectives of this study were a) to investigate whether an eight-week walking intervention using a commercially available activity tracker and a behavioural change intervention could increase daily step counts in people living with chronic stroke; b) to investigate the acceptability of the intervention. Methods This study used a mixed methods design using an embedded approach with an experimental design. The quantitative method was quasi-experimental using a single group, pre-test, post-test design. Qualitative data was collected from a self-administered survey to investigate the acceptability of the intervention, and to provide context to the quantitative data. Participants were community dwelling, chronic stroke survivors (median time since stroke = 13.5 months). The intervention involved an individually, tailored eight-week walking programme monitored by a Fitbit™ Zip activity tracker. The intervention contained weekly face-to-face consultations for the first four weeks, to establish a progressive walking programme and promote exercise self-efficacy by incorporating strategies such as barrier identification, problem-solving, goal setting, self-monitoring and action planning. The primary outcome was the change in mean daily step counts. Secondary outcomes were resting systolic and diastolic blood pressure, walking endurance, stroke specific self-efficacy, health-related quality of life, adherence and acceptability of the intervention. Results Eight participants completed the study. The mean daily step count increased by 1343 (SD = 2467) steps or by a mean change of 52% compared to baseline steps. There was no statistically significant change in the secondary outcome measures except for health-related quality of life measured on the EuroQol-5D-5L VAS which increased by a mean of 14 points (SD=13.7). Participants were positive about the intervention and it appeared acceptable, although many barriers to completing the intervention were reported. Common barriers identified were lack of motivation, lack of time, fatigue, pain and environmental barriers such as unfavourable weather. There were no difficulties reported with regards to using the Fitbit™ Zip activity tracker. Conclusion This study used a low-cost commercially available activity tracker device alongside a behavioural change intervention delivered by a physiotherapist. The results show it is possible to increase daily step counts in a population of chronic stroke participants and that the intervention was acceptable. More research with larger sample sizes, a comparison group and longer follow-up time is warranted to determine whether the increase in daily step count can be maintained.