Cardiorespiratory exercise and self-management early after stroke to increase daily physical activity: results from a stepped-wedge cluster randomized trial

ABSTRACT Trial design Stepped-wedge cluster superiority randomized controlled trial. Objective This study aimed to determine if Promoting Optimal Physical Exercise for Life (PROPEL) program increases participation in physical activity up to six months post-discharge from stroke rehabilitation, compared to participation in group cardiorespiratory exercise (GCE) alone. Methods People with sub-acute stroke participated in the PROPEL (n=107) or GCE (n=65) intervention phases. The primary outcome was adherence to physical activity guidelines over seven days at six months post-discharge from rehabilitation. Secondary outcomes were exercise self-efficacy (Short Self-Efficacy for Exercise scale), exercise-related beliefs and attitudes (Short Outcome Expectation for Exercise scale), and perceived barriers to physical activity (Barriers to Being Active Quiz). Results Fifty seven participants (PROPEL, n=29; GCE, n=28) were included in the analysis. At six months post-discharge, 6/17 PROPEL participants and 9/22 GCE participants met the guidelines for intensity and duration of physical activity; the odds of meeting the physical activity guidelines did not differ between phases (p>0.84). PROPEL participants reported higher self-efficacy for exercise than GCE participants (p=0.0047). Conclusions Participation in the PROPEL increases self-efficacy for exercise compared to GCE alone after stroke. However, increased self-efficacy for exercise did not increase the odds of meeting physical activity guidelines. Trial registration NCT02951338