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

PURPOSE: This study aimed to determine if the 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: This was a stepped-wedge cluster superiority randomised controlled trial. 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 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: While PROPEL participants reported higher self-efficacy for exercise than those who completed GCE alone, we were unable to find evidence that this translated to increased odds of meeting physical activity guidelines. TRIAL REGISTRATION: NCT02951338IMPLICATIONS FOR REHABILITATIONIntegration of cardiorespiratory exercise with behaviour modification strategies to improve physical activity participation after discharge from stroke rehabilitation increases self-efficacy for exercise when compared to cardiorespiratory exercise alone.Increased self-efficacy for exercise may not increase the odds of meeting physical activity guidelines post-stroke.Improving self-efficacy for exercise during stroke rehabilitation may encourage participation in moderate to vigorous physical activity up to 6-months post-discharge from rehabilitation.