Hendrickx W1,2, Vliestra L3, Valkenet K2, Wondergem R1,2,4, Veenhof C1,2,5, English C6, Pisters MF1,2,4
1Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands, 2Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport & Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 3Department of Medicine, University of Otago, Dunedin, New Zealand, 4Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands, 5Innovation for Human Movement Care Research Group, HU University of Applied Sciences, Utrecht, Netherlands, 6School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia

Background: People who have had a stroke or Transient Ischemic Attack(TIA) have a high risk of recurrent stroke. Insufficient amounts of physical activity is one of the risk factors for recurrent stroke. Research has shown that people with stroke or TIA often do not meet the recommended amounts of physical activity, so improving their amounts of physical activity could help reduce the risk of recurrent stroke. Though several reviews have looked at the effects of lifestyle interventions on a number of risk factors of recurrent stroke, the effectiveness of these interventions to increase the amounts of physical activity performed by people with stroke or TIA are still unclear.

Purpose: To determine the effect of lifestyle interventions on the amount of physical activity performed by people with a stroke or TIA.

Methods: A systematic review was conducted following the guidelines of the PRISMA statement. Pubmed, Embase and Cinahl, were searched until August 2018. Randomised controlled trials that compared lifestyle interventions, aiming to increase the amount of physical activity conducted by participants with a stroke or TIA, with controls were included. The Physiotherapy Evidence Database (PEDro) score was used to assess the quality of the articles. A best evidence synthesis was conducted based on the method by van Peppen et al 2004.

Results: Out of the 8245 studies identified in the search, twelve studies were included. All interventions contained a form of education, motivation and/or guidance to support to make stroke-preventive lifestyle changes, including physical activity. Five of the included studies showed a significant difference in the amount of physical activity in favour of the lifestyle interventions group. One found a significant difference in the change in the amount of physical activity in favour of the intervention. Six studies found no significant differences. Therefore, the overall level of evidence is 'insufficient'. When looking solely at studies that had a specific focus on physical activity it is seen that three out of the five studies showed a significant difference in favour of the intervention.

Conclusion(s): Although there is a positive trend found in favour of lifestyle interventions with a specific focus on physical activity to increase the amount of physical activity performed by people with stroke or TIA, no definitive conclusions can be drawn. More high quality research is needed to draw any definitive conclusions.

Implications: Since sufficient amounts of physical activity are lacking in people with stroke or TIA, interventions to improve these amounts are indicated. The results of this review suggest that a specific focus on physical activity within lifestyle interventions might be needed. Due to their expertise on physical activity, stroke and TIA, physical therapist might be able to make a significant contribution, though further research is needed to confirm the suggestion and definitively determine the most effective methods and strategies to change the behaviour.

Keywords: Stroke, Physical activity, Lifestyle interventions

Funding acknowledgements: Non

Topic: Neurology

Ethics approval required: No
Institution: Utrecht University
Ethics committee: Not applicable
Reason not required: Since this was a systematic review ethical approval was not applicable to this study

All authors, affiliations and abstracts have been published as submitted.

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