Interventions to Promote Long-Term Participation in Physical Activity After Stroke: A Systematic Review of the Literature

Objective: To investigate the effects of interventions to promote long-term participation in physical activity (PA) on measures of frequency, duration, or intensity of PA at 3 months or longer in community-dwelling stroke survivors. Data Sources: MEDLINE, Cumulative Index to Nursing and Allied Health (ClNAHL), Psycll\TFO, and Cochrane Library of Systematic Reviews between 1987 and December 2012. Search terms included "physical activity, exercise promotion," "stroke," "behavior change interventions," and their synonyms. Study Selection: Randomized controlled trials or comparison studies involving stroke survivors, with follow-up of >= 3 months, examining interventions to increase long-term participation in PA. Data Extraction: Preferred reporting items for systematic reviews and meta-analyses guidelines informed data extraction. Risk of bias was assessed using the Cochrane Collaboration tool. Two reviewers independently reviewed abstracts and extracted data. Data Synthesis: Of 2888 studies, 11 involving 1704 participants were included. Risk of bias occurred in randomization methods and blinding. Limited data and study heterogeneity meant that data pooling was not possible. Odds ratios and continuous data as weighted mean differences, however, were calculated using fixed-effect models and 95% confidence intervals. Two intervention types were identified: individualized tailored counseling with or without supervised exercise (n=6 studies) and supervised exercise with advice (n=5 studies). Three studies illustrated increased odds of meeting recommended PA levels and participation in PA at 12 months after tailored counseling (P<.05). Two studies showed improved step count at 3 months with supervised exercise only (P<.05); however, PA levels had declined by 3 months. Tailored home exercise was the only predominantly exercise-based intervention to demonstrate higher PA participation at 12 months. Conclusions: This study provides some evidence that tailored counseling alone or with tailored supervised exercise improves long-term PA participation and functional exercise capacity after stroke better than does tailored supervised exercise with general advice only. Interventions to improve participation in PA should incorporate PA-specific tailored counseling based on sound behavioral theory to promote long-term participation in PA. (C) 2014 by the American Congress of Rehabilitation Medicine