Background. Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). Purpose. The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). Data Sources. Searches were conducted in 5 databases. Study Selection. Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. Data Extraction. One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. Data Synthesis. Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was >78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). Limitations. Limitations of this review include not pooling data reported as medians. Conclusions. Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.

Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.

Purpose: To describe how physical activity is monitored following stroke; to summarise methods and devices used across the stroke pathway and document their psychometric properties. Methods: Searches of five databases identified studies that included stroke survivors whose physical activity was quantitatively measured. Two reviewers independently determined inclusion. A descriptive synthesis was undertaken and reliability data for specific methods of monitoring physical activity were pooled where possible. Results: Ninety-one papers (60 using devices and 31 using observational methods) met inclusion criteria, with 3479 participants aged 21–96 years. Twenty-nine devices (72% accelerometers) were identified. Devices were typically used to measure ambulant participants more than 6 months following stroke. Direct observation of physical activity was commonly used for inpatients. No outcome measurements were common to all methods/devices. Test–retest reliability was not reported for 23 devices; for the remaining six it ranged from r = 0.44 to r = 0.99. Inter-rater reliability of observational methods ranged from 0.51 to 1.0. Validity was infrequently reported. Conclusions: Physical activity outcomes were variable. Devices allow for unobtrusive, sustained monitoring in free-living environments. Observational methods suit inpatient settings but are time and labour intensive. No single approach appears superior but standardisation of outcomes would improve the field.

Objectives: To determine the personal and social factors perceived to influence physical activity levels in stroke survivors. Data sources: Four electronic databases (MEDLINE, CINAHL, PubMed and Embase) were searched from inception to November 2020, including reference and citation list searches. Study selection: The initial search yielded 1499 papers, with 14 included in the review. Included articles were peer-reviewed, qualitative studies, reporting on the perceived factors influencing physical activity levels of independently mobile community-dwelling adults, greater than 3 months post stroke. Data extraction: Data extracted included location, study aim, design, participant and recruitment information and how data were collected and analysed. Data synthesis: Thematic analysis was undertaken to identify meanings and patterns, generate codes and develop themes. Five main themes were identified: (i) Social networks are important influencers of physical activity; (ii) Participation in meaningful activities rather than ‘exercise’ is important; (iii) Self-efficacy promotes physical activity and physical activity enhances self-efficacy; (iv) Pre-stroke identity related to physical activity influences post-stroke physical activity; and (v) Formal programmes are important for those with low self-efficacy or a sedentary pre-stroke identity. Conclusions: Physical activity levels in stroke survivors are influenced by social activities and support, pre-stroke identity, self-efficacy levels and completion of activities that are meaningful to stroke survivors.

Background: Physical activity is important for secondary stroke prevention. Currently, there is inconsistency of outcomes and tools used to measure physical activity following stroke. Aim: To establish internationally agreed recommendations to enable consistent measurement of post-stroke physical activity. Methods: Stroke survivors and carers were surveyed online once regarding what is important in physical activity measurement. Three survey rounds with expert stroke researchers and clinicians were conducted using Keeney’s Value-Focused Thinking Methodology. Survey 1 identified physical activity tools, outcomes, and measurement considerations which were ranked in Survey 2. Consensus recommendations on tools were then formulated by the consensus group based on survey responses. In Survey 3, participants reviewed ranked results and evidence gathered to determine their support for consensus recommendations. Results: Twenty-five stroke survivors, 5 carers, 18 researchers, and 17 clinicians from 16 countries participated. Time in moderate-vigorous physical activity and step count were identified as the most important outcomes to measure. Key measurement considerations included the ability to measure across frequency, intensity, duration domains in real-world settings; user-friendliness, comfort, and ability to detect changes. Consensus recommendations included using the Actigraph, Actical, and Activ8 devices for physical activity intensity; ActivPAL for duration and Step Activity Monitor for frequency; and the IPAQ and PASE questionnaires. Survey 3 indicated 100% support for device and 96% for questionnaire recommendations. Conclusions: These consensus recommendations can guide selection of physical activity measurement tools and outcomes. Tool selection will depend on measurement purpose, user-knowledge, and resources. Comprehensive measurement requires the use of devices and questionnaires.