This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To summarise the available evidence regarding the effectiveness of commercially available wearable devices and smart phone applications for increasing physical activity levels for people with stroke.
Description of the condition
Between 1990 and 2010 absolute numbers of people living with stroke increased by 84% worldwide, and stroke is now the third leading cause of disability globally (Feigin 2014). As such, the disease burden of stroke is substantial. It has been estimated that 91% of the burden of stroke is attributable to modifiable risk factors such as smoking, poor diet, and low levels of physical activity (Feigin 2016). A low level of physical activity (less than four hours per week) is the second highest population-attributable risk factor for stroke, second only to hypertension (O’Donnell 2016). The promotion of physical activity, which has been defined as body movement produced by skeletal muscles resulting in energy expenditure (Caspersen 1985), is therefore an important health intervention for people with stroke.
The association between health and physical activity is well established. Prolonged, unbroken bouts of sitting is a distinct health risk independent of time engaged in regular exercise (Healy 2008). There is evidence from cross-sectional and longitudinal studies that high sitting time and low levels of physical activity contribute to poor glycaemic control (Owen 2010). Three systematic reviews and meta-analyses of observational studies have confirmed that, after adjusting for other demographic and behavioural risk factors, physical activity is inversely associated with all-cause mortality in men and women (Nocon 2008; Löllgen 2009; Woodcock 2011). Yet despite this knowledge, populations worldwide are becoming more sedentary, and physical inactivity has been labelled a global pandemic (Kohl 2012).
In addition to overcoming the sedentary lifestyles and habits prevalent in many modern societies, people with stroke have additional barriers to physical activity such as weakness, sensory dysfunction, reduced balance, and fatigue (Billinger 2014). Directly after a stroke, people should be admitted to hospital for co-ordinated care and commencement of rehabilitation (SUTC 2013). Early rehabilitation after stroke is frequently focused on the recovery of physical independence (Pollock 2014). Recovery after stroke is enhanced by active practice of specific tasks, and greater improvements are seen when people with stroke spend more time in active practice (Veerbeek 2014). Yet findings from research conducted around the world indicate that people in the first few weeks and months after stroke are physically inactive in hospital settings with around 80% of the day spent inactive (sitting or lying) (West 2012). These high levels of inactivity are concerning because recovering the ability to walk independently is an important goal of people with stroke. The reported paucity of standing and walking practice in the early phase after stroke potentially limits the opportunities of people with stroke to optimise functional recovery, particularly for standing and walking goals. Further, physical inactivity may lead to an increased risk of hospital-acquired complications, such as pressure ulcers, pneumonia, and cardiac compromise (Lindgren 2004).
Physical activity levels of people with stroke remain lower than their age-matched counterparts even when they return to living in the community (English 2016). Community-dwelling stroke survivors spend the vast majority of their waking time sitting down (English 2014). Promisingly, early research suggests that increasing physical activity in people with stroke is feasible, and that an increase in physical activity levels after stroke may have a positive impact on fatigue, mood, community participation, and quality of life (QoL) (Graven 2011; Duncan 2015).