Walking to better health after stroke

The study will comprise a blinded (assessors and biostatistician but not participants) randomised controlled trial (RCT), followed by participant focus groups/interviews, to investigate the feasibility of using such a walking intervention to enhance health and wellbeing for people with stroke for a larger, future RCT. Participants allocated to the intervention group will undergo a 12-week walking programme facilitated by weekly contact with a physiotherapist as follows: Intervention group participants: Week 1 (1-1.5 hours) a) The week following assessment, participants in the intervention group will meet the physiotherapist responsible for their individual programme at the physiotherapy clinic or at their home. Two to three physiotherapists will be trained in the delivery of the intervention protocol and in using behavioural techniques to facilitate participants to set their own walking goals and to assist in developing self-motivation to be able to continue walking for health and wellbeing without further oversight or encouragement following the 12-week programme. Participants will be allocated one physiotherapist who will work with them on an individual basis throughout. Each walking programme will be carried out in a location of the participants choosing eg within the home, outside, at a gym. b) Participants will be provided with a Fitbit One(TM) activity monitor and a smartphone device programmed with the Fitbit(TM) App (participants can elect to use their own smartphone/tablet or laptop if available and preferred) and instructed how to use these devices. The number of steps a participant takes each day is displayed on the device and can be synchronised and viewed in the Fitbit(TM) App using a Bluetooth(TM) compatible device if the wearer is in close proximity. Both the participant and the physiotherapist will be able to access information from the Fitbit(TM) App following synchronisation. c) Participants will complete a 10-minute self-efficacy walk using the Fitbit One(TM) to monitor step count in order to demonstrate Fitbit One(TM) use and aid participant and physiotherapist in setting individualised, realistic daily step goals during the programme. d) Participants will be asked to familiarise themselves with wearing the Fitbit One(TM) and using the App over the following week with no specific step goal. Week 2 (1-1.5 hours) a) Participants will meet for a second time with the physiotherapist face-to-face, discuss Fitbit One(TM) use and, using motivational interviewing techniques, a daily step count goal will be agreed using step count information from the previous week and the self-efficacy walk. b) Participants will learn how to introduce moderate or moderate-to-vigorous intensity walking elements into the programme using the Rate of Perceived Exertion (RPE) Scale. Perceived exertion is how hard a person feels they are physically working. During activity, participants will learn how to self-monitor how they feel on the RPE scale between 6 (no exertion) to 20 (maximal exertion) and adjust the intensity of their walking by altering the speed or gradient for example. Perceived exertion ratings between 12 to 14 (somewhat hard) on the RPE Scale suggest PA is being performed at a moderate level of intensity, whilst ratings of 15 to 16 (hard) suggests moderate to vigorous PA. c) The physiotherapist will assist the participant in planning their weekly walking activity and exploring potential facilitators and barriers to success and how to document this in an electronic dairy or in a provided paper dairy (depending on participant’s preference). Weeks 3-12 (30-60 minutes) a) Over the subsequent 10-weeks participants will receive a mix of weekly face-to-face visits (to a maximum of six) and phone/video-conferencing (e.g. Zoom/Skype) calls by the physiotherapist. Each week participants will discuss their daily step counts, walking intensity, any problems encountered in reaching their walking goal and make plans for the following week. In this way the daily step count will hopefully be gradually increased in a manner acceptable to each individual participant. The target number of steps each participant takes per day will differ depending on the individual but will not exceed a 10% increase per week. Following intervention a) Immediately following completion of the 12-week programme, participants will return to see the blinded assessor for reassessment. b) Participants will also be invited to participate in a focus group discussion designed to explore their thoughts and experiences of using the Fitbit(TM)-driven walking as a tool to encourage PA, changes to their walking/PA levels, ability to sustain changes and perspectives of walking on health and wellbeing.