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Question: Does long-term and individualised physical activity and exercise coaching prevent long-term functional decline in adults following stroke? Design: Pragmatic, assessor-blinded, parallel-group, randomised, controlled trial. Setting: Stroke units and outpatient clinics of Trondheim University Hospital and Bærum Hospital in Norway. Participants: Adults with first-ever or recurrent stroke, discharged from hospital or inpatient rehabilitation, community-dwelling, with a modified Rankin Scale (mRS) score < 5, and no serious comorbidities. Exclusion criteria included short life expectancy and score < 21 on Mini Mental State Examination (< 17 if aphasic). Randomisation of 380 participants allocated 186 to individualised coaching and 194 to standard care. Interventions: Both groups received standard care, including comprehensive stroke unit treatment in the acute stage and post-discharge rehabilitation (typically 45 minutes of physiotherapy per week for 3 to 6 months). The experimental group received additional monthly individualisedcoaching (in theirhome orviatelephone) bya physiotherapist for 18 months. Based on individual preferences and goals, participants were coached to perform 45 to 60 minutes of exercise (including 2 to 3 bouts of vigorous activity) per week, as well as 30 minutes of physical activity every day. Participants were instructed to record amount and intensity of exercise and activity each day. The control group received standard care only. Outcome measures: The primary outcome was motor function on the Motor Assessment Scale at 18 months. Secondary outcome measures included Barthel Index, mRS, item 14 of the Berg Balance Scale, Timed Up and Go test,10-m walk maximum gait speed, 6minute walk test, and the Stroke Impact Scale. Results: A total of 315 participants (n = 153 experimental, n = 162 control) were assessed at 18 months, but all randomised participants were included in the intention-to-treat analysis. Of the experimental participants who completed exercise diaries, 43 to 59% and 50 to 54% complied with the required weekly physical activity and exercise goals, respectively. Compared to baseline, both groups declined on the Motor Assessment Scale at 18 months, with an adjusted between-group mean difference of –0.7 points favouring the control group (95% CI –2.8 to 1.4 points). Of the secondary outcomes, only Timed Up and Go showed a significant between-group difference favouring the control group (7 seconds, 95% CI 3 to 11 seconds). Conclusion: Long-term individualised coaching did not improve maintenance of motor function more than standard care. This result may have been influenced by the high level of standard care in Norway, and the moderate compliance with theprescribed exerciseand activity dosesintheintervention group.

journal of physiotherapy

Critically appraised paper: Long-term, individualised physical activity and exercise coaching does not improve maintenance of motor function after stroke [commentary]