Maintenance of Improvements in Walking Activity in Individuals with Chronic Stroke: Follow-Up From the PROWALKS Randomized Controlled Trial

Abstract

BackgroundIndividuals with chronic stroke are less active, which is both a consequence of stroke-related impairments and a risk factor for future health complications. The PROWALKS clinical trial found significant gains in real-world walking activity (steps/day) after 12 weeks of a step activity monitoring behavioral intervention, provided either alone (SAM) or with high-intensity gait training (FAST + SAM), but not after high-intensity gait training alone (FAST). Previous research in individuals after stroke suggests that tailored behavioral counseling may lead to better long-term physical activity participation, but no previous work has focused on post-intervention maintenance of walking activity changes.ObjectiveTo investigate whether steps/day changes after training (POST) were maintained at 6 months (6MO) and 12 months (12MO) after baseline. We hypothesized that SAM and FAST + SAM groups would have better maintenance of steps/day changes than the FAST group. Methods. This analysis included all participants who completed the PROWALKS intervention (n = 200, mean[SD] age: 63.27[12.41], 102 male/98 female, >6 months post-stroke). Analysis outcomes were steps/day change from POST-6MO, and from POST-12MO.ResultsAll groups significantly decreased in steps/day from POST-6MO (P = .001, FAST decreased by mean[SE] 160[272], SAM by 1016[270], FAST + SAM by 400[300]), and POST-12MO (P < .001, FAST decreased by 610[280], SAM by 1072[306], FAST + SAM by 568[313]). There were no significant differences between groups.ConclusionsAll intervention groups showed significant declines in steps/day between POST and 6MO and between POST and 12MO. These results add to a growing body of literature suggesting that a behavioral intervention to initiate behavior change may not be sufficient for maintenance of change.Registration:This study is registered at ClinicalTrials.gov, NCT02835313.

Keywords: high-intensity gait; maintenance; step activity monitoring; stroke; walking.

Figure 1.

CONSORT diagram (POST=post-intervention testing; 6MO=6-month follow-up; 12MO=12-month follow-up; CPET=cardiopulmonary exercise test.)

Figure 2.

Primary outcome: changes in steps/day by treatment group between POST and 6-month follow-up, and between POST and 12-month follow-up. Error bars denote standard error. (6MO=6-month follow-up; 12MO=12-month follow-up; F+S=FAST+SAM group.) a) Steps/day mean values by group. b) Magnitude of steps/day change for each group between POST and each of the two follow-up points (6MO and 12MO). Dots indicate mean, violin plots indicate individual results.