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. 2025 Oct 22:e13316.
doi: 10.1002/advs.202513316. Online ahead of print.

The Adaptive Physical Activity Study in Stroke (TAPAS): A Feasibility Sequential Multiple Assignment Randomized Trial

Aoife Whiston  1   2 , Emma Carr  3 , Nathan Cardy  4 , Padraic Rocliffe  1   5 , Siobhan M O'Reilly  1   6 , Daniel Carter  7 , Mairead O'Donoghue  8 , Aine Cronin  6 , James G Bradley  3 , Mike Butler  3 , Liam Glynn  1   9 , Jane C Walsh  10 , Cathal Walsh  11 , Kelley Kidwell  12 , Margaret O'Connor  11   13   14 , Chris Macey  15 , Lorna Paul  16 , Claire Fitzsimons  17 , Julie Bernhardt  18 , Jon Salsberg  9   11 , Sara Hayes  1   6   13
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The Adaptive Physical Activity Study in Stroke (TAPAS): A Feasibility Sequential Multiple Assignment Randomized Trial

Aoife Whiston et al. Adv Sci (Weinh). .

Abstract

Physical inactivity post-stroke increases risk of recurrent stroke. Adaptive physical activity (PA) interventions are recommended, and alternative designs, such as sequential multiple assignment randomized trials (SMARTs) can be used. This SMART investigates the feasibility of a mobile health (mHealth) PA intervention post-stroke. People post-stroke are randomized to 12-week online exercise (EX) or lifestyle PA (LPA). Six-week daily step count data are used to classify participants as responders or nonresponses. Nonresponders are re-randomized to switch or augment their mHealth intervention, responders continue unchanged. Primary outcomes include recruitment, retention and adherence rates. Secondary outcomes include PA, sedentary behavior, fatigue, quality of life, psychological distress, and activities of daily living. General linear models estimate trends regarding first-stage interventions, nonresponse strategies, and adaptive interventions are examined using weighted and replicated regressions. Fifty participants are included. Recruitment, retention, and adherence rates are 85%, 84%, and 82%. Positive trends are seen for nonresponse strategies, switching interventions, on step count, fatigue, and quality of life. Starting with EX and switching to LPA show potential benefits for fatigue, quality of life and return to normal living. Potential benefits of these interventions are preliminary and require validation in a full-scale trial. This SMART offers novel evidence supporting the design of adaptive mHealth PA interventions post-stroke, confirming the feasibility of a definitive SMART.

Keywords: adaptive intervention; mobile health; physical activity; sequential multiple assignment randomized trial; stroke; stroke prevention.

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