A new program developed by University of Alberta researchers is showing promise in helping stroke survivors stride towards recovery after leaving hospital.
A pilot study confirmed that the intervention, known as BIG STEPS, could safely and practically help people sit less and move more after returning home following hospitalization for a stroke — a “whole-of-the-day” approach that is important for long-term health and wellness, says lead author Dr. Victor Ezeugwu of the Faculty of Rehabilitation Medicine.
“Stroke survivors may not stay physically active enough on their own after leaving hospital, and that means they could be missing out on vital health benefits, such as lowering their risk of having another stroke,” he notes.
The 12-week BIG STEPS program, adapted from earlier U of A research exploring the effect of a home-based ‘sit less, move more’ program after stroke, consists of behavioural coaching with structured goal progression to increase daily steps and reduce sedentary time.
“Recovery continues for months after stroke happens, but many people become much less active once their structured rehabilitation ends, so BIG STEPS was designed to support them during this transition by combining coaching from a physical therapist with individual walking goals and wearable sensors for self-monitoring,” Ezeugwu says.
Early, high-intensity walking has proven important as part of stroke rehabilitation, he adds, noting that the walking goals of BIG STEPS increase gradually over time as confidence and ability improve.
“The coaching helps people with their expectations, goal-setting and navigating everyday barriers such as fatigue, fear of falling, bad weather or simply finding ways to balance daily routines.” The activity sensors — commercial smartwatches — provide immediate feedback so participants can see their progress, while therapists can safely adjust goals based on objective information.
Over 17 months, the study tracked 28 adults who’d had a stroke within the preceding three months and were transitioning back to home life. The participants, who had an average age of 68, were split into two equal groups. The first began the BIG STEPS program right away, and the second group delayed their start for 12 weeks. Both groups continued to receive standard post-stroke medical care and rehabilitation, including mobility, balance and strengthening exercises provided through physical therapy.
Participants received an initial home visit from a licensed physical therapist, followed by up to 11 virtual check-ins. Each person received an educational handbook and a smartwatch to self-monitor their activity progress. Therapists used the data to determine how participants were actually spending their day, and to safely ramp up personalized weekly step goals. The participants also used a thigh-worn medical sensor for several days at a time to precisely track sitting, standing and stepping times and transitions between postures.
The group who started BIG STEPS immediately not only walked substantially more each day, but also spent considerably less of their day being inactive, the study showed. By the 12-week mark, they were averaging 6,534 steps per day, compared with 4,031 steps per day in the delayed group. The early group also successfully cut their daily sitting or lying time by about 1.4 hours per day, doubling the reduction seen in the delayed start group.
“These findings suggest the program helped participants change their overall daily movement behaviours — not just simply take more steps,” Ezeugwu notes.
Once the delayed group received the BIG STEPS program after week 12, their activity levels rose as well, ultimately matching the improvements of the early group by week 24.
“That is encouraging, because it suggests the improvements were associated with receiving the BIG STEPS intervention rather than simply the passage of time during recovery,” he adds.
Participants also remained highly engaged throughout the 12-week program, wore their devices consistently, attended the coaching sessions and had no serious adverse events related to participation, suggesting that “this type of personalized home-based program can be delivered safely during the early months after stroke,” he notes.
Through a Canadian Institutes of Health Research grant, BIG STEPS will now be evaluated in a larger study, looking at whether the intervention improves everyday movement behaviours, timed walking capacity, quality of life and long-term health outcomes, while also helping identify which stroke survivors could benefit most from the program.
If the pilot study’s findings are confirmed, the BIG STEPS approach “could make ongoing health promotion after stroke more accessible, personalized and available for many more people,” Ezeugwu says.
“That’s important, considering that generally, support services like this are less available and accessible once folks return home from organized hospital settings. Huge resources go into saving a person when they experience a stroke, but there are far fewer resources to support them once they leave the hospital. BIG STEPS could help fill that gap during this transition.”
The study received funding support from the Glenrose Hospital Foundation and through individual researcher awards from the Heart and Stroke Foundation of Canada, the Brain Canada Foundation, the Canadian Consortium of Clinical Trial Training and Alberta Innovates. Victor Ezeugwu is a member of the Women and Children's Health Research Institute.
