A stroke survivor with complex physical impairments sits down at a power-assisted exercise machine in a community venue, and the equipment helps them move in ways their body cannot manage alone. This project refines that idea—power-assisted circuit exercise (PACE)—for people living with stroke who have significant mobility limitations. Standard gym equipment is often inaccessible to them, and existing stroke rehab programmes rarely offer the sustained, community-based exercise that could improve strength, balance, and cardiovascular health. The researchers will co-design the intervention with stroke survivors, test it in small groups, and gather detailed feedback from participants and staff to improve the programme before a larger trial. If successful, this work will produce a refined, ready-to-test exercise programme that can be delivered in community settings like leisure centres. That could give stroke survivors a practical, long-term option for maintaining physical function and wellbeing outside hospital walls—something that currently does not exist for many with complex needs. The project is a refinement study, not a test of effectiveness, so its direct impact is on research design: it aims to remove uncertainties so that a future large-scale trial can produce reliable answers about whether PACE works and for whom.
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Background There is a need to develop accessible solutions to enable People Living with Stroke (PLwS) who have complex impairment to engage in exercise. Power Assisted Exercise (PAE) equipment is designed for use by clinical populations and pockets of circuit-based PAE for PLwS running in community venues in the UK suggest that this type of intervention can be feasible, but research is needed to refine the intervention. Aims and Objectives Aim: to co-design, evaluate and refine a Power Assisted Circuit Exercise (PACE) intervention for community dwelling PLwS to take forward in a future effectiveness-implementation study. Objectives: Co-design a logic model to identify intervention components and describe causal mechanisms which will affect patient outcomes. Test and re-test a co-produced PACE intervention. Evaluate the acceptability and stakeholder experience using a mixed method approach. Co-create a refined logic model which will underpin a future research protocol. Methods Patient/public involvement: A diverse patient/public involvement and engagement (PPIE) group with lived experience of stroke will guide activities and outputs across 4 work streams. Work Stream 1: Qualitative data will be collected during focus groups with diverse existing users and potential users of PACE including ISRAAC, a Somali community group. Data will be shared with local stakeholders and the PPIE group to co-develop an intervention logic model. Work Stream 2: Sampling and recruitment: Purposive sampling will be implemented to recruit 30 PLwS to participate in the PACE intervention. Measurement: Baseline and post-intervention assessment will include the Stroke Impact Scale, SF-36-Vitality component, EQ-5D-5L scales to record self-reported wellbeing. Physical measures will comprise Timed Up and Go Test, 10 Metre Walk Test and a power-assisted submaximal exercise test. Intervention: Group PACE intervention with n=3 participants per group located at the Advanced Wellbeing Research Centre. Schedule will comprise two sessions per week over an eight-week period. Intervention will be delivered over two temporal phases to enable refinement between phase one and phase two. Work Stream 3: Qualitative data will be collected from participants recruited to Work Stream 2 to guide intervention refinement. Phase One: Semi-structured interviews with participants (n=8) and a group interview with research assistants (n=2) delivering the intervention. The public involvement group and ISRAAC will be engaged in data analysis to co-create a revised protocol for phase two. Phase Two: Two focus groups (n=8) with participants from phase two of Work Stream Two. Data will undergo thematic analysis. Work Stream 4: Project outputs will be co-developed with the PPIE group. ISRAAC Workshop: Discussion of findings and next steps to refine logic model. Focus Groups: Two on-line focus groups (n=20) with local service providers to review logic model within context of future multi-site study. Timelines Work Stream 1: Start May 2025; complete December 2025 Work Stream 2: Start Nov 2025; complete December 2026 Work Stream 3: Start May 2026; complete February 2027 Work Stream 4: Start Jan 2027; complete March 2027 Impact This research will address uncertainties associated with PACE for PLwS. It will raise awareness amongst communities and stakeholders to facilitate future implementation and evaluation.
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