Stroke survivors in England spend more time sitting and lying down than their peers, and this sedentary behaviour worsens their recovery independently of any exercise they might do. With at least 1.2 million people living in England after a stroke, many face poor long-term outcomes including reduced physical function, depression, anxiety, and higher cardiovascular risk. This project aims to develop and test a low-cost intervention—co-designed with patients, carers, and clinicians—that reduces total sedentary time and breaks up long periods of sitting. The research team will first update evidence reviews, then interview patients and staff in two stroke services to understand what drives sedentary behaviour. They will co-produce an intervention, test it in three services, and finally run a cluster randomised trial across 34 stroke services involving 1,156 patients. The primary outcome is disability at 12 months, measured by the WHODAS 2.0 questionnaire, with daily sitting time tracked by an activity monitor. If successful, the intervention could become a practical, scalable way to improve stroke recovery without requiring expensive equipment or major lifestyle overhauls.
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Aims and objectives We seek to enhance health and disability outcomes for stroke survivors through the development and evaluation of strategies to both reduce overall time spent sedentary and break up long bouts of sedentary behaviour. Research questions relate to identification of existing evidence; exploration of capabilities, opportunities and motivation related to sedentary behaviour after stroke; determining whether an intervention developed using principles of co-production is feasible and whether trial design issues can be addressed before assessing the clinical and cost-effectiveness of the intervention. Background and rationale There is increasing evidence that sedentary behaviour has a detrimental effect on health and well being independent of the level of moderate to vigorous physical activity someone might undertake. At least 1.2M people living in England have had a stroke, and longer-term outcomes are poor for many. Survivors of stroke are particularly sedentary compared to age-matched controls. Negative effects of sedentary behaviour include reduced physical function, increased symptoms of depression and anxiety, increased mortality and elevated markers associated with cardiovascular risk. Our research is focused on the reduction of levels of sedentary behaviour: in terms of total amounts of time and the number of extended periods of time spent sitting/lying to provide a relatively low cost solution to improving outcomes after stroke. The applicant team are the leading proponents of sedentary behaviour research in stroke. Research plan We propose to develop and evaluate a complex intervention to reduce sedentary behaviour after stroke. We will develop the intervention with appropriate implementation plans through a co-production approach incorporating behaviour change principles. Workstream 1 Update of the quantitative and qualitative evidence relating to sedentary behaviour through systematic review of the literature. The literature will be analysed to identify behaviour change techniques contributing to effectively reducing sedentary behaviour. Workstream 2 Observations (in hospital and in the community) and semi-structured interviews in two stroke services will be undertaken to inform the co-production process. Interviews with patients and their carers, at three and six months post-stroke (approximately 10 at each time point, in each service), and with members of the multi-disciplinary team will explore the capability, opportunity and motivation to address sedentary behaviours from their perspectives. Interviews will be analysed using Framework Analysis. Workstream 3 Informed by previous workstreams and behaviour change principles, development of an agreed intervention to reduce sedentary behaviour through use of co-production principles in two stroke services. Workstream 4 A case study and action research approach will be used in three services to clarify: content; methods of delivery of the intervention; fidelity assessment and capture learning from, and acceptability to, staff and participating stroke survivors. Trial procedures relating to patient eligibility criteria, recruitment process and data collection will also be clarified. It is anticipated that 15 patients (and carers if available) will be recruited in each service. Workstream 5 A multicentre cluster Randomised Controlled Trial evaluating the clinical and cost-effectiveness of the intervention incorporating an internal pilot phase and embedded process evaluation. Primary outcome: WHODAS 2.0 at 12 months following participant recruitment. 34 stroke services each recruiting 34 patients will result in 1156 patients overall and provide 90% power at 5% significance level to detect moderate effect size of 0.3 in WHODAS 2.0 questionnaire. Key secondary outcome: mean daily time spent sitting measured by activity monitor (activPAL) at 12 months. All outcomes will be assessed at baseline, 6, 12 and 24 months after recruitment. The
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