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Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity—study protocol for a stepped-wedge randomised trial
  1. Avril Mansfield1,2,3,
  2. Dina Brooks1,3,4,
  3. Ada Tang5,
  4. Denise Taylor6,7,
  5. Elizabeth L Inness1,3,
  6. Alex Kiss2,
  7. Laura Middleton1,8,
  8. Louis Biasin1,3,
  9. Rebecca Fleck9,
  10. Esmé French10,
  11. Kathryn LeBlanc9,
  12. Anthony Aqui1,
  13. Cynthia Danells1,3
  1. 1 Toronto Rehabilitation Institute, Toronto, Ontario, Canada
  2. 2 Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
  3. 3 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
  4. 4 West Park Healthcare Centre, Toronto, Ontario, Canada
  5. 5 School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
  6. 6 St Joseph’s Care Group, Thunder Bay, Ontario, Canada
  7. 7 Northern Ontario School of Medicine, West Campus, Thunder Bay, Ontario, Canada
  8. 8 Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
  9. 9 Regional Rehabilitation Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
  10. 10 Northwestern Ontario Regional Stroke Network, Thunder Bay, Ontario, Canada
  1. Correspondence to Dr Avril Mansfield; avril.mansfield{at}


Introduction Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not sufficiently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation. We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency, duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation.

Methods and analysis Individuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited (target n=192 total). A stepped-wedge design will be employed; that is, the PROPEL intervention (group exercise plus self-management) will be ‘rolled out’ to each site at a random time within the study period. Prior to roll-out of the PROPEL intervention, sites will complete the control intervention (group aerobic exercise only). Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors, and standardised physical activity questionnaire. Adherence to exercise guidelines will be evaluated by (1) number of ‘active minutes’ per week (from the activity monitor), (2) amount of time per week when heart rate is within a target range (ie, 55%–80% of age-predicted maximum) and (3) amount of time per week completing ‘moderate’ or ‘strenuous’ physical activities (from the questionnaire). We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed-model logistic regression, with fixed effects of time and phase and random effect of cluster (site).

Ethics and dissemination To date, research ethics approval has been received from five of the six sites, with conditional approval granted by the sixth site. Results will be disseminated directly to study participants at the end of the trial, and to other stake holders via publication in a peer-reviewed journal.

Trial registration number NCT02951338; Pre-results.

  • Stroke
  • Exercise
  • Physical Activity
  • Behaviour Change
  • Physiotherapy

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  • Contributors AM conceived of the study and is the grant holder. AM, DB, AT and DT will lead implementation of the study at each site, with assistance from ELI, LB, RF, EF, KL and CD. ELI, LB and CD developed the intervention. AK provided statistical expertise and will conduct the primary statistical analysis. All authors contributed to refining the study protocol and approved the final manuscript.

  • Funding This study was supported by the Canadian Institutes of Health Research (PJT148906).

  • Disclaimer The funding sources had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to submit results.

  • Competing interests AM holds a New Investigator Award from the Canadian Institutes of Health Research (MSH141983). DB holds a Canada Research Chair. AT is supported by a personnel award from the Heart and Stroke Foundation, Ontario Provincial Office (CS I 7468).

  • Ethics approval Research Ethics Board of the University Health Network.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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