Critically appraised paper: Long-term, individualised physical activity and exercise coaching does not improve maintenance of motor function after stroke [commentary]

This study suggests that additional monthly coaching focusing on physical activity to maintain motor performance, in the 18 months after discharge from rehabilitation, is not warranted. However, the findings should be considered in the context of the Norwegian healthcare system, where 91% of stroke survivors are managed in comprehensive stroke units, which provide intensive, evidence-based rehabilitation.1 In settings where a high standard of stroke rehabilitation is not available, the impact of monthly coaching on motor performance in the long-term may be significant and warrants further investigation. In this study, 43 to 64% of coaching group participants completed the prescribed amount of physical activity. This poor compliance may have contributed to the findings. Low compliance with physical activity is common following stroke, with < 50% of survivors completing the recommended 150 minutes of moderate physical activity each week.2 This raises the question of how physiotherapists might assist stroke survivors to increase and maintain physical activity. While physical activity was not an outcome of this study, 60 to 64% of people in the coaching group were participating in the recommended amount of physical activity. It is possible that coaching stroke survivors about physical activity may improve the amount of physical activity, but may not be specific enough for maintaining motor performance. Motor performance may need to be explicitly targeted to prevent decline in the years following discharge from rehabilitation. Coaching stroke survivors from early in the rehabilitation journey, with a strong focus on empowerment and less focus on prescription, is also worth investigation. The decline in motor performance that was evident in these stroke survivors highlights the need to develop effective strategies that extend well beyond rehabilitation and provide long-term benefit to stroke survivors. While it is promising that these stroke survivors were performing high levels of physical activity, optimal interventions for encouraging more physical activity in the long term also need to be determined.