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Purpose: This study aimed to determine if the Promoting Optimal Physical Exercise for Life (PROPEL) program increases participation in physical activity up to six months post-discharge from stroke rehabilitation, compared to participation in group cardiorespiratory exercise (GCE) alone., Methods: This was a stepped-wedge cluster superiority randomised controlled trial. People with sub-acute stroke participated in the PROPEL ( n  = 107) or GCE ( n  = 65) intervention phases. The primary outcome was adherence to physical activity guidelines over seven days at six months post-discharge from rehabilitation. Secondary outcomes were exercise self-efficacy (Short Self-Efficacy for Exercise scale), exercise-related beliefs and attitudes (Short Outcome Expectation for Exercise scale), and perceived barriers to physical activity (Barriers to Being Active Quiz)., Results: Fifty-seven participants (PROPEL, n  = 29; GCE, n  = 28) were included in the analysis. At six months post-discharge, 6/17 PROPEL participants and 9/22 GCE participants met the guidelines for intensity and duration of physical activity; the odds of meeting physical activity guidelines did not differ between phases ( p  > 0.84). PROPEL participants reported higher self-efficacy for exercise than GCE participants ( p  = 0.0047)., Conclusions: While PROPEL participants reported higher self-efficacy for exercise than those who completed GCE alone, we were unable to find evidence that this translated to increased odds of meeting physical activity guidelines., Trial Registration: NCT02951338IMPLICATIONS FOR REHABILITATIONIntegration of cardiorespiratory exercise with behaviour modification strategies to improve physical activity participation after discharge from stroke rehabilitation increases self-efficacy for exercise when compared to cardiorespiratory exercise alone.Increased self-efficacy for exercise may not increase the odds of meeting physical activity guidelines post-stroke.Improving self-efficacy for exercise during stroke rehabilitation may encourage participation in moderate to vigorous physical activity up to 6-months post-discharge from rehabilitation.

Purpose: Reactive balance training (RBT) aims to improve reactive balance control. However, because RBT involves clients losing balance, clinicians may view that it is unsafe or not feasible for some clients. We aimed to explore how clinicians implement RBT to treat balance and mobility issues., Materials and Methods: Physiotherapists and kinesiologists across Canada who reported that they include RBT in their practices were invited to complete telephone interviews about their experiences with RBT. Interviews were transcribed verbatim, and analysed using a deductive thematic analysis., Results: Ten participants completed telephone interviews, which lasted between 30-60 min. Participants primarily worked in a hospital setting (inpatient rehabilitation ( n  = 3); outpatient rehabilitation ( n  = 2)), and were treated clients with neurological conditions ( n  = 5). Four main themes were identified: 1) there is variability in RBT approaches; 2) knowledge can be a barrier and facilitator to RBT; 3) reactive balance control is viewed as an advanced skill; and 4) RBT experience builds confidence., Conclusions: Our findings suggest a need for resources to make clinical implementation of RBT more feasible.Implications for rehabilitationTrust between the therapist and client improves self-efficacy and feelings of apprehension/fear when conducting reactive balance training.Being creative and improvising with equipment that is readily available in clinics enables reactive balance training, without the need for high-tech equipment.Clinicians should consider using standardized tools with reactive balance control components, such as the Balance Evaluation Systems Test or Performance Oriented Mobility Assessment, to assess balance control.

Background : Reactive balance training (RBT) has been previously found to reduce fall risk in individuals with sub-acute stroke; however, our understanding of the effects of RBT on specific balance impairments is lacking. Objective : To quantify changes in common balance reaction impairments in individuals with sub-acute stroke resulting from RBT, relative to traditional balance training, using a prospective cohort study design with a historical control group. Methods : Individuals with sub-acute stroke completed either RBT or traditional balance training as part of their routine care during physiotherapy in inpatient rehabilitation. Reactive balance control was assessed using lean-and-release perturbations pre-intervention, post-intervention, and 6-months post-intervention (follow-up). Individuals with impaired balance reactions (delayed foot-off times, slide steps, and/or a preference for stepping with the preferred limb) at the pre-intervention assessment were identified using video and force plate data. Outcome measures (foot-off times, frequency of trials with slide steps, and stepping with the preferred limb) from the RBT participants with impaired reactions were compared for each of the three assessments to the mean values for the participants with impaired reactions in the historical control group. Results : Improvements were observed in all outcome measures for the RBT participants between pre-intervention and post-intervention, and/or between post-intervention and follow-up. These improvements were generally equivalent to, if not better than, the improvements demonstrated by the historical control group. Conclusions : Findings further support the use of RBT for post-stroke inpatient rehabilitation, and provide insight into specific balance reaction impairments that are improved by RBT.