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BACKGROUND There is a lack of effective interventions to maintain gains made in gait performance after Task Oriented Circuit training for stroke survivors. Participatory design methods, such as co-design, might be helpful in developing interventions and tools for facilitating physio-and exercise therapists in supporting an active lifestyle, defined as walking behavior, in stroke survivors. OBJECTIVE To develop an intervention that supports an active lifestyle in stroke survivors METHODS A multidisciplinary team consisting of staff members of the Royal Dutch Society for Physical Therapy, kinetic – and physiotherapists, specialized in neuro rehabilitation and conducting Task Oriented Circuit Class training in primary care settings or day therapy centers within residential care facilities, stroke survivors and their carers, experts on measuring movement behavior in stroke survivors, a company specialised in manufacturing sensors and related software, behavioural change specialists, and co-designers collaborated together in a co-design process using the 4 phases (discover, define, develop and deliver) of the design process. RESULTS In the design process, the team iteratively developed a prototype accelerometer system for measuring walking behavior with a feedback function for stroke survivors and their therapists and a prototype toolbox for therapists to support facilitating behavioral change in their stroke survivors. CONCLUSIONS this study shows how co-design can be applied to develop interventions for stroke survivors. The prototype system for measuring walking behavior and the toolbox both incorporate behavioral change techniques to support a more physically active lifestyle in stroke survivors. Further research should investigate the feasibility of the intervention. CLINICALTRIAL Not applicable

BackgroundThere currently is no field test available for measuring maximal exercise capacity in people with stroke.ObjectiveTo determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke.DesignLongitudinal study design.SettingRehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation.SubjectsPeople with subacute or chronic stroke.InterventionsA standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST).Main measuresNumber of shuttles completed, 1stVentilatory Threshold (1stVT).ResultsThe associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001).ConclusionsThe Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.

Objective: The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke survivors. The objective of this study was to evaluate the 3 most commonly used methods for calculating oxygen consumption and -cost by assessing test-retest reliability and measurement error in community dwelling chronic stroke survivors during a 6 Minute Walk Test. Methods: In this secondary analysis of a longitudinal study, reproducibility of the outcome of walking distance, walking speed, oxygen consumption and oxygen cost from 3 methods (Kendall's tau, assumed steady-state and total walking time oxygen consumption) were determined using Intraclass Correlation Coefficient, Standard Error of Measurement and Smallest Detectable Change. Results:20 from the 31 participants successfully performed the 6 minute walk test-retest within a timeframe of 1 month. Within the 2 tests the reproducibility of walking distance and walking speed was high. The 3 methods to determine reproducibility for oxygen cost and oxygen consumption were considered good (Kendall's tau), good (assumed steady-state) and excellent (total walking time). Conclusions: The method using oxygen consumption and -cost over the total walking time resulted in the highest reproducibility considering the Intraclass Correlation Coefficient, its 95% Confidence Interval, and smaller absolute differences.