Enhancing the uptake of exercise and physical activity after stroke and TIA

The "START" project

Stroke is the 4th leading cause of death and the leading cause of adult disability in the UK, affecting over 110,000 individuals annually. One in five patients who suffer a stroke die within the first 30 days, and over 40% of the remainder are left functionally dependent at 6 months. Annual direct and indirect costs to the UK health economy approach £9 billion. A quarter of these strokes are recurrent. Recurrent stroke carries a greater clinical and economic burden than first ever stroke, and are often preventable if secondary vascular risk is optimised.

Exercise can help to reduce secondary vascular risk by reducing blood pressure, cholesterol and weight. Physical inactivity is an independent risk factor for primary and secondary stroke. Despite this, less than half of adults over the age of 65 years in the UK achieve nationally recommended levels of activity, and this declines further after stroke and TIA. There is overwhelming evidence that aerobic exercise and education delivered as cardiac rehabilitation (CR), reduces blood pressure, re-infarction rates, cardiovascular and overall mortality among patients with coronary heart disease. National guidelines for stroke (NICE 2016) recommend that people with stroke or TIA should aim to achieve 150 minutes or more of moderate intensity exercise (enough to break a sweat) each week in bouts of more than 10 minutes. Unfortunately, only a minority of patients achieve this after TIA or stroke. 

With the principles of co-production in mind, this Getting Research into Practice (GRiP) project was undertaken to help redesign the stroke service pathway in Sheffield in order to enhance uptake of physical activity and exercise programmes after stroke and transient ischaemic attack (TIA).

The main aim of this project was to develop changes to the stroke services that encourage exercise uptake among service users. Through the method of codesign the project team anticipated this would occur through several outcomes:
  • Understanding the barriers and facilitators to exercise and physical activity participation after stroke and TIA; 
  • Networking with various care and industry organisations to understand what types of physical activity are available for people with disability to participate in across Sheffield; 
  • Develop ideas for service reorganisation that enhance exercise uptake, and pilot their delivery; 
  • Work with design students at Sheffield Hallam University (SHU) to develop platforms and materials for education among service users and staff, physical activity tracking and gamification; 
  • Undertake activities to disseminate findings locally and nationally.
The full report is available here.