How effective are different approaches to helping stroke patients in hospital become more active?

Why it matters

Being physically active after a stroke can have many benefits. It may help brain plasticity – the brain’s ability to change and reorganise itself in response to experiences, learning, injury or disease. Staying active may also help the brain to recover, prevent physical decline and reduce boredom.

There’s a short period after a stroke when the brain adapts more easily, which often overlaps with patients’ time in hospital rehabilitation. To make the most of this time, hospitals aim to keep patients as active as possible.

Guidelines say stroke patients should receive be supported to have frequent, intensive therapy and stay active throughout the day, not just during therapy sessions. But this can be difficult for many reasons, including physical limitations, fatigue, available resources, motivation, ward culture, the hospital environment, and lack of support from family and friends.

This systematic review looks at the evidence currently available about how stroke inpatients are supported in becoming more active. It also explores whether interventions designed to increase inpatients’ levels of physical activity after a stroke affect their ability to move and carry out daily activities, their overall quality of life or have any negative side effects.

Although we recognise that some types of exercise and physical activity are more beneficial than others, we have included all forms of physical activity, both structured and unstructured, on the basis that increasing overall activity levels of any type may be beneficial during inpatient rehabilitation.

What we found

While being physically active after a stroke is generally beneficial, the evidence for whether specific interventions in hospital reliably improve patients’ physical function or quality of life is currently limited.

It’s believed that giving patients general feedback about their activity levels and providing extra physiotherapy may help to increase their physical activity while they are in hospital following a stroke, but the research evidence to support this is weak, and the same applies to patient-directed activity programmes or feedback on upper limb activity. More high-quality research is needed to give clearer results and better guidance for clinical practice, so that patients in rehabilitation can be supported to be more physically active.

These types of interventions shouldn’t be stopped, however, as the absence of strong evidence doesn’t necessarily mean that they are ineffective, only that there currently isn’t enough research to be certain.

Research is needed to improve confidence in the results and to give clear advice for professionals on helping patients to be more active during their hospital rehabilitation. Future studies should also include interviews and other evaluations to understand why some exercise programs work better than others. This kind of evaluation would help explain how these programs affect activity levels and patient outcomes.