Advancing Power Assisted Exercise for People with Stroke

Background The prevalence of stroke is increasing and the estimated societal cost per year in the UK is £26 billion. Exercise interventions for people with stroke decrease the risk factors for recurrent stroke, improve mobility and enhance psycho-social wellbeing. However, stroke rehabilitation services are focussed on recovery of functional independence and do not deliver the recommended dosage of aerobic or resistance training. Barriers to long term engagement in exercise following stroke include inaccessible equipment, transport and low self-efficacy. Power assisted exercise equipment is available in selected leisure and rehabilitation venues within the UK and represents an exercise solution for people with impaired mobility following stroke. The purpose of this doctoral programme of research was to explore the use of power assisted exercise equipment by people with stroke and advance, through co-design, the equipment to enable a tailored prescription to meet their bespoke requirements. Methods This programme of research used both qualitative and quantitative methodologies. Phase one examined the feasibility of a programme of power assisted exercise for people with complex neurological impairment. Feasibility was defined in terms of participant’s ability to safely access the equipment, attain regular attendance and complete the programme. In phase two, initially a systematic review of qualitative studies which explored the experiences of venue-based exercise amongst people with stroke was conducted. Thereafter, an in-depth, interpretative analysis of the lived experience of using power assisted exercise equipment was undertaken. Phase three reported on a funded programme of research underpinned by the medical device technology framework. Co-design and usability evaluation methods were implemented to develop a new graphical user interface synchronised with effort detection technology on the power assisted exercise equipment. Findings Phase one established that power assisted exercise equipment is safe and accessible for use by people with complex neurological impairment. The findings from phase two suggested that venue-based exercise tailored towards people with stroke had a positive effect on reported functional ability and was associated with restoration of an internal locus of control. Participation in power assisted exercise at a specialist stroke venue facilitated transition from NHS rehabilitation and was associated with reported improvements in strength, control of movement and mobility. Adoption of the medical device technology framework in phase three ensured effective user engagement in the co-design and usability evaluation of the new graphical user interface. Future research Future research on power assisted exercise for people with stroke is recommended including an examination of its feasibility within the in-patient setting and evaluation of impact upon physiological risk factors and functional ability amongst community dwelling people with stroke. Conclusion Power assisted exercise equipment is accessible and acceptable for use by people with stroke. The development of effort detection technology synchronised with the co-designed graphical user interface has realised the potential of power assisted exercise equipment for the effective prescription and monitoring of exercise amongst PwS, including those with very limited mobility. This novel body of work further adds to the evidence base of exercise for people with stroke and has proposed an accessible alternative solution for people with neurological impairment.