We reviewed the available evidence regarding the effectiveness of commercially available, wearable devices (for example pedometers, Fitbit, and Garmin watches) and smartphone applications (for example Runkeeper, Fitbit application) for increasing physical activity levels for people with stroke.
Promoting physical activity is an important health intervention for people with stroke. The association between health and physical activity is well known. People with stroke face additional challenges to engage in sufficient physical activity for health benefits, and are often very inactive. Increasing physical activity levels in stroke survivors in both hospital and community settings is important.
Providing feedback to stroke survivors about their physical activity levels is one strategy that could change their behaviour and increase physical activity levels. Wearable devices that count steps or measure activity, or smartphone applications that provide feedback about physical activity could be useful. Understanding how effective such devices are to increase physical activity has the potential to benefit all people after stroke.
We included four trials in this review, comprising 245 participants, ranging in age from 22 to 92 years. Three trials measured physical activity outcomes after the treatment period. Trials were conducted in hospital and community settings. All participants were able to communicate and provide informed consent, and all were able to walk at least five steps without supervision or assistance. The experimental groups in the trials received feedback at least daily on the number of steps taken.
We searched for studies up to 3 March 2018.
We found that the use of wearable activity monitors to provide feedback on physical activity did not increase physical activity levels in people with stroke. No conclusions could be drawn regarding the influence of stroke severity, walking ability, stroke survivor age, or time poststroke on the outcomes. The four included studies were conducted in different settings, and used different outcome measures, which limited the ability to combine data. No study reported whether the use of physical activity monitors was harmful. More research is needed to determine if they are effective.
Quality of the evidence
Using the GRADE approach, the quality of the evidence was low to very low, due to the small number of studies, small sample sizes, and because no study was able to blind the participants or the therapists delivering the intervention (they were aware that a device was being used and aware of the feedback that was being provided by the device).