Changes in time (min/d) spent in the 11 superdomains in the Moderate and Extensive groups relative to the Control group at mid-program, end-program, and 3 and 6 months follow-up.

<p>Note: 3M = 3 months, 6M = 6 months. Significant differences according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126665#pone.0126665.t002" target="_blank">Table 2</a> are shown in bold.</p><p>Changes in time (min/d) spent in the 11 superdomains in the Moderate and Extensive groups relative to the Control group at mid-program, end-program, and 3 and 6 months follow-up.</p

Time Regained: When People Stop a Physical Activity Program, How Does Their Time Use Change? A Randomised Controlled Trial

UNLABELLED: The aim of this study was to investigate how previously inactive adults who had participated in a structured, partly supervised 6-week exercise program restructured their time budgets when the program ended. Using a randomised controlled trial design, 129 previously inactive adults were recruited and randomly allocated to one of three groups: a Moderate or Extensive six-week physical activity intervention (150 and 300 additional minutes of exercise per week, respectively) or a Control group. Additional physical activity was accumulated through both group and individual exercise sessions with a wide range of activities. Use of time and time spent in energy expenditure zones was measured using a computerised 24-h self-report recall instrument, the Multimedia Activity Recall for Children and Adults, and accelerometry at baseline, mid- and end-program and at 3- and 6-months follow up. At final follow up, all significant changes in time use domains had returned to within 20 minutes of baseline levels (Physical Activity 1-2 min/d, Active Transport 3-9 min/d, Self-Care 0-2 min/d, Television/Videogames 13-18 min/d in the Moderate and Extensive group, relative to Controls, respectively, p > 0.05). Similarly, all significant changes in time spent in the moderate energy expenditure zone had returned to within 1-3 min/d baseline levels (p > 0.05), however time spent in vigorous physical activity according to accelerometry estimates remained elevated, although the changes were small in magnitude (1 min/d in the Moderate and Extensive groups, relative to Controls, p = 0.01). The results of this study demonstrate strong recidivist patterns in physical activity, but also in other aspects of time use. In designing and determining the effectiveness of exercise interventions, future studies would benefit from considering the whole profile of time use, rather than focusing on individual activities, TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000248066

CONSORT flow diagram of participant recruitment, enrolment and progression through the study.

<p><i>Note</i>: 3m = 3-month, 6m = 6-month.</p

Changes in time (min/d) spent in energy expenditure zones in the Moderate and Extensive groups relative to the Control group at mid-program, end-program and 3- and 6-month follow up according to the MARCA and accelerometry.

<p>Note: 3M = 3 months, 6M = 6 months. Significant differences according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0126665#pone.0126665.t004" target="_blank">Table 4</a> are shown in bold. EE = energy expenditure, METs = metabolic equivalents, VLPA = very light physical activity, LPA = light physical activity, MPA = moderate physical activity, VPA = vigorous physical activity.</p><p>Changes in time (min/d) spent in energy expenditure zones in the Moderate and Extensive groups relative to the Control group at mid-program, end-program and 3- and 6-month follow up according to the MARCA and accelerometry.</p

Changes in time from baseline to 6-month follow in the Moderate (top panel) and Extensive (bottom panel) groups, relative to Controls.

<p><i>Note</i>: AT = Active Transport, PA = Physical Activity, TV/VG = Television/Videogames.</p

Changes in time (min/d) relative to Controls, from baseline to 6 months follow-up in time spent by the Moderate (left panel) and Extensive (right panel) groups in the different energy expenditure zones according to MARCA recalls (panel A) and accelerometry (Panel B).

<p><i>Note</i>: SED/SLEEP = sedentary/sleep, VLPA = very light physical activity, LPA = light physical activity, MPA = moderate physical activity, VPA = vigorous physical activity.</p

Factors related to high-risk movement behaviour in people with stroke who are highly sedentary and inactive

To identify Capabilities, Opportunities, and Motivational factors influencing movement behaviour throughout the day in people with stroke who are highly sedentary and inactive to enable intervention development. A qualitative study was conducted using semistructured interviews with people with stroke. The interview guide was based on the Capabilities, Opportunities, and Motivation Behavioural model. Eleven interviews were conducted. Participants reported a lack of knowledge regarding healthy movement behaviour patterns, a lack of insight into their own movement behaviour, and some physical and cognitive limitations to engage in certain physical activities. Several social and environmental elements affecting movement behaviours were mentioned, their impact on movement behaviour varied among participants. Movement behaviour was mostly driven by habits and daily routine, without conscious regulation. Our findings show that people with stroke are unaware of their own movement behaviour or of the consequences of these behaviours on health. Movement behaviour is, for the most part, based on daily routine and personal habits. This indicates the need for a behaviour change intervention. Such interventions will need to include providing information about healthy movement behaviour, feedback on individual’s movement behaviour and individualized support, taking into account the social and environmental context and personal capabilities. There is a need to provide insight and feedback regarding individuals’ movement behaviour and information about healthy movement behaviour to enable people with stroke who are highly sedentary and inactive to improve their movement behaviour.Movement behaviour is, for the most part, based on daily routine and personal habits.People need individualised support, and personal capabilities, the social and environmental context need to be taken into account to support sustainable movement behaviour change.These findings can be used in clinical practise and to inform intervention development to support movement behaviour change in people after stroke who are highly sedentary and inactive. There is a need to provide insight and feedback regarding individuals’ movement behaviour and information about healthy movement behaviour to enable people with stroke who are highly sedentary and inactive to improve their movement behaviour. Movement behaviour is, for the most part, based on daily routine and personal habits. People need individualised support, and personal capabilities, the social and environmental context need to be taken into account to support sustainable movement behaviour change. These findings can be used in clinical practise and to inform intervention development to support movement behaviour change in people after stroke who are highly sedentary and inactive.</p

Exploring post-stroke fatigue from the perspective of stroke survivors: what strategies help? A qualitative study

Post-stroke fatigue is a research priority for stroke survivors and health professionals but there is limited evidence to guide management. We aimed to explore (1) the experience of post-stroke fatigue from the perspective of stroke survivors and their caregivers and (2) fatigue management strategies that are used. This was a qualitative study using semi-structured interviews. People with self-reported post-stroke fatigue and caregivers were recruited using maximum variation sampling. Analysis was done via the framework approach. We recruited 17 stroke survivors, nine male (53%), most under 65 years (n = 12, 76%), and greater than 1-year post-stroke (n = 16, 94%, range 10-months to 22-years). One-third of participants self-reported having aphasia (n = 5, 36%). We also recruited eight caregivers, most of whom were female (n = 7, 88%). We identified four themes: (1) fatigue is unexpected after stroke and symptoms vary; (2) the individual experience of fatigue is complex, influenced by multifactorial and biopsychosocial factors; (3) learning to adapt and accept fatigue; and (4) Strategies to manage fatigue and personal approaches to rest. Post-stroke fatigue experience varies presenting cognitively, physically, and psychologically according to a complex interplay of biopsychosocial factors and personal triggers. Self-management strategies are individualised and include organisation, medications, lifestyle modifications, and peer support.Implications for rehabilitationPost-stroke fatigue is a complex individual experience involving biopsychosocial factors, and stroke survivors need assistance to identify their triggers and support from family, peers, and the stroke community to live well with fatigue.Fatigue is not commonly discussed by health professionals and stroke survivors need simple, practical advice over the long-term to reduce fear and distress.There are a range of strategies that may be helpful. Stroke survivors may benefit from adopting problem-solving approaches, trial pacing, lifestyle modifications and planning, and find forms of rest that work for them. Post-stroke fatigue is a complex individual experience involving biopsychosocial factors, and stroke survivors need assistance to identify their triggers and support from family, peers, and the stroke community to live well with fatigue. Fatigue is not commonly discussed by health professionals and stroke survivors need simple, practical advice over the long-term to reduce fear and distress. There are a range of strategies that may be helpful. Stroke survivors may benefit from adopting problem-solving approaches, trial pacing, lifestyle modifications and planning, and find forms of rest that work for them.</p

Public perspectives on acquired brain injury rehabilitation and components of care: A citizens’ jury

Background: Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked ‘What considerations are important to include in a model of care of brain injury rehabilitation?’. Methods: Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days. Results: Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made. Conclusion: Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term. Patient and public contribution: As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations. © 2020 The Authors. Health Expectations published by John Wiley & Sons Lt

Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens’ Jury

Background: Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked ‘What considerations are important to include in a model of care of brain injury rehabilitation?’. Methods: Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days. Results: Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made. Conclusion: Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term. Patient and public contribution: As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations. © 2020 The Authors. Health Expectations published by John Wiley & Sons Lt