JMIR Publications

ABSTRACT

Background:

Regular physical activity is a crucial and an important modifiable lifestyle factor reducing the risk of recurrent incidents after stroke or transient ischemic attack (TIA). Mobile Health (mHealth) has emerged as a promising approach for providing long-term support for physical activity. However, little is known about how individuals post-stroke or TIA adhere to and engage with mHealth interventions.

Objective:

This study aimed to: (1) describe adherence to supervised sessions in an mHealth intervention targeting physical activity, (2) describe engagement with self-managed mHealth support for physical activity during and after the intervention, (3) compare characteristics of participants with high and low adherence and engagement, and (4) examine whether high adherence and engagement were associated with maintained physical activity after having completed the intervention and at a 12-month follow-up.

Methods:

In this study, a secondary analysis of data from the experimental arm of a feasibility randomized controlled trial was conducted. The experimental group received a 6-month mHealth version of the i-REBOUND program, which included supervised mHealth support for physical activity and behavior change, followed by a 6-month post-intervention period with access to self-managed mHealth support. Adherence outcomes included attendance at supervised exercise and counseling sessions, while engagement outcomes measured weekly interactions with self-managed mHealth support during and after the intervention. Participants’ level of physical activity (steps per day) was measured using accelerometers at baseline, and at 6- and 12 months post-baseline. Logistic regression analysis examined the associations between high adherence and engagement during the intervention and post-intervention period and maintained physical activity (i.e. >7000 steps/day) across the 12-month study period.

Results:

Of the 57 participants enrolled (67% female, average age 71), 96% had mild stroke symptoms, and 51 (89%) completed the intervention. Adherence to supervised mHealth support was high (supervised exercise sessions: 79%, counseling: 98%), while engagement with self-managed mHealth support was high during the intervention (83%) but declined post-intervention (38%). A larger proportion of females (77%) demonstrated high adherence to the intervention compared to males (23%, P = .043). High adherence (≥80%) during the intervention was associated with maintained physical activity between baseline and the 6-months follow-up (odds ratio: 5.50, P = .015), while high engagement (≥80%) during post-intervention was associated with maintained physical activity between the 6- and 12 month follow-up (odds ratio: 4.12, P = .043).

Conclusions:

Supervised mHealth support was well received with high adherence, while modules for self-management of physical activity faced challenges in engaging the participants. Future research should focus on co-creating self-managed mHealth support with individuals post-stroke or TIA to better understand and address their needs of support for long-term engagement in physical activity. Clinical Trial: ClinicalTrials: NCT0511195