Increasing Physical Activity in Stroke Survivors Using STARFISH, an Interactive Mobile Phone Application: a Randomised Controlled Study

Stroke is one of the most common disabling conditions worldwide. The various physical impairments that arise from stroke may encourage a physically inactive lifestyle (Michael et al. 2005). Ninety percent of stroke survivors have some functional disability with reduced mobility being the major impairment (Gresham et al. 1975). Stroke survivors generally spend less time physically active and more time sedentary than their age-matched healthy counterparts (Alzahrani et al. 2011; Michael and Macko 2007; Rand et al. 2010) Physical inactivity following a stroke is associated with decreased muscle strength and cardiovascular fitness, decreased ability to perform activities of daily living and a heightened risk for recurrent stroke and cardiovascular disease (Ivey et al. 2005). Cardiovascular disease is the leading cause of death in chronic stroke. Inactivity and low cardiovascular fitness are two of the modifiable risk factors associated with cardiovascular disease. Activities which promote mobility and fitness are therefore vital for the prevention of further cardiovascular events.

The previous Chest, Heart and Stroke, Scotland (CHSS) funded pilot study demonstrated that community dwelling stroke survivors are significantly less physically active and spend significantly more time sedentary compared to healthy, matched controls. (Paul et al. 2015). The investigators have also reported that using the STARFISH smartphone app (described below) for six weeks had a positive effect on physical activity These pilot results support the development of a fully powered, randomised controlled trial.

Starfish description Research team members have developed STARFISH, a smartphone app, which aims to encourage users to become more physically active. The sensors within a standard smartphone record the number of steps taken per day by the individual.

STARFISH is undertaken in groups of four to facilitate social support and each group member receives a personalised daily step count target. Each person is represented by coloured fish, and participants can see their own and other group members' fish in a fish tank on their smartphone. When the participant is walking, their fish swims and blows bubbles and, as participants progress towards their daily step count target, their fish's fins and tail grow. When all group members reach their target on five days of the week, the group is rewarded by another sea creature appearing in their fish tank (e.g. a seahorse).

Aims and Objectives