Physical activity and cardiovascular risk in people following stroke

Submission note: A thesis submitted in total fulfilment of the requirement for the degree of Doctor of Philosophy to the Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

The importance of physical activity for cardiovascular health is well documented. Physical activity participation following stroke is essential for secondary stroke prevention. The body of work in this thesis sought to investigate physical activity following stroke. Two important themes were explored: physical activity measurement in stroke survivors, and longitudinal assessment of physical activity and how this relates to cardiovascular risk. These themes were addressed in the following studies: 1. A systematic review of the stroke literature investigating how physical activity is measured. 2. A second systematic review which synthesised the literature describing the physical activity levels of people following stroke in the acute, subacute and chronic phases of recovery. 3. A study examining the optimal duration of physical activity monitoring that is required to attain reliable estimates of physical activity in stroke survivors. 4. An observational study that describes physical activity levels of stroke survivors on completion of rehabilitation and explores factors associated with physical activity. x 5. A two-year longitudinal prospective observational study of physical activity and cardiovascular risk following stroke. This study describes physical activity levels and explores the relationship between physical activity and cardiovascular risk over time. These studies demonstrated that physical activity has been measured using a wide variety of methods in stroke survivors, with no single device displaying superior measurement properties. Physical activity is low following stroke. Physical activity is related to both physical and cognitive abilities, does not appear to change over time and is related to important cardiovascular risk factors. The findings of this thesis will help to inform future development of interventions to promote physical activity for the prevention of recurrent stroke and cardiovascular disease.