Science Update: Step monitoring and coaching more effective at improving physical activity after stroke than traditional therapy, NIH-funded study suggests

Findings could inform programs to help stroke patients increase activity and avoid further complications

Two people smiling while walking briskly on a path.
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A step monitoring and coaching intervention to help people who had a stroke gradually increase their daily step count appears to be more effective than traditional high-intensity walking therapy, suggests a study funded by the National Institutes of Health. Previous studies found that even after successfully completing a high-intensity walking program, most stroke survivors remain sedentary, placing them at risk for heart disease, diabetes, and additional strokes. The authors believe their findings will inform interventions to help stroke survivors increase their activity level and reduce the risk of complications, loss of independence, and death.

The study was conducted by Darcy Reisman, Ph.D., P.T. of the University of Delaware, and colleagues. It The primary results appears in Stroke. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.


From 6 to 12 months after having a stroke, more than 50% of survivors have trouble walking and less independence. Individuals who are inactive after stroke have three times the risk of additional strokes, compared to stroke survivors who are active.

According to the authors, most studies seeking to increase activity levels in stroke survivors have sought to increase their capacity—the walking speed and distance they can achieve during a therapy session in a clinic. However, these studies generally do not lead to improvements in walking performance—the amount of walking patients do in their unstructured, everyday environment.

For the current study, researchers compared a traditional high-intensity walking program to a performance improvement program in which participants wore a step monitor and met with a therapist who reviewed their walking progress and helped them set future goals. 250 participants attended 2 to 3 sessions per week for a total of about 12 weeks.


The study’s participants were assigned at random to either the traditional high-intensity walking program, the performance improvement program, or a program that combined the two therapies.

For the traditional high-intensity program, participants walked 30 minutes on a treadmill at an increased pace determined for them individually, according to their age, heart rate, and physical ability. The treadmill session was followed by 10 minutes of free walking, also at an increased pace.  

For the performance improvement program, participants wore a Fitbit to track their daily step count. At each session, therapists reviewed participants’ step count and suggested ways to help them increase it. Therapists sought to help participants increase their activity 5 to 8 percent after every 4 to 6 sessions.

After completing their programs, all participants wore a Fitbit for at least three days. Their average step count was compared to their initial step count when they entered the study.

Participants in the performance improvement program increased their daily step count by 1,542 steps. Those in the combined program increased their count by 1,307 steps. Those in the traditional high-intensity program increased by only 406 steps. The authors noted, however, that those in the combined program increased their capacity (distance and walking speed), as well as their step count.

Overall, the study showed that the step monitoring program alone was most effective at increasing daily activity, followed by the combined high intensity/step count program. The least effective program was the high intensity walking program alone.


The findings suggest that a step monitoring behavioral program results in better outcomes for stroke survivors, and therefore, could reduce their risk for heart disease, additional strokes, loss of independence, and death.


Thompson, ED, et al. Increasing activity after stroke: a randomized controlled trial of high-intensity walking and step activity intervention. Stroke. 2024.

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