# The Adaptive Physical Activity Study in Stroke (TAPAS): A Feasibility Sequential Multiple Assignment Randomized Trial

## TL;DR

This study tests a mobile health physical activity program for stroke survivors, showing it's feasible and may improve activity levels and quality of life.

## Contribution

The study introduces a novel adaptive mHealth intervention design for post-stroke physical activity using a SMART approach.

## Key findings

- Recruitment, retention, and adherence rates were 85%, 84%, and 82%, indicating strong feasibility.
- Nonresponse strategies showed positive trends in step count, fatigue, and quality of life.
- Switching from exercise to lifestyle activity showed potential benefits for fatigue and quality of life.

## Abstract

Physical inactivity post‐stroke increases risk of recurrent stroke. Adaptive physical activity (PA) interventions are recommended, and alternative designs, such as sequential multiple assignment randomized trials (SMARTs) can be used. This SMART investigates the feasibility of a mobile health (mHealth) PA intervention post‐stroke. People post‐stroke are randomized to 12‐week online exercise (EX) or lifestyle PA (LPA). Six‐week daily step count data are used to classify participants as responders or nonresponses. Nonresponders are re‐randomized to switch or augment their mHealth intervention, responders continue unchanged. Primary outcomes include recruitment, retention and adherence rates. Secondary outcomes include PA, sedentary behavior, fatigue, quality of life, psychological distress, and activities of daily living. General linear models estimate trends regarding first‐stage interventions, nonresponse strategies, and adaptive interventions are examined using weighted and replicated regressions. Fifty participants are included. Recruitment, retention, and adherence rates are 85%, 84%, and 82%. Positive trends are seen for nonresponse strategies, switching interventions, on step count, fatigue, and quality of life. Starting with EX and switching to LPA show potential benefits for fatigue, quality of life and return to normal living. Potential benefits of these interventions are preliminary and require validation in a full‐scale trial. This SMART offers novel evidence supporting the design of adaptive mHealth PA interventions post‐stroke, confirming the feasibility of a definitive SMART.

This study examines the feasibility of a mobile health physical activity intervention for individuals post‐stroke using a sequential multiple assignment randomized trial (SMART) design. High recruitment, retention, and adherence rates are observed, with promising trends in step count, fatigue, and quality of life. Findings indicate potential for progression to a full‐scale trial.