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

Aoife Whiston1,2, Emma Carr3, Nathan Cardy4

  • 1Health Research Institute, University of Limerick, County Limerick, Limerick, V94 T9PX, Ireland.

Advanced Science (Weinheim, Baden-Wurttemberg, Germany)
|October 22, 2025
PubMed
Summary
This summary is machine-generated.

Adaptive mobile health interventions improve physical activity and quality of life after stroke. This study confirms the feasibility of using sequential multiple assignment randomized trials (SMARTs) for adaptive physical activity (PA) interventions.

Keywords:
adaptive interventionmobile healthphysical activitysequential multiple assignment randomized trialstrokestroke prevention

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Digital Health

Background:

  • Physical inactivity post-stroke elevates the risk of recurrent stroke.
  • Adaptive physical activity (PA) interventions are crucial for recovery.
  • Sequential Multiple Assignment Randomized Trials (SMARTs) offer a flexible design for adaptive interventions.

Purpose of the Study:

  • To assess the feasibility of a mobile health (mHealth) adaptive PA intervention for individuals post-stroke.
  • To evaluate recruitment, retention, and adherence rates of the mHealth intervention.
  • To explore preliminary effects on physical activity, fatigue, and quality of life.

Main Methods:

  • A SMART design was employed, randomizing participants to online exercise (EX) or lifestyle PA (LPA).
  • Non-responders were re-randomized to switch or augment their intervention based on 6-week step count data.
  • General linear models and weighted/replicated regressions analyzed intervention trends.

Main Results:

  • Recruitment, retention, and adherence rates were high (85%, 84%, 82% respectively).
  • Positive trends were observed for nonresponse strategies, intervention switching, step count, fatigue, and quality of life.
  • Starting with EX and switching to LPA showed potential benefits for fatigue, quality of life, and daily living.

Conclusions:

  • This SMART demonstrated the feasibility of adaptive mHealth PA interventions post-stroke.
  • The findings support the design of definitive SMART trials for optimizing PA interventions.
  • Adaptive mHealth strategies show promise for improving outcomes in stroke survivors.