Background Evidence suggests that frequent engagement in daily activities requiring physical activity may influence risk factors for recurrent stroke. The effects of nonpharmacological interventions on daily physical activity levels and sedentary behavior are unclear. Objective To describe the effects of interventions on levels of daily physical activity and sedentary behavior among people with stroke. Methods OVID/Medline, CINAHL, PsycINFO, and the Cochrane Database were searched using the following search terms: stroke, rehabilitation, intervention, sedentary, physical activity, lifestyle, self‐management, and exercise. Data extraction and risk of bias assessment were conducted by two authors. Results Thirty‐one interventions were identified that included exercise, behavior change techniques, and education components. These components were delivered alone and in varying combinations. At postintervention, between‐group effects on change scores (Cohen's d = 0.17–0.75, P < .05) or between‐group differences in odds of participating in daily physical activity (odds ratio [OR] = 2.07, P < .05) were detected in six studies, and within‐group effects in nine studies (Cohen's d = 0.21–3.97, P < .05). At follow‐up, between‐group differences in odds of participating in daily physical activity were detected in one study (OR = 2.64, P < .05), and within‐group effects in two studies (Cohen's d = 0.25, P < .05). No effects (P < .05) were detected in 17 studies. Conclusion It may be possible to modify daily physical activity levels and sedentary behavior poststroke; however, there is insufficient evidence to suggest the superiority of a particular intervention approach. Future studies should explore the unique contributions of individual intervention components to guide development of parsimonious multicomponent interventions that are effective for promoting daily physical activity and reducing sedentary behavior among people with stroke. Level of Evidence I.

Background: Telehealth affords rehabilitation professionals opportunities to expand access to intervention for people in rural areas. Complex interventions have not been adapted for remote delivery using mobile health technologies. Strategy training is a complex intervention that teaches clients skills for identifying barriers and solutions to engagement in meaningful activities. Our goal was to adapt the delivery of strategy training for remote delivery using mobile health technology. Methods:We conducted a sequential descriptive case series study (n=5) in which communitydwelling participants with chronic stroke and prior exposure to strategy training used the iADAPTS mobile health application for 5 weeks. Expert practitioners advised revisions to the intervention process. Safety was assessed via monitoring occurrence of adverse events and risk for adverse events. Acceptability was assessed via the Client Satisfaction Questionnaire-8 (CSQ-8) and the Patient-Provider Connection Short Form of the Healing Encounters and Attitudes Lists (HEAL PPC).Results: Revisions to the intervention process supported the delivery of strategy training using mobile health technology after stroke. No adverse events occurred and risk for adverse events was managed through the intervention process. Acceptability was high (CSQ-8, 25 to 32; HEAL PPC, 59.9 to 72.5). Conclusions:Strategy training can be adapted for delivery using mobile health technology, with careful consideration to methods for training participants on new technology and the intervention delivery. Future research should establish the efficacy and effectiveness of integrating mobile health in delivery of interventions that promote engagement in client-selected activities and community participation.

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Executive functions, visuospatial skills, mood, and gender distinguished individuals with high or low engagement in inpatient rehabilitation following stroke. Further studies should examine additional factors that may influence engagement (therapist-client relationship, treatment expectancy). (JINS, 2018, 24, 572-583).

Purpose of Review Behavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed. Recent Findings Behavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors. Summary Behavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted.