Objective To evaluate the evidence on the effectiveness of high‐intensity interval training (HIIT) in improving fitness and mobility post stroke. Type Systematic review. Literature Survey Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for articles published in English up to January 2018. Methodology Studies were included if the sample was adult human participants with stroke, the sample size was ≥3, and participants received >1 session of HIIT. Study and participant characteristics, treatment protocols, and results were extracted. Synthesis Six studies with a total of 140 participants met inclusion criteria: three randomized controlled trials and three pre‐post studies. HIIT protocols ranged 20 to 30 minutes per session, 2 to 5 times per week, and 2 to 8 weeks in total. HIIT was delivered on a treadmill in five studies and a stationary bicycle in one study. Regarding fitness measures, HIIT produced significant improvements in peak oxygen consumption compared to baseline, but the effect was not significant compared to moderate intensity continuous exercise (MICE). Regarding mobility measures, HIIT produced significant improvements on the 10‐Meter Walk Test (10MWT), 6‐Minute Walk Test (6MWT), Berg Balance Scale (BBS), Functional Ambulation Categories (FAC), Timed Up and Go Test, and Rivermead Motor Assessment compared to baseline. The effect of HIIT was significant compared to MICE on the 10MWT and FAC but not on the 6MWT or BBS. Conclusions There is preliminary evidence that HIIT may be an effective rehabilitation intervention for improving some aspects of cardiorespiratory fitness and mobility post stroke. Level of Evidence I.

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To the Editor:As a hospice social worker, I do my best to help dying patients and their loved ones use what time remains in ways that are meaningful and that enable them to share stories and memories, honor relationships, express what is in their hearts, and say goodbye in a way that, ideally, brings some measure of peace. It has been a truism over the years that these opportunities often arise organically as families sit with patients, provide physical care, and face challenges together.For many hospice patients living in nursing homes or assisted living facilities, though, those days are over-at least for the immediate future. Amidst the COVID-19 pandemic, family and friends have often been unable to visit due to facility restrictions intended to protect residents from infection. This restriction is also true for many whose loved ones are dying in the hospital.Imagine knowing a loved one is in the last weeks or days of their life and being told you cannot visit. Imagine the moral anguish, confusion, anger, frustration, and guilt that might occur. Imagine the sadness and grief and pain of having such a tender time taken away.This situation has sent families scrambling for alternate ways of communicating with dying loved ones and for saying goodbye. Alternatives include practical adaptations such having virtual visits using online technologies such as Facetime, Skype, or Zoom. For patients not able to engage in this way it might mean sending cards or delivering messages over the phone or through facility or hospital staff.It has also sent hospice counseling staff scrambling to respond in ways that might enhance the comfort and perspective of loved ones forced to remain away. Responses have included using counseling and psychoeducational strategies to help people name, process, and bring mindfulness and self-compassion to whatever they are experiencing. It has also included helping them connect with internal strengths, external supports, and a perspective on the situation, however painful, that allows for meaning and acceptance.

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