A new 12-week home-based intervention called BIG STEPS safely helps stroke survivors increase daily physical activity and reduce sedentary time after leaving the hospital, according to a pilot study by University of Alberta researchers. Led by Dr. Victor Ezeugwu of the Faculty of Rehabilitation Medicine, the intervention combines physical therapist coaching, wearable smartwatches, and individual walking goals to address the critical transition period when structured hospital rehabilitation ends.
How the BIG STEPS Program Works for Stroke Recovery
Recovery continues for months after a stroke occurs, but many patients experience a sharp drop in activity levels once formal clinical rehabilitation wraps up, according to Dr. Victor Ezeugwu. To bridge this gap, the BIG STEPS program utilizes a “whole-of-the-day” approach that pairs behavioural coaching with structured goal progression. Participants receive an initial home visit from a licensed physical therapist, followed by up to 11 virtual check-ins. Each person also receives an educational handbook and a commercial smartwatch to self-monitor daily progress. According to the study findings, these wearable activity sensors provide immediate feedback, allowing therapists to safely adjust personalized weekly step goals based on objective information while helping patients navigate everyday barriers like fatigue, bad weather, or a fear of falling.
Did you know? In addition to commercial smartwatches used for daily feedback, participants in the study also wore a thigh-worn medical sensor for several days at a time to precisely track sitting, standing, and stepping times and posture transitions.
Comparing Early Versus Delayed Intervention Data
Over a 17-month study period, researchers tracked 28 adults with an average age of 68 who had suffered a stroke within the preceding three months and were transitioning back to home life. The participants were split into two equal groups: one that began the BIG STEPS program immediately and another that delayed participation for 12 weeks. Both cohorts continued receiving standard post-stroke medical care and physical therapy involving mobility, balance, and strengthening exercises.
The comparative data revealed stark differences in movement behaviors between the two groups:
- Immediate Group Step Count: Averaged 6,534 steps per day by the 12-week mark.
- Delayed Group Step Count: Averaged 4,031 steps per day at the same 12-week mark.
- Sedentary Time Reduction: The early start group cut daily sitting or lying time by about 1.4 hours per day, doubling the reduction observed in the delayed start group.
Once the delayed group began the BIG STEPS program after week 12, their activity levels rose to match the improvements of the early group by week 24. According to Dr. Ezeugwu, this trajectory suggests that the observed health improvements stemmed directly from the intervention rather than merely the passage of time during recovery.
Frequently Asked Questions
What is the primary goal of the BIG STEPS program?
The program aims to help stroke survivors sit less and move more after returning home from the hospital, lowering their risk of having another stroke by maintaining vital physical activity.
What equipment do participants use during the 12-week intervention?
Participants use a commercial smartwatch for immediate activity feedback, an educational handbook, and a thigh-worn medical sensor used periodically to track posture transitions.
How do physical therapists guide the participants?
Licensed physical therapists provide an initial home visit and up to 11 virtual check-ins, utilizing objective sensor data to safely ramp up personalized weekly walking goals.
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