‘Walk ‘n Watch’ protocol boosts quality of life after stroke

Key takeaways:

• Patients in the protocol improved an average of 43.6 meters on a walk test vs. those given usual care.
• Walk ‘n Watch also led to improved quality of life and mobility.

A protocol designed to progressively increase physical therapy intensity for stroke survivors improved walking distance, speed and quality of life compared with standard care, data presented at the International Stroke Conference show.

While guidelines currently recommend progressive exercise after a stroke, Janice J. Eng, PhD, a professor in the neurorehabilitation research program in the department of physical therapy at the University of British Columbia, said in a press release related to the study that uptake is lagging. So, Eng and colleagues tested the implementation of the “Walk N’ Watch” protocol in a real-world setting to determine its impact on uptake of higher-intensity activity.

“Less than 5% of clinical trials are pragmatic or real-world trials — these are trials that are effective in today’s health care setting,” Eng told Healio in an email. “The Walk ‘n Watch protocol can be implemented into practice immediately to improve the outcomes of patients with stroke.”

Eng and colleagues assessed the efficacy of the “Walk ‘n Watch” protocol for patients hospitalized with stroke, in which individuals completed a daily minimum of 30 minutes of progressively intense, weight-bearing, walking-related activities measured by trackers that logged heart rate and step number.

The researchers employed a stepped-wedge cluster design to randomly assign 12 sites across Canada to implement Walk ‘n Watch or continue providing standard care. At each Walk ‘n Watch location, a “protocol champion” was designated to confer with therapists about the benefits and challenges of protocol implementation.

The analysis included 306 patients (61.4% men) who suffered either ischemic or hemorrhagic stroke, 144 of whom underwent the protocol and the remaining to standard-of-care physical therapy.

Eng and colleagues analyzed the protocol’s effect using the standard 6 Minute Walk Test (6MWT). They conducted assessments at baseline, then 4 weeks later, closer to the date of discharge for each patient.

Overall, the average baseline measurement of the 6MWT for all enrollees was 152 meters.

Results showed a 43.6-meter improvement in 6MWT scores for patients in the Walk ‘n Watch group compared with those given standard of care.

The researchers additionally reported that those in the Walk ‘n Watch cohort saw improved quality of life as measured by the EuroQol-5 Dimension metric, along with better balance and mobility assessed via the Short Physical Performance Battery and faster gait speed.

“The major advance for this study was that we trained all front-line therapists in the stroke units at the 12 sites,” Eng said in the release. “The therapists completed the safety screening and ensured the participant’s eligibility for this protocol. We wanted to see what would happen if we moved this protocol into standard-of-care practice so all therapists and all participants could follow this protocol. This was a very successful, real-world trial.”

Reference:

Changing therapy practice to add higher-intensity walking improves early stroke recovery. https://newsroom.heart.org/news/changing-therapy-practice-to-add-higher-intensity-walking-improves-early-stroke-recovery?preview=2f38&preview_mode=True. Published Jan. 30, 2025. Accessed Feb. 5, 2025.