STROKE AEROBIC EXERCISE IMPLEMENTATION TOOLKIT (START)

ABOUT the Stroke Aerobic Exercise Implementation Toolkit (START)

Participation in aerobic exercise after stroke can improve aerobic fitness, support functional recovery, and promote longer-term healthy exercise behaviours. Despite the evidence, however, clinical implementation in stroke rehabilitation remains challenging.

START was developed to bridge the “knowledge-to-practice” gap and provide stroke rehabilitation teams with practical “how-to” information, resources and strategies to support the implementation of aerobic exercise into real-world, complex, stroke rehabilitation settings.

WHO should use START?

START was developed for use by physical therapists and other healthcare professionals who provide rehabilitation, or leaders and managers who are responsible for implementing programs of care, for people with stroke in rehabilitation settings. START can be useful for individual healthcare professionals or stroke rehabilitation teams who want to implement aerobic exercise in inpatient and outpatient stroke rehabilitation, or community clinic settings.

WHAT is in START?

START provides information, resources and case-based videos to build practical knowledge for implementing aerobic exercise, for example:

• pre-participation screening
• conducting a graded submaximal exercise test
• developing a FITT prescription
• implementing and monitoring aerobic exercise training
• supporting patient conversations about participating in aerobic exercise

START also provides tools and strategies to support local implementation in your practice setting, for example:

• engaging your team including program leaders, physicians, other partners and local experts
• identifying gaps in practice, barriers and facilitators, and setting readiness
• identifying resource requirements (staff, equipment, budget)
• frameworks for evaluating processes and outcomes

How to ACCESS START?

All resources are in PDF format unless otherwise indicated.

• ➤ START toolkit (includes toolkit with appendices)
• ➤ Appendices (PDFs available as individual downloads for ease of use)
  • ⮚ Appendix A.
    Gap Analysis
  • ⮚ Appendix B.
    Organizational Readiness for Change Assessment: Implementing Aerobic Exercise in Stroke Rehabilitation
  • ⮚ Appendix C.
    Facilitators and Barriers for Aerobic Exercise Implementation
  • ⮚ Appendix D.
    Staffing Checklist (sample)
  • ⮚ Appendix E.
    Equipment Checklist (sample)
  • ⮚ Appendix F.
    Budget Worksheet (sample)
  • ⮚ Appendix G.
    Toronto Rehab – UHN Aerobic Exercise Screening Stratification Tool
  • ⮚ Appendix H.
    Toronto Rehab – UHN Submaximal Graded Exercise Assessment Form
  • ⮚ Appendix I.
    Toronto Rehab – UHN Submaximal Graded Exercise Assessment Guidelines
  • ⮚ Appendix J.

    Training Modules (video content)
    • ⮞ J1.
      Graded Submaximal Exercise Test: An Overview
    • ⮞ J2.
      Graded Submaximal Exercise Test: Determining Heart Rate Outer Limits
    • ⮞ J3.
      Video Case Example
    • ⮞ J4.
      Exercise Prescription: Determining FITT
    • ⮞ J5.
      Exercise Prescription: If Only It Were So Straightforward
  • ⮚ Appendix K.
    FITT Worksheet: Using Submaximal Test Results to Identify FITT Parameters
  • ⮚ Appendix L.
    Clinical Indicators of Exercise Intensity: Rating of Perceived Exertion Scale (including pictorial version) and Talk Test
  • ⮚ Appendix M.
    Exercise Training Log Template
  • ⮚ Appendix N.
    Patient Information Sheet: Submaximal Exercise Testing
  • ⮚ Appendix O.
    Supporting Long-term Engagement in Physical Activity and Exercise: “My Exercise Plan after Rehabilitation”
  • ⮚ Appendix P.
    Patient Satisfaction Questionnaire (sample)

START TEAM

The development of START actively involved end-users of the toolkit in its development. Our team includes physical therapists, kinesiologists, a physiatrist, program managers, researchers, and a person with lived experience, with collective expertise in stroke rehabilitation, aerobic exercise, and knowledge translation.

• Elizabeth L. Inness^1,2, PT, PhD. (Co-Lead Author)
• Ada Tang³, PT, PhD. (Co-Lead Author)
• David Jagroop¹, MHSc
• Louis Biasin^1,2, PT, BScPT
• Cynthia Danells^1,2, PT, BScPT, MSc
• Angie Andreoli^1,2, BScPT, MSc
• Mark Bayley^1,4, MD
• Jayne Hall⁵, PT, BHScPT
• Avril Mansfield^1,2,6, RKin, PhD
• Alison McDonald⁷, PT, BScPT
• Diane Nishri¹, MSc, Patient Partner
• Nancy M. Salbach^1,2, PT, PhD
• Denise Taylor^8,9, PT, MPH, BScPT
• Karl Wong¹⁰, PT, BHScPT, MHSc

1. KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
2. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
3. McMaster University, School of Rehabilitation Science, Hamilton, ON, Canada
4. Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
5. Hamilton Health Sciences, Hamilton, ON, Canada
6. Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
7. Nova Scotia Health Authority, Halifax, NS, Canada
8. St Joseph’s Care Group, Thunder Bay, ON, Canada
9. Northern Ontario School of Medicine, Thunder Bay, ON, Canada
10. St John’s Rehab, Sunnybrook Health Sciences Centre, Toronto, ON, Canada