1 Mansfeld A, et al. BMJ Open 2017;7:e015843. doi:10.1136/bmjopen-2017-015843 Open Access ABSTRACT Introduction Physical exercise after stroke is essential for improving recovery and general health, and reducing future stroke risk. However, people with stroke are not suffciently active on return to the community after rehabilitation. We developed the Promoting Optimal Physical Exercise for Life (PROPEL) programme, which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation. This study aims to evaluate the effect of PROPEL on long-term participation in exercise after discharge from stroke rehabilitation. We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency, duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation. Methods and analysis Individuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited (target n=192 total). A stepped-wedge design will be employed; that is, the PROPEL intervention (group exercise plus self-management) will be ‘rolled out’ to each site at a random time within the study period. Prior to roll-out of the PROPEL intervention, sites will complete the control intervention (group aerobic exercise only). Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors, and standardised physical activity questionnaire. Adherence to exercise guidelines will be evaluated by (1) number of ‘active minutes’ per week (from the activity monitor), (2) amount of time per week when heart rate is within a target range (ie, 55%–80% of age-predicted maximum) and (3) amount of time per week completing ‘moderate’ or ‘strenuous’ physical activities (from the questionnaire). We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed- model logistic regression, with fxed effects of time and phase and random effect of cluster (site). Ethics and dissemination To date, research ethics approval has been received from fve of the six sites, with conditional approval granted by the sixth site. Results will be disseminated directly to study participants at the end of the trial, and to other stake holders via publication in a peer-reviewed journal. Trial registration number NCT02951338; Pre-results. INTRODUCTION Background and rationale People often have low aerobic capacity after stroke, 1 2 which can limit the stroke survivors’ ability to complete activities of daily living. 1 3 4 Aerobic exercise is beneficial post stroke for improving aerobic capacity, 5–7 maintaining or promoting recovery 8 and for general health, including reducing risk of another stroke or other cardiovascular events. 9 Indeed, aerobic Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity—study protocol for a stepped-wedge randomised trial Avril Mansfeld, 1,2,3 Dina Brooks, 1,3,4 Ada Tang, 5 Denise Taylor, 6,7 Elizabeth L Inness, 1,3 Alex Kiss, 2 Laura Middleton, 1,8 Louis Biasin, 1,3 Rebecca Fleck, 9 Esmé French, 10 Kathryn LeBlanc, 9 Anthony Aqui, 1 Cynthia Danells 1,3 To cite: Mansfeld A, Brooks D, Tang A, et al. Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity—study protocol for a stepped-wedge randomised trial. BMJ Open 2017;7:e015843. doi:10.1136/ bmjopen-2017-015843 ► Prepublication history and additional material are available. To view these fles please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2017- 015843) Received 4 January 2017 Revised 7 March 2017 Accepted 25 April 2017 For numbered affliations see end of article. Correspondence to Dr Avril Mansfeld; avril. mansfeld@uhn.ca Protocol Strengths and limitations of this study ► This multicentre trial will determine if an exercise and self-management intervention can increase participation in physical activity after stroke rehabilitation. ► The novel ‘stepped-wedge’ trial design is suitable given the group-based delivery of the intervention and relatively small number of sites involved. ► Participation in physical activity will be determined with three methods: self-report (activity questionnaire), daily heart rate monitoring and daily activity monitoring. ► The trial is single-blinded (participants cannot be blinded to intervention allocation), which potentially introduces a source of bias.