Development and evaluation of strategies to reduce sedentary behaviour in patients after stroke and improve outcomes (RECREATE)

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Objectives and brief methodology

Time spent in sedentary behaviour (sitting/lying down) has recently emerged as an important topic. Too much time spent in sedentary behaviours is linked with ill health and mortality. This seems to be independent of physical activity: a short burst of activity such as an exercise class will not offset the detrimental health effects of many hours sitting. Research suggests that sedentary behaviour is particularly common in stroke survivors who may spend up to 80% of their waking day sitting or lying down. Interventions to reduce sitting time have enormous potential, would be low cost and may be more achievable than a structured exercise programme, particularly in stroke survivors afraid of another stroke or falling.


Aims & Objectives

We aim to enhance health and disability outcomes for stroke survivors through the development and evaluation of strategies to reduce overall time spent sedentary and break up long bouts of sedentary time.


  1. Ensure that intervention development is informed by up-to-date review of the quantitative and qualitative evidence.
  2. Inform development of an intervention by observations and qualitative investigation of sedentary behaviour with stroke survivors, their carers and health professionals including exploring their capability, opportunities and motivation to address this behaviour.
  3. Use co-production principles to develop intervention strategies to reduce sedentary behaviour in people after stroke.
  4. Test the implementation of the intervention and clarify trial design components in three stroke services.
  5. Conduct a large pragmatic cluster randomised trial evaluation of the developed intervention with internal pilot, process evaluation and cost-effectiveness analysis


We propose to develop and evaluate a complex intervention to reduce sedentary behaviour after stroke. We will develop the intervention with appropriate implementation plans through a co-production approach incorporating behaviour change principles.

Workstream 1
Update of the quantitative and qualitative evidence relating to sedentary behaviour through systematic review of the literature. The literature will be analysed to identify behaviour change techniques contributing to effectively reducing sedentary behaviour.

Workstream 2
Observations (in hospital and in the community) and semi-structured interviews in two stroke services will be undertaken to inform the co-production process. Interviews with patients and their carers, at six and nine months post-stroke (approximately 10 at each time point, in each service), and with members of the multidisciplinary team, will explore the capability, opportunity and motivation to address sedentary behaviours from their perspectives. Interviews will be analysed using Framework Analysis.

Workstream 3
Informed by previous workstreams and behaviour change principles, development of an agreed intervention to reduce sedentary behaviour through use of co-production principles in two stroke services.

Workstream 4
A case study and action research approach will be used in three services to clarify: content; methods of delivery of the intervention; fidelity assessment and capture learning from, and acceptability to, staff and participating stroke survivors. Trial procedures relating to patient eligibility criteria, recruitment process and data collection will also be clarified. It is anticipated that 15 patients (and carers if available) will be recruited in each service.

Workstream 5
A multicentre cluster Randomised Controlled Trial evaluating the clinical and cost-effectiveness of the intervention incorporating an internal pilot phase and embedded process evaluation.

Partners & Collaborators

Grant applicants
Anne Forster, David Clarke, Karen Birch, Gill Carter, Ivana Holloway, Sue Oxley, Amanda Farrin, Anita Patel, Coralie English, Gillian Mead, Rebecca Lawton, Claire Fitzsimons.


Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, University of Edinburgh, Queen Mary University of London and University of Newcastle (Australia)


01/10/2017- 31/09/2024

Funding agency

National Institute for Health Research (NIHR)

Publications and outputs

Corepal R, Hall JF, English C, Farrin A, Fitzsimons CF, Forster A, Lawton R, Mead G, Clarke D. A protocol for a systematic review of process evaluations of interventions investigating sedentary behaviour in adults. BMJ Open 2019; 9(9):e031291. doi:10.1136/bmjopen-2019-031291

Hall JF, Crocker TF, Clarke DJ, Forster A. Supporting carers of stroke survivors to reduce carer burden: development of the Preparing is Caring intervention using Intervention Mapping. BMC Public Health 2019; 19:1408; doi:10.1186/s12889-019-7615

Further information

For further information contact: Professor Anne Forster on 01274 383406 or by email:

This summary presents independent research funded by the National Institute for Health Research Programme Grants for Applied Research (NIHR PGfAR) (Grant Reference Number: RP-PG-0615-20019). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.