Factors influencing implementation of aerobic exercise after stroke


This systematic review aimed to explore the perspectives of healthcare, exercise and fitness staff working with people post-stroke on the factors affecting implementation of aerobic exercise after stroke.


This review was registered with PROSPERO (registration number CRD42018099579) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

OVID SP MEDLINE, OVID SP EMBASE and CINAHL databases were searched up to December 2018. Search terms included synonyms of stroke, aerobic exercise and barriers/facilitators.

Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on type of study design. Staff included, but were not limited to, physiotherapists, healthcare professionals, exercise professionals and fitness instructors.

Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software.


Twenty studies were included. Four reported on the implementation of aerobic exercise and sixteen on general exercise interventions post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included staffs' self-efficacy and knowledge, patients' needs, communication and collaboration within and between organisations and resources including equipment, staff and training.


This is the first systematic review exploring the factors identified by staff as influencing the implementation of aerobic exercise after stroke. Key factors included staff characteristics and intervention and system-level issues. Future research should investigate which of these factors are modifiable to improve implementation, but it is likely that this will have resource and cost implications.


  • Aerobic exercise after stroke is an effective intervention but there are challenges to implementation from a staff and system perspective.
  • Overcoming the challenges to successful implementation is likely to involve resources and cost regardless of the setting or health context.

To overcome the identified challenges future research should aim to investigate which factors are modifiable.

Funding acknowledgements

This work was supported by a Grant from the Chartered Society of Physiotherapy Charitable Trust (Grant number PRF/17/B01).

Additional notes

This work was presented at Physiotherapy UK 2019