Establishing the effectiveness of combined walking and cognitive training in long-term stroke: a series of N-of-1 studies

Introduction: This study aimed to evaluate the effectiveness of a combined walking and cognitive intervention to improve memory and
attention in long-term stroke survivors. It also assessed the influencing
effects of mood, anxiety and sleep quality on self-reports of memory
and attention.
Method: A series of N-of-1 studies were conducted. Twelve ambulatory
participants (age range 33–76 years, time since stroke 17–209 months)
were recruited. Participants completed baseline, intervention and follow-up phases each lasting eight weeks. Throughout, participants completed a daily diary for memory, attention, mood, anxiety and sleep
quality and recorded step counts. Participants also wore an activPALTM
pedometer and completed neuropsychological tests of memory and
attention (RBMT-3 and TEA), measures of subjective memory (EMQR), depression (BDI-II), anxiety (DASS) and sleep quality (PSQI) at
weeks one, eight, 18 and 25. The intervention consisted of a physical
activity consultation based upon the Transtheoretical Model of Behaviour Change and guided walking sessions during which participants
played memory and attention games. The games were individually tailored based on the participant’s test profile.
Results: Time-series analysis of the diary data showed considerable
within and between-person variability throughout the study. Participants were able to increase their physical activity levels and engage in
the tailored cognitive games, however, the degree of change on the neuropsychological tests pre and post-intervention varied.
Conclusion: A combined walking and cognitive intervention is of benefit to some long-term stroke survivors. N-of-1 is a valuable method to
use to assess the effectiveness of an intervention as it highlights individual differences otherwise concealed