The importance of physical activity to promote health is not new. However, the importance of physical activity in people with neurological conditions is increasingly being recognised. With many of the consequences of neurological conditions including difficulties with mobility, balance and strength; it stands to reason that optimising physical activity levels can result in many physical benefits. Physical activity can have many other flow-on effects with benefits seen in reduced mortality, and enhanced community participation and quality of life (Gordon et al., 2004). We are yet to understand the full extent to which physical activity contributes to rehabilitation outcomes; however, there is a growing body of research highlighting that the intensity of activity within rehabilitation environments is often inadequate for therapeutic gains (Kuys, Brauer, & Ada, 2006; McClanachan, Gesch, Wuthapanich, Fleming, & Kuys, 2013; Polese, Scianni, Kuys, Ada, & Teixeira-Salmela, 2014). It is not surprising therefore, that levels of physical activity continue to be poor following reintegration into the community (Morris, MacGillivray, & McFarlane, 2014). It is important that, as health care professionals, we support and encourage physical activity in all our clients. To that end, this special issue of Brain Impairment is devoted to raising the issue of physical activity in people with neurological conditions, and addressing questions such as: Why is physical activity important? How do we measure it? How do we enhance it, and what are the benefits of increased activity? This special issue brings together experts from around the world investigating and promoting physical activity across the continuum of care in various neurological populations including stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease.

The role of physical activity (PA) after stroke is increasingly recognised as important for function, fitness and wellbeing. Current evidence shows that targeted PA after stroke improves cardiovascular fitness, walking ability and muscle strength and may ameliorate depression and improve quality of life. Secondary stroke prevention and management of cardiovascular risk factors are further health benefits. Despite increasing emphasis on organised exercise classes for stroke, PA levels remain low and effects of organised exercise interventions are not maintained once programmes have finished. Barriers to PA after stroke are complex and innovative approaches to maintaining and promoting long-term engagement in activity are required. This commentary proposes that using the International Classification of Disability and Functioning (ICF) to guide thinking about PA after stroke may help us develop and apply comprehensive solutions that increase PA levels. This approach considers stroke survivors’ PA engagement in terms of Body – the physical impairments imposed by stroke; Person – the role of identity, and psychological factors on PA; and Environment – the physical and social environments that influence PA engagement. The commentary discusses how innovative solutions addressing these issues may enable stroke survivors to be better supported to lead active lifestyles.

The ultimate goal of upper-limb rehabilitation after stroke is to promote real-world use, that is, use of the paretic upper-limb in everyday activities outside the clinic or laboratory. Although real-world use can be collected through self-report questionnaires, an objective indicator is preferred. Accelerometers are a promising tool. The current paper aims to explore the feasibility of accelerometers to measure upper-limb use after stroke and discuss the translation of this measurement tool into clinical practice. Accelerometers are non-invasive, wearable sensors that measure movement in arbitrary units called activity counts. Research to date indicates that activity counts are a reliable and valid index of upper-limb use. While most accelerometers are unable to distinguish between the type and quality of movements performed, recent advancements have used accelerometry data to produce clinically meaningful information for clinicians, patients, family and care givers. Despite this, widespread uptake in research and clinical environments remains limited. If uptake was enhanced, we could build a deeper understanding of how people with stroke use their arm in real-world environments. In order to facilitate greater uptake, however, there is a need for greater consistency in protocol development, accelerometer application and data interpretation.

Stroke is a leading cause of disability worldwide, with approximately one third of people left with permanent deficits impacting on their function. This may contribute to a physically inactive lifestyle and further associated health issues. Current research suggests that people after stroke are not meeting the recommended levels of physical activity, and are less active than people with other chronic illnesses. Thus, it is important to understand how to support people after stroke to uptake and maintain physical activity. Wearable sensors and mobile health (mHealth) technologies are a potential platform to measure and promote physical activity. Some of these technologies may incorporate behaviour change techniques such as real-time feedback. Although wearable activity trackers and smartphone technology are widely available, the feasibility and applicability of these technologies for people after stroke is unclear. This article reviews the devices available for assessment of physical activity in stroke and discusses the potential for advances in technology to promote physical activity in this population.

Reduced cardiorespiratory fitness or cardiorespiratory deconditioning is a secondary physical impairment commonly reported to affect people after traumatic brain injury (TBI), both in the short- and long-term. Eleven studies have measured peak oxygen uptake ${\rm ({\dot V}O}_{{\rm 2peak}} )$ to evaluate fitness in this population. The mean (SD) ${\rm \dot VO}_{{\rm 2peak}}$ from these studies was 27.2 (6.7) mL.kg−1·min−1, which is markedly below the average fitness level of age-matched healthy individuals. The aetiology of cardiorespiratory deconditioning has not been well evaluated among people with TBI; however, studies on prolonged bed rest and studies on the acute consequences of TBI inform our current understanding. The primary aim of this paper is to present a model to describe the physiological factors contributing to the development of cardiorespiratory deconditioning among people with severe TBI. We propose that both central and peripheral factors contribute to reduced fitness, and that these changes occur because of both the initial brain damage and trauma sustained and the prolonged and initially extreme physical inactivity that is commonly experienced after this type of injury. Reduced fitness can significantly affect the ability to return to pre-injury activities. Given that reintegration into the community is a key goal of rehabilitation among people with TBI, interventions that can prevent or reverse reduced fitness need to be implemented.

Purpose: Use accelerometers to examine the physical activity behaviours of individuals following TBI undergoing inpatient rehabilitation.

Method: Twenty-one individuals with Traumatic brain injury (TBI) undergoing inpatient rehabilitation (9 females, 12 males; M age = 43.8 ± 14.7 years; M GCS = 9.1 ± 4.3; M time since injury = 40.8 ± 22.1 days; M length of stay (LOS) = 30 ± 14 days) wore accelerometers for an average of 8.4 ± 2.0 consecutive days (1440 minutes/day). Activity counts (AC) were collected at 1 minute epochs and descriptive statistics were calculated to assess intensity of activity and time spent being active and sedentary.

Results: During scheduled therapy, time individuals completed an average of 161.4 ± 65.5 AC/minute, which decreased to 114.5 ± 51.3 during non-therapy time and 22.2 ± 10 when sleeping. Using population level cut points, individuals were on average considered inactive during therapy, inactive or sedentary during non-therapy time, and only one participant spent >1 minute in moderate intensity activity. The mean length of active and sedentary bouts was 9 minutes.

Discussion: Findings indicate that the amount and intensity of activity completed is low amongst individuals completing inpatient rehabilitation after TBI, with the majority considered sedentary or inactive. While the sample is small, it is important to develop and implement safe and effective strategies to increase activity levels during rehabilitation.

Objectives: (1) Evaluate the features of purpose-built apartment living on access, environmental control, and home and community mobility of people living with neurotrauma and (2) Examine tenant perceptions of those features.

Research design: Observational case series pilot study. Setting: Three apartments within a residential development in Melbourne, Australia. Participants: Three males (aged 30–55 years) with traumatic brain and/or spinal cord injury living in the three separate apartments.

Method and procedures: Measures: Two-published measures of user experience of built and technology environments, coupled with customised interdisciplinary post-occupancy evaluation (POE) methods and GPS-enabled mobility tracking. Analysis: Measures completed per manual guidelines and data reported descriptively. Customised measured drawings produced to represent tenants’ physical access and mobility. GPS community mobility data plotted on Google Earth.

Results: Built design features which enabled access and mobility included linear paths of travel, well-located furnishings, and joinery design that allowed approach from either side using a wheelchair. Personal home furnishing choices posed barriers to physical access. Home automation technologies positively influenced participants’ sense of control and independence, but posed learning challenges. Close proximity of housing to accessible public transport and services enabled community travel options.

Conclusion: Findings from this pilot study indicate the combination of housing location, design and technologies used, together with availability of local community services, provides an acceptable level of environmental control, access, mobility and tenant experience. Further research is required to determine validity of the novel measures used, and deliver rigorous research design to evaluate those features most important in achieving optimal outcomes.

People with Multiple Sclerosis (MS) undertake insufficient physical activity based on current guidelines. Recent work points to the benefits of increasing the amount of time spent in all non-sedentary physical activity. The current study sought to explore the potential benefits to community participation, as well as examine factors predictive, of engagement in ‘habitual’ and/or low-intensity physical activity. Seventy-four people with MS were compared to 67 healthy controls using the Frenchay Activities Index (FAI). Findings revealed differences in habitual activity level (p < .001), and low-intensity physical activity (p < .001), with people with MS having a lower level of engagement than healthy people. After controlling for the impact of MS on mobility, years since symptom onset, physical fatigue and reduced positive affect were the most significant predictors of engagement in ‘at least weekly’ low-intensity physical activity. Higher frequency of low-intensity physical activity was significantly associated with greater home, social and occupational participation (all p < .05), and physical health status (p < .01), but not mental health status (p = .964) in people with MS. Results suggest that improving habitual activity level and engagement in low-intensity physical activity may be of benefit for people with MS.

People with Parkinson's disease (PD) are encouraged to participate in physical activity levels equivalent to those recommended for the general population. Understanding factors that influence this activity is important for facilitating this participation. This study examined factors associated with participation in moderate and high intensity daily ambulatory activity in people with mild to moderate PD. Fifty community-dwelling people with mild-moderate PD were monitored with accelerometers over three days to characterise their daily ambulatory activity levels. Personal factors, disease characteristics, gait and cognitive capacity were measured. Prediction models were created to identify factors influencing ambulation activity. People with PD spent approximately 77 minutes walking per day, mostly at a moderate intensity resulting in a median of 6300 steps/day. Disease severity predicted time spent in moderate ambulation bouts (R2 = 0.116, p = .017). Gait (Timed Up and Go (TUG) Test) and executive function together predicted engagement in high intensity ambulatory activity (R2 > 0.170, p < .022). While disease severity, gait performance and executive function were predictive of engagement in moderate and high intensity walking activity, additional personal and social factors should be considered and are likely to also strongly impact on activity levels.

This paper investigates the premise that long-term engagement in performance-focussed sports training may lead to significantly enhanced clinical outcomes for people with neurological impairments (NI). The minimum volume of moderate-intensity activity recommended for good health is 450 MET.minutes/week, although evidence from the general population indicates that outcomes may be enhanced by completing up to five times this volume (2250 MET.minutes/week) at vigorous (rather than moderate) intensity. Most studies evaluating physical activity interventions for people with NI deliver low volumes (<450 MET.minutes/week), which may explain why evidence for some clinical outcomes is weak. Athletes (with or without NI) who aim to achieve high-level sports performance undertake an increasingly large volume of vigorous intensity physical activity over several seasons. Evidence that people with NI may enhance clinical outcomes through performance-focussed sports training includes: evidence from studies investigating the benefits of high-intensity and/or high volume clinical exercise; scientific evidence from elite/high-level athletes; and anecdotal evidence from Paralympic athlete testimonials. Additionally, sports participants with NI may also accrue an important array of psychosocial benefits, including higher rates of employment, and higher satisfaction with life and social integration. Rigorous, prospective, longitudinal clinical monitoring of people with NI undertaking performance-focussed sports training are required to evaluate its clinical utility.