Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study

Lorna Paul, Sally Wyke, Stephen Brewster, Naveed Sattar, Jason M.R. Gill, Gillian Alexander, Danny Rafferty, Angus K. McFadyen, Andrew Ramsay, Aleksandra Dybus

Research output: Contribution to journalArticlepeer-review


Background: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviours. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behaviour change techniques (feedback, self-monitoring and social support), in which users? physical activity is visualised by fish swimming. Objective: To evaluate the potential effectiveness of STARFISH in stroke survivors. Method: Twenty three people with stroke (12 women; age: 56.0 $ 10.0 years, time since stroke: 4.2 $ 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n=15) or control (n=8) groups. The intervention group followed the STARFISH programme for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten Metre Walk Test, Stroke Specific Quality of Life Scale, Psychological General Well-Being Index. Results: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p=0.005 for group-time interaction). Similar patterns of data and group-time interaction were seen for walking time (p=0.002) and fatigue (p= 0.003). There were no significant group-time interactions for other outcome measures. Conclusion: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.
Original languageEnglish
Pages (from-to)170-177
Number of pages8
JournalTopics in Stroke Rehabilitation
Issue number3
Early online date8 Jan 2016
Publication statusPublished - Apr 2016


  • physical activity
  • stroke survivors
  • mobile phone applications

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