Stroke survivors often experience persistent mobility limitations because rehabilitation programs rarely adopt guideline-recommended high-repetition walking protocols. A pragmatic phase 3 stepped-wedge cluster-randomized controlled trial, published in The Lancet Neurology, evaluated the Walk ‘n Watch program, a structured and progressive walking protocol, across 12 inpatient stroke rehabilitation units in seven Canadian provinces. More than 85 physical therapists delivered a minimum of 30 minutes of walking-focused activity per session, progressing intensity using heart rate, step counts, and baseline six-minute walk test (6MWT) results.

Between June 2021 and March 2024, 314 patients were enrolled, and 306 were included in the primary analysis (mean age 68 years; 61% male; mean time since stroke 29 days). At 4 weeks, the Walk ‘n Watch group achieved a mean 6MWT improvement of 133.6 m from baseline versus 86.5 m with usual care. The adjusted between-group difference was 43.6 m (95% CI 12.7–76.1). This was the first inpatient phase 3 RCT to engage all front-line therapists in delivering a structured, progressive protocol that improved walking outcomes after stroke. The program also improved walking speed, balance, mobility, and quality of life, with no severe adverse events reported.

Key Takeaway: 

Walk ‘n Watch provides clinically meaningful functional gains in real-world stroke rehabilitation and can be integrated into standard care with minimal additional resources.