Stroke is the third most common cause of death and the most common cause of severe disability in the United Kingdom. Low levels of physical activity substantially increase the risk of a first ever ischaemic stroke and haemorrhagic stroke.1 Although data about the association between physical activity and recurrent stroke are lacking, it is biologically plausible that physical activity after stroke might improve the profile of vascular risk factors and so reduce the risk of recurrent stroke and other vascular events.2 In the linked study (doi:10.1136/bmj.b2810), Boysen and colleagues report a randomised controlled trial of repeated encouragement and advice aimed at increasing physical activity after stroke.3

Levels of physical activity in community dwelling adults with mild motor impairment after stroke are about half those of healthy older people.4 Physical fitness (including aerobic fitness, muscle strength, and muscle power) is substantially lower in people after stroke than in age matched controls.5 Physical fitness …