Our point, which we stand by, was that stroke survivors

appear to be no more at risk of recurrent stroke and cardiovascular events due to the amount of activity they do. This is reflected in our statement that, ‘This would mean that they were no more at risk of recurrent stroke and cardiovascular events due to low levels of physical activity than their healthy peers.’ It is certainly possible that they are more at risk due to the pattern in which that activity is accumulated, but we refrained Epacadostat from making strong statements about this possibility for two reasons. First, we did not measure the pattern of accumulation of sedentary time and can therefore only make indirect estimates about such patterns from our data about transitions. Second, the data about activity pattern and risk is from people

without stroke and may not extrapolate to people with stroke. We agree, nevertheless, with Dr English’s interpretation of how the evidence about sedentary behaviour might apply to our data. It is therefore interesting to consider what our data can reveal about this issue. Without reanalysis of the data, examination of transitions provides the best insight into the differences find more between stroke survivors and healthy controls in terms of bouts of activity. The transitions we recorded included lie to sit, sit to lie, recline to sit, sit to recline, recline to stand, stand to recline, sit to stand and stand to sit. Despite this comprehensive measurement of transitions, the amount of time spent making transitions was very small in both groups, with a mean of 1 min in the stroke group and 2 min in the control group. Although this difference was statistically significant (mean between-group difference 1 min, 95% CI 0.3 to 2), this difference was also very small. This suggests that the sedentary behaviour

was likely to be accumulated in long bouts by both groups, putting both groups at risk of cardiovascular disease. We strongly agree with Dr English that further research is needed to understand the influence of almost the pattern of accumulation of sedentary time in stroke survivors. We welcome future findings in this important area. “
“Kathleen Sluka is a well regarded educator and researcher who has published over 100 peer-reviewed papers. She has provided a voice for the role of physical therapy in pain through national (USA) and international professional bodies including the International Association for the Study of Pain (IASP). This book draws on material that she has prepared for a doctoral course titled ‘Mechanisms and Management of Pain’; as such Dr Sluka edits the text and is the first author on the large majority of chapters. Other contributions are provided by a mix of American, European, and Australasian authors. The target audience of the book is students of physical therapy and physical therapists who treat people with pain.