Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke
- 1 November 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 42 (11), 3207-3213
- https://doi.org/10.1161/strokeaha.111.620187
Abstract
Background and Purpose—: Comprehensive cardiac rehabilitation (CCR), which integrates structured lifestyle interventions and medications, reduces morbidity and mortality among cardiac patients. CCR has not typically been used with cerebrovascular populations, despite important commonalities with heart patients. We tested feasibility and effectiveness of 6-month outpatient CCR for secondary prevention after transient ischemic attack or mild, nondisabling stroke. This article presents risk factors. A future article will discuss psychological outcomes. Methods—: Consecutive consenting subjects having sustained a transient ischemic attack or mild, nondisabling stroke within the previous 12 months (mean, 11.5 weeks; event-to-CCR entry) with ≥1 vascular risk factor, were recruited from a stroke prevention clinic providing usual care. We measured 6-month CCR outcomes following a prospective cohort design. Results—: Of 110 subjects recruited from January 2005 to April 2006, 100 subjects (mean age, 64.9 years; 46 women) entered and 80 subjects completed CCR. We obtained favorable, significant intake-to-exit changes in: aerobic capacity (+31.4%; P P =0.008), total cholesterol/high-density lipoprotein (−11.6%; P P =0.003), waist circumference (−2.44 cm; P 2 ; P =0.003), and body weight (−1.43 kg; P =0.001). Low-density lipoprotein (−0.24 mmol/L), high-density lipoprotein (+0.06 mmol/L), systolic (−3.21 mm Hg) and diastolic (−2.34 mm Hg) blood pressure changed favorably, but nonsignificantly. A significant shift toward nonsmoking occurred ( P =0.008). Compared with intake, 11 more individuals (25.6% increase) finished CCR in the lowest-mortality risk category of the Duke Treadmill Score ( P <0.001). Conclusions—: CCR is feasible and effective for secondary prevention after transient ischemic attack or mild, nondisabling stroke, offering a promising model for vascular protection across chronic disease entities. We know of no similar previous investigation, and are now conducting a randomized trial.This publication has 29 references indexed in Scilit:
- Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trialBMC Neurology, 2010
- Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trialBMC Neurology, 2009
- Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat DietThe New England Journal of Medicine, 2008
- Combining Multiple Approaches for the Secondary Prevention of Vascular Events After StrokeStroke, 2007
- Physical Activity and Exercise Recommendations for Stroke SurvivorsCirculation, 2004
- A 12-Item Short-Form Health SurveyMedical Care, 1996
- Heart disease in patients with stroke: Incidence, impact, and implications for rehabilitation part 1: Classification and prevalenceArchives of Physical Medicine and Rehabilitation, 1993
- Prediction of Maximal Oxygen Consumption During Handrail-Supported Treadmill ExerciseJournal of Cardiopulmonary Rehabilitation, 1987
- The Hospital Anxiety and Depression ScaleActa Psychiatrica Scandinavica, 1983
- “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinicianJournal of Psychiatric Research, 1975