Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke

Prior, Peter; Hachinski, Vladimir; Unsworth, K.; Chan, Richard; Mytka, Sharon; O’Callaghan, Christina; Suskin, Neville

doi:10.1161/strokeaha.111.620187

Cited by 83 publications

(79 citation statements)

References 42 publications

(31 reference statements)

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“…210,211 Several studies have shown that aerobic exercise and strength training will improve cardiovascular fitness after stroke. 197,[210][211][212][213][214][215] Structured programs of therapeutic exercise have been shown to improve mobility, balance, and endurance, 213 and beneficial effects have been demonstrated in different ethnic groups and in both older and younger patients. 216 Together, these studies provide important information on the safety and selected clinical benefits of exercise after stroke.…”

Section: Strokementioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,939

1,326

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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Section: Strokementioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,939

1,326

View full text Add to dashboard Cite

show abstract

“…The use of a comprehensive exercise and lifestyle program modeled after cardiac rehabilitation in people after a TIA and mild stroke was shown to yield improvements in total cholesterol, body composition, blood pressure, and behavior change toward nonsmoking. 68 Physical activity can be effective only if it is done consistently. Unfortunately, although physical activity is clearly established and widely recognized as a means to reduce the risk of stroke and other CVDs in virtually all individuals, sedentary behaviors remain a persistent and significant problem for the general population, and even more so for chronic disease populations, including those with stroke.…”

Section: Importance Of Comprehensive Stroke Care and Cvd Risk Reductionmentioning

confidence: 99%

“…Studies have established the feasibility and effectiveness of adapting exercise-based cardiac rehabilitation interventions for individuals with mild to moderate disability from stroke, 172,207 and comprehensive models that integrate exercise, lifestyle modification, and medications have been shown to be beneficial for individuals after TIA or stroke with little to no residual deficits. 68,208 Larger clinical trials are currently under way to examine whether similar models of care involving exercise and risk factor modification can be adapted and implemented among individuals with TIA or a broader range of clinical presentation after stroke. 209,210 These trials represent important steps toward the development of optimal secondary prevention strategies that integrate exercise interventions into a comprehensive risk-reduction program for stroke survivors.…”

Section: Exploring Effective Models Of Carementioning

confidence: 99%

Physical Activity and Exercise Recommendations for Stroke Survivors

Billinger¹,

Arena

Bernhardt³

et al. 2014

Stroke

1,072

623

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2532Purpose-This scientific statement provides an overview of the evidence on physical activity and exercise recommendations for stroke survivors. Evidence suggests that stroke survivors experience physical deconditioning and lead sedentary lifestyles. Therefore, this updated scientific statement serves as an overall guide for practitioners to gain a better understanding of the benefits of physical activity and recommendations for prescribing exercise for stroke survivors across all stages of recovery. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and indicate gaps in current knowledge. Results-Physical inactivity after stroke is highly prevalent. The assessed body of evidence clearly supports the use of exercise training (both aerobic and strength training) for stroke survivors. Exercise training improves functional capacity, the ability to perform activities of daily living, and quality of life, and it reduces the risk for subsequent cardiovascular events. Physical activity goals and exercise prescription for stroke survivors need to be customized for the individual to maximize long-term adherence. Conclusions-The recommendation from this writing group is that physical activity and exercise prescription should be incorporated into the management of stroke survivors. The promotion of physical activity in stroke survivors should emphasize low-to moderate-intensity aerobic activity, muscle-strengthening activity, reduction of sedentary behavior, and risk management for secondary prevention of stroke. (Stroke. 2014;45:2532-2553.)

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“…Participation in CR programs have been shown to reduce mortality by about 25%-30% and to have favorable effects on re-hospitalization and functional capacity (Grace et al, 2008). Emerging evidence supports the feasibility, safety and benefits of CR for transient ischemic attack/mild non-disabling stroke patients as well (Lennon et al, 2008;Prior et al, 2011;Tang et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…CAD and transient ischemic attack or mild, non-disabling stroke have similar atherosclerotic etiology and modifiable risk factors. As such, similar to secondary prevention for CAD, recurrent vascular events in stroke patients can be prevented with an exercise-based, lifestyle intervention in combination with medication therapies (Prior et al, 2011;Sacco et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Elements of patient–health-care provider communication related to cardiovascular rehabilitation referral

et al. 2014

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Cardiovascular rehabilitation (CR) has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-healthcare provider (HCP) interactions regarding CR, and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their HCPs. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 HCPs and 50 patients were recorded. CR referral was related to greater HCP interactivity (Odds Ratio [OR]=2.82, 95% CI 1.01-7.86), and less patient concern and worry (OR=0.64, 95% CI 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral.

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Comprehensive Cardiac Rehabilitation for Secondary Prevention After Transient Ischemic Attack or Mild Stroke

Cited by 83 publications

References 42 publications

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Physical Activity and Exercise Recommendations for Stroke Survivors

Elements of patient–health-care provider communication related to cardiovascular rehabilitation referral

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