Effect and efficacy of lifestyle interventions as secondary prevention

Abstract

Introduction Improvements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice. Aim In this systematic review and meta‐analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes. Methods PubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta‐analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of. Results Twenty‐nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; −3.85 mmHg [95%CI −6.43; −1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; −9.83 mmHg [95%CI −16.56; −3.09]). Conclusion Modifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

“…This includes increased physical activity, smoking cessation, reduction in alcohol consumption, and a healthy diet and is positive for overall health. 632,637 These recommendations are beneficial for many so-called noncommunicable conditions, related to an individual’s way of life. After the acute hospitalization and rehabilitation period, the family often takes on the role of a caregiver for the patient with ICH after the return to home.…”

Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke

“…Another limitation of this study is inadequate recruitment and retention of participants, which could lead to underpowered analyses or missing data points that would challenge the internal validity of reported results. Efforts to maximise enrolment and minimise loss to follow-up will include not recruiting participants too soon poststroke, 67 consideration of participants’ needs regarding timing of the intervention, establishing consistent study procedures (eg, same time and location of intervention sessions), maintaining regular communication with participants including automated reminders about upcoming sessions or study tasks, and having the sessions delivered by an experienced and charismatic instructor who can readily establish good rapport with participants. 77 …”

“…Participants will include adults with stroke or TIA who (1) are ≥18 years, (2) reside in Queensland, (3) are between 3 months and 5 years post stroke or TIA and (4) were discharged home from hospital after their most recent stroke or TIA (ie, were not referred to in-patient rehabilitation). The 3-month cut-off is based on evidence for lower rates of participant retention in interventions among individuals recruited very soon after their stroke67; and the 5-year cut-off is based on similar intervention studies for stroke secondary prevention68 as well as evidence that the rate of stroke recurrence is similar at 1 and 5 years poststroke 1 69. Eligible participants will be recruited from the community and through hospital-based stroke clinics.…”

Mastering Health Following Minor Stroke—A Qualitative Explorative Study

“…16 There is moderate evidence that health behavioural interventions have a beneficial effect in secondary prevention of stroke, although we lack evidence on the best approaches. 23 Patients with minor stroke have difficulties receiving information. 22,24 We found several informants to had difficulties recalling details about their hospital stay and the information they had been given.…”