Lifestyle interventions for secondary disease prevention in stroke and transient ischaemic attack: a systematic review

Lennon, Olive; Galvin, Rose; Smith, Kathryn A.; Doody, Catherine; Blake, Catherine

doi:10.1177/2047487313481756

Cited by 54 publications

(81 citation statements)

References 40 publications

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“…In addition, a meta-analysis of 17 RCTs showed that lifestyle interventions (eg, health promotion or education, lifestyle counseling) may reduce the risks leading to another stroke or cardiovascular event. 874 A meta-analysis of 8 RCTs showed that exercise referral schemes that provide a clear referral by primary care professionals to third-party professionals to increase exercise or physical activity can increase the number of participants who achieve 90 to 150 min/wk of moderate physical activity and reduce depressive symptoms in sedentary individuals with or without a medical diagnosis (obesity, hypertension, depression, diabetes mellitus). 875 In a qualitative study, stroke survivors described great physical and psychological well-being after participation in an exercise referral scheme.…”

Section: Referral To Community Resourcesmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

1,937

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Referral To Community Resourcesmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

1,937

840

View full text Add to dashboard Cite

show abstract

“…[50,52] A recent systematic review of lifestyle interventions for secondary stroke prevention demonstrated lifestyle interventions could potentially reduce blood pressure when combined with medication and medical guidelines. [53] The effect on blood pressure should be further explored in a larger study as blood pressure is the main driver of vascular risk following stroke. [5] Exercise led to clinically significant improvements in both walking speed (0•3 ± 0•14 m/s) and endurance (85 ± 47m), supporting recent findings.…”

Section: Discussionmentioning

confidence: 99%

Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke

Moore

Hallsworth

Jakovljevic

et al. 2014

Neurorehabil Neural Repair

113

177

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“…Modifications of lifestyle factors include physical exercise, healthy diet, moderate alcohol consumption, and smoking cessation. Multimodal lifestyle interventions have been successful in changing the lifestyle habits of stroke survivors [103, 104]. Two randomized trials have been performed with multifactorial interventions including optimal medical treatment for secondary prevention in addition to physical activity, diet, weight control, smoking cessation, healthy diet with better glycemic control, and cognitive stimulation.…”

Section: Lifestyle Interventionsmentioning

confidence: 99%

Post-stroke dementia – a comprehensive review

Mijajlović

Pavlović

Brainin

et al. 2017

BMC Med

490

411

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Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients (‘at risk brains’) from those with better prognosis or to discriminate Alzheimer’s disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.

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Lifestyle interventions for secondary disease prevention in stroke and transient ischaemic attack: a systematic review

Abstract: There is currently insufficient high quality research to support lifestyle interventions post-stroke or TIA on mortality, CVD event rates and cardio-metabolic risk factor profiles. Promising blood pressure reductions were noted in multimodal interventions which addressed lifestyle.

Cited by 54 publications

References 40 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke

Post-stroke dementia – a comprehensive review

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