Physician Advice, Patient Actions, and Health-Related Quality of Life in Secondary Prevention of Stroke Through Diet and Exercise

Abstract

Background and Purpose-Healthy diet and exercise are recommended for secondary prevention in stroke patients. We examined the prevalence of persons with stroke who received physician advice for, and engaged in, dietary change and exercise, and we also sought to determine whether engaging in these actions was associated with differences in health-related quality of life (HRQOL). Methods-Data are from 51 193 participants in the 1999 Behavioral Risk Factor Surveillance System, a state-based telephone survey. The participants noted whether they were advised to eat fewer high fat/high cholesterol foods and to exercise more and whether they engaged in these activities. HRQOL measures were the reported number of the preceding 30 days when physical health was not good, mental health was not good, usual activities were limited, and both physical and mental health were good (healthy days). Results-Overall, 2.4% of the participants reported a history of stroke. Sixty-one percent of those who reported a history of stroke had been advised to eat fewer high fat/high cholesterol foods, and 85.4% of those who had received such advice reported a dietary change compared with 56.0% of those who did not receive such advice. Almost 64% of those who reported a stroke had been advised to exercise more, and 76.5% of those who received such advice reported exercising more versus 38.5% of those who did not receive such advice. Persons with stroke who reported exercising had fewer limited activity days and days when physical health was not good and more healthy days than did persons who did not exercise. Dietary actions were not associated with differences in HRQOL. Conclusions-Results highlight the importance of provider advice for secondary prevention among persons with stroke.

Why do providers contribute to disparities and what can be done about it?

“…25,26,[82][83][84][85][86][87][88][89][90][91][92][93][94][95][96] Interpersonal skills such as active listening, relationship building, and communication skills are fundamental and necessary (but perhaps not sufficient) to the provision of high-quality and equitable health care. Finally, this analysis also underscores the fact that stereotyping and bias is not simply a product of the individual provider but is caused by features of the health care setting that decrease cognitive capacity, such as fatigue, overload, and time pressure.…”

Physical Activity and Exercise Recommendations for Stroke Survivors

“…92 Indeed, a recent study found that physician recommendations to exercise resulted in a doubling of the likelihood that stroke survivors would exercise. 93 This cost-effective intervention, which is now strongly supported by sound research, holds tremendous promise. The challenge for healthcare providers is to bring this promise to fruition.…”

Treatment of Risk Factors to Prevent Stroke

“…Exercise reduces blood pressure, decreases body weight, and improves other risk factors, including metabolic syndrome [89]. The role of the health provider is important and the physician's advice regarding physical activity to patients can significantly modify exercise and diet style, including those with a prior stroke [90]. One recent observation of note is associated with the onset of stroke with physical activity [91].…”