Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

Abstract

The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.

A Scoping Review of Non-Pharmacological, Non-Surgical Secondary Prevention Strategies in Ischaemic Stroke and TIA in National Stroke Guidelines and Clinical Audit Documents

“…SAP-E 2018–2030 addresses challenges facing stroke survivors and families, associated with life after stroke, including the assessment and management of modifiable risk factors in the prevention of recurrent stroke [ 15 ]. Individuals after stroke are known to have low adherence with lifestyle and cumulative lifestyle-related health behaviours [ 81 ] and show significantly lower engagement in health behaviours in comparison to matched controls [ 82 ]. Only one-third of the guideline documents reviewed in this study recommended routinely assessing for lifestyle-related risk factors.…”

A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention

“…The immediate and long-term consequences of stroke make it challenging for individuals to return to the community and participate in life activities [ 2 ]. Adjustments such as learning new behaviours or modifying one’s lifestyle are essential for reducing the risk of future cardiovascular events and supporting recovery, but uptake is poor [ 3 ]. The ease with which adjustments occur is multifaceted and relies, in part, on a person’s self-efficacy including beliefs about their capabilities in performing various everyday activities [ 4 ].…”

A mixed-method feasibility study of a new digital health support package for people after stroke: The Recovery-focused Community support to Avoid readmissions and improve Participant are Stroke (ReCAPS) intervention

“…2 Adjustments such as learning new behaviours or modifying one's lifestyle are essential for reducing the risk of future cardiovascular events and supporting recovery, but uptake is poor. 3 The ease with which adjustments occur is multifaceted and relies, in part, on a person's self-e cacy including beliefs about their capabilities in performing various everyday activities. 4 There is evidence that self-management programs targeted at self-e cacy improve outcomes such as quality of life, physical function and enhance resilience after stroke.…”