Program of Rehabilitative Exercise and Education to Avert Vascular Events After Non-Disabling Stroke or Transient Ischemic Attack (PREVENT Trial): A Randomized Controlled Trial

Abstract

Background Non-disabling stroke (NDS) and transient ischemic attack (TIA) herald the possibility of future, more debilitating vascular events. Evidence is conflicting about potency of exercise and education in reducing risk factors for second stroke. Methods Three-site, single-blinded, randomized controlled trial with 184 participants <3 months of NDS or TIA (mean age, 65 years; 66% male) randomized to usual care (UC) or UC + 12-week program of exercise and education (PREVENT). Primary (resting systolic blood pressure) and secondary outcomes (diastolic blood pressure [DBPrest], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], TC/HDL, triglycerides, fasting glucose, and body mass index) were assessed at baseline, post-intervention, and 6- and 12-month follow-up. Peak oxygen consumption (VO2peak) was measured at baseline, post-intervention, 12-month assessments. Results Significant between-group differences at post-intervention favored PREVENT group over UC: DBPrest (mean difference [MD]: −3.2 mmHg, 95% confidence interval [CI]: −6.3, −.2, P = .04) and LDL-C (MD: −.31 mmol/L, 95% CI: −.42, −.20, P = .02). Trends of improvement in PREVENT group were noted in several variables between baseline and 6-month follow-up but not sustained at 12-month follow-up. Of note, VO2 peak did not change over time in either group. Conclusion Impact of PREVENT on vascular risk factor reduction was more modest than anticipated, possibly because several outcome variables approximated normative values at baseline and training intensity may have been sub-optimal. Further investigation is warranted to determine when exercise and education programs are viable adjuncts to pharmaceutical management for reduction of risk factors for second stroke. Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: #NCT00885456

Cardiovascular Rehabilitation for transient ischaemic Attack and Mild Stroke: the CRAMS effectiveness-implementation hybrid study protocol

“…Over 6-months we will assess the effectiveness and implementation of a CVR program for people with a TIA or mild stroke, providing recommendations on how to increase referrals and integrate this population into existing cardiac rehabilitation programs. There is limited evidence on the effectiveness of cardiac rehabilitation for people with TIA and stroke, whether programs are stroke-specific or integrated including people with heart disease [30][31][32][33][34][35]. Additionally, no studies appear to have investigated the cost-effectiveness or implementation determinants of such programs.…”

“…The evidence for people with TIA or stroke attending cardiac rehabilitation is limited. One large randomised controlled trial has recently been reported, the PREVENT trial, finding modest effects on vascular risk factors for stroke following a 12-week exercise and education program for people with TIA or mild stroke [ 30 ]. Two small randomised controlled trials have also been identified in the literature, although it is unclear whether these studies are stroke only cardiac rehabilitation programs or integrated programs (TIA, stroke, heart disease) [ 31 , 32 ].…”

“…Additionally, the inclusion criteria differ between studies. One study included participants > 1 year post stroke and any severity [31], while the other studies included people with TIA and mild stroke within one month [32] and three months [30] of diagnosis. There is some evidence of integrated cardiac rehabilitation programs, including participants with TIA, mild stroke and coronary heart disease, using pre-post study designs [33][34][35].…”

“…There is some evidence of integrated cardiac rehabilitation programs, including participants with TIA, mild stroke and coronary heart disease, using pre-post study designs [33][34][35]. Despite this limited evidence, all studies found that the cardiac rehabilitation model was feasible in this population, improving fitness and reducing cardiovascular disease risk [30][31][32][33][34][35]. Utilising existing cardiac rehabilitation programs for people with TIA or mild stroke may positively impact health status without creating new programs, but more robust evidence is required to determine its impact on physical function, risk factors, quality of life, morbidity and mortality, including the feasibility of conducting integrated cardiac rehabilitation programs within health services and its cost-effectiveness [26].…”

Antioxidant Capacities and Enzymatic Inhibitory Effects of Different Solvent Fractions and Major Flavones from Celery Seeds Produced in Different Geographic Areas in China

“…In addition, there is a crosstalk between the causes of increased free radical production in organisms and the factors that trigger DM [ 4 ]. Unfortunately, there is no cure for DM, but it can be treated through DM education, dietary treatment, exercise therapy, pharmacotherapy, glucose monitoring, and the detection and control of other cardiovascular disease risk factors [ 5 , 6 ]. Most clinical drugs used to control DM, such as acarbose, metformin, or miglitol, have many side effects, including gastrointestinal disturbance, weight gain, hypoglycemia, edema, and liver damage [ 7 ].…”