Increasing time spent engaging in moderate-to-vigorous physical activity by community-dwelling adults following a transient ischemic attack or non-disabling stroke: a systematic review

Abstract

Purpose

The risk of recurrent stroke following a transient ischaemic attack (TIA) or non-disabling stroke is high. Clinical guidelines recommend this patient population accumulate at least 150 minutes of moderate-to-vigorous physical activity each week to reduce the risk of recurrent stroke. We aimed to identify interventions that increase time adults spend in moderate-to-vigorous physical activity following TIA or non-disabling stroke.

Method

We searched thirteen databases for articles of secondary prevention interventions reporting outcomes for duration in moderate-to-vigorous physical activity or exercise capacity.

Results

Eight trials were identified (n = 2653). Of these, three (n = 198) reported changes in time spent in moderate-to-vigorous physical activity. Only one trial (n = 70), reported significant change in time spent engaging in moderate-to-vigorous physical activity (between-group difference: 11.7 min/day [95% CI 4.07–19.33]) when comparing participation in a six-month exercise education intervention to usual care. No trial measured moderate-to-vigorous physical activity after intervention end.

Conclusion

Despite recommendations to participate in regular physical activity at moderate-to-vigorous intensity for secondary stroke prevention, there is very little evidence for effective interventions for this patient population. There is need for clinically feasible interventions that result in long-term participation in physical activity in line with clinical guidelines. Trial registration: Protocol registration: PROSPERO CRD42018092840

Implications for rehabilitation

• There is limited evidence of the effectiveness of interventions that aim to increase time spent engaging in moderate-to-vigorous physical activity (MVPA) for people following a TIA or non-disabling stroke.

• A program comprising aerobic and resistance exercises ≥2 per week, supervised by a health professional (supplemented with a home program) over at least 24 weeks appears to be effective in assisting people adhere to recommended levels of moderate to vigorous physical activity after TIA or non-disabling stroke.

• Secondary prevention programs which include health professional supervised exercise sessions contribute to better adherence to physical activity guidelines; didactic sessions alone outlining frequency and intensity are unlikely to be sufficient.

Keywords:

• Transient ischemic attack
• non-disabling stroke
• moderate-to-vigorous physical activity
• physical activity
• secondary stroke risk intervention
• systematic review

Acknowledgements

We wish to thank Ms Debbie Booth, Medical Librarian, for her assistance in designing the Medline search strategy, which we used as a guide for subsequent database searches.

The first author is a recipient of a University of Newcastle Higher Research Scholarship and a PhD student associated with a clinical trial registered with the Hunter New England Research Ethics Committee, HNEHREC ref no: 17/06/21/4.03. NSW HREC ref. No: HREC/17/HNE/235. SSA ref No. SSA/17/HNE/236.

Ethical approval

This systematic review is registered with PROSPERO CRD42018092840.

Maria Sammut is a PhD student associated with a clinical trial registered by Dr Heidi Janssen with the Hunter New England Research Ethics Committee, HNEHREC ref no: 17/06/21/4.03. NSW HREC ref. No: HREC/17/HNE/235. SSA ref No. SSA/17/HNE/236.

Author contributions

The study was conceived by HJ, CE, MN and MS. Protocol development was by MS, HJ and CE. Database search, article selection and abstract review was by MS and HJ. Data extraction and quality analysis was by MS and HJ. The first draft of the manuscript was written by MS. All authors reviewed and edited the manuscript, and approved the final version of the manuscript.

Disclosure statement

The authors report no declarations of interest.