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 CRD42018092840Implications for rehabilitationThere 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.