Skip to main content

Advertisement

SpringerLink
Log in

Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke

  • Original Article
  • Published:
Translational Stroke Research Aims and scope Submit manuscript

Abstract

Participation in exercise and education programs following transient ischemic attack (TIA) or minor stroke may decrease cardiovascular disease risk. The purpose of this study was to assess the long-term effect (3.5 years) of an exercise and education program administered soon after TIA or minor stroke diagnosis on clinical outcome measures (stroke classification and number, patient deaths, hospital/emergency department admission) and cost implications obtained from standard hospital records. Hospital records were screened for 60 adults (male, n = 31; 71 ± 10 years), diagnosed with TIA or non-disabling stroke, who had previously been randomised and completed either an 8-week exercise and education program, or usual care control. Follow-up clinical outcomes and cost implications were obtained 3.5 ± 0.3 years post-exercise. Participants randomised to the exercise and education program had significantly fewer recurrent stroke/TIAs (n = 3 vs. n = 13, Cohen’s d = 0.79) than the control group (P ≤ 0.003). Similar finding were reported for patient deaths (n = 0 vs. n = 4, d = 0.53), and hospital admissions (n = 48 vs. n = 102, d = 0.54), although these findings were only approaching statistical significance. The relative risk (mean; 95%CI) of death, stroke/TIAs and hospital admissions were 0.11 (0.01 to 1.98), 0.23 (0.07 to 0.72) and 0.79 (0.57 to 1.09), respectively. Hospital admission costs were significantly lower for the exercise group ($9041 ± 15,080 NZD [~$6000 ± 10,000 USD]) than the control group ($21,750 ± 22,973 NZD [~$14,000 ± 15,000 USD]) during the follow-up period (P < 0.05, d = 0.69). The present study demonstrates the long-term patient benefit and economic importance of providing secondary prevention, exercise and education programs for patients with TIA and minor stroke. URL: http://www.anzctr.org.au/; Trial Registration Number: ACTRN12611000630910.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.

    Article  PubMed  Google Scholar 

  2. Wardlaw J, Brazzelli M, Miranda H, Chappell F, McNamee P, Scotland G, et al. An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation. Southampton: NIHR Journals Library; 2014 (Health Technology Assessment, No. 18.27.) Available from: http://www.ncbi.nlm.nih.gov/books/NBK263109/.

    Google Scholar 

  3. Horer S, Schulte-Altedorneburg G, Haberl RL. Management of patients with transient ischemic attack is safe in an outpatient clinic based on rapid diagnosis and risk stratification. Cerebrovasc Dis. 2011;32:504–10.

    Article  PubMed  Google Scholar 

  4. Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell P, Mas J. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005;36:2748–55.

    Article  PubMed  Google Scholar 

  5. Albers GW, Caplan LR, Easton JD, Fayad PB, Mohr JP, Saver JL, et al. Transient ischemic attack—proposal for a new definition. New Engl J Med. 2002;347:1713–6.

    Article  PubMed  Google Scholar 

  6. Dennis MS, Bamford JM, Sandercock PA, Warlow CP. Incidence of transient ischemic attacks in Oxfordshire. England Stroke. 1989;20:333–9.

    Article  CAS  PubMed  Google Scholar 

  7. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000;284:2901–6.

    Article  CAS  PubMed  Google Scholar 

  8. Giles M, Rothwell P. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6:1063–72.

    Article  PubMed  Google Scholar 

  9. Wu C, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Int Med. 2007;167:2417–22.

    Article  Google Scholar 

  10. Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011;45:1489–94.

    Article  Google Scholar 

  11. van Wijk I, Kappelle LJ, van Gijn J, Koudstaal PJ, Franke CL, Vermeulen M, et al. Long-term survival and vascular event risk after transient ischaemic attack or minor ischaemic stroke: a cohort study. Lancet. 2005;365:2098–104.

    Article  PubMed  Google Scholar 

  12. Di Carlo A. Human and economic burden of stroke. Age Ageing. 2009;38:4–5.

    Article  PubMed  Google Scholar 

  13. Stroke-Foundation. New Zealand guidelines for the assessment and management of people with recent transient iscahemic attack (TIA). 2008.

  14. Lawrence M, Pringle J, Kerr S, Booth S, Govan L, Roberts NJ. Multimodal secondary prevention behavioural interentions for tia and stroke: a systematic review and meta analysis. PLoS One. 2015;10:e0120902.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Royal College of Physicians. Intercollegiate stroke working party. National clinical guidelines for stroke. London: Royal College of Physicians; 2012.

    Google Scholar 

  16. Faulkner J, Lambrick D, Woolley B, Stoner L, Wong L, McGonigal G. Effects of early exercise engagement on vascular risk in patients with transient ischaemic attack and non-disabling stroke. J Stroke Cerebrovasc Dis. 2013;22:e388–96.

    Article  PubMed  Google Scholar 

  17. Faulkner J, Lambrick D, Woolley B, Stoner L, Wong L, McGonigal G. The long-term effect of exercise on vascular risk factors and aerobic fitness in those with tia; a randomized controlled trial. J Hypertens. 2014;32:2064–70.

    Article  CAS  PubMed  Google Scholar 

  18. Kono Y, Yamada S, Yamaguchi J, Hagiwara Y, Iritani N, Ishida S, et al. Secondary prevention of new vascular events with lifestyle intervention in patients with noncardioembolic mild ischemic stroke: a single-center randomized controlled trial. Cerebrovasc Dis. 2013;36:88–97.

    Article  PubMed  Google Scholar 

  19. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh III EE. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke. 1993;24:35–41.

    Article  PubMed  Google Scholar 

  20. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.

    Article  CAS  PubMed  Google Scholar 

  21. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.

    Google Scholar 

  22. Altman DG. Confidence intervals for the number needed to treat. Brit Med J. 1998;317:1309–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Goldstein LB, Bushnell C, Adams R, Appel L, Braun T, Howard V, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517–84.

    Article  PubMed  Google Scholar 

  24. Durstine J, Moore G, Painter P, Roberts S. ACSM's exercise management for persons with chronic diseases and disabilities. 3rd ed. Champaign, IL: Human Kinetics; 2009.

    Google Scholar 

  25. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics 2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.

    Article  PubMed  Google Scholar 

  26. Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, et al. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the council on clinical cardiology, subcommittee on exercise, cardiac rehabilitation, and prevention; the council on cardiovascular nursing; the council on nutrition, physical activity, and metabolism; and the stroke council. Stroke. 2004;35:1230–40.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Sport and Exercise, University of Winchester, Winchester, UK

    James Faulkner & Andrew Mitchelmore

  2. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lee Stoner

  3. Wellington Regional Hospital, Wellington, New Zealand

    Jeremy Lanford & Evan Jolliffe

  4. Faculty of Health Sciences, University of Southampton, Southampton, UK

    Danielle Lambrick

Authors
  1. James Faulkner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lee Stoner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeremy Lanford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evan Jolliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Mitchelmore
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danielle Lambrick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Faulkner.

Ethics declarations

Funding

This research study was funded by the Massey University Research Fund.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures were in accordance with the ethical standards of the institutional and national research committee (New Zealand Health and Disabilities Ethics Committee) and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

All participants provided written informed consent prior to taking part in the study.

Electronic Supplementary Material

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Faulkner, J., Stoner, L., Lanford, J. et al. Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke. Transl. Stroke Res. 8, 220–227 (2017). https://doi.org/10.1007/s12975-016-0510-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12975-016-0510-6

Keywords

Search

Navigation