The effectiveness of cardiovascular rehabilitation for transient ischaemic attack and mild stroke: A randomised controlled trial.

Abstract

ObjectivesEvaluate the effectiveness of integrated cardiovascular rehabilitation on functional exercise capacity, physical activity, anthropometrics, blood pressure, quality-of-life, anxiety, and depression, for people with transient ischaemic attack (TIA) or mild stroke, over 6 months compared with usual care.DesignRandomised controlled trial.SettingUniversity health centre.ParticipantsAdults (≥18 years) with a TIA or mild stroke in the past 12-months.InterventionOverall, 140 TIA and mild stroke participants were randomised 1:1 to a once-weekly 6-week cardiovascular rehabilitation programme (n = 70), or usual care (n = 70).Main measuresOutcomes assessed at baseline, 6 weeks, and 6 months included 6-min walk test distance (6MWTD), moderate-to-vigorous physical activity, body mass index, waist circumference, blood pressure, Assessment of Quality-Of-Life 6 dimensions (AQoL-6D) and Hospital Anxiety and Depression Scale.ResultsParticipants' median age was 73 years (interquartile range 63-80). Fully-adjusted analyses showed no between-group differences in 6MWTD, while AQoL-6D coping scores improved significantly, favouring cardiovascular rehabilitation at 6 weeks (β:  3.6, 95% CI:  0.07-7.2). There were significant within-group improvements in the intervention group only for AQoL-6D mental health at 6 weeks and coping at 6 months. No other outcomes differed between groups. Subgroup analyses showed small, non-significant 6MWTD gains among TIA intervention participants (Cohen's d = 0.40).ConclusionsCardiovascular rehabilitation was not more effective than usual care in improving exercise capacity, physical activity, anthropometrics, blood pressure, anxiety or depression. Though a short-term quality-of-life improvements suggest psychosocial benefits. Future studies should explore minimum effective programme dosage using sensitive exercise capacity measures, evaluating TIA and mild stroke populations separately.Clinical Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12621001586808, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621001586808.