Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Suskin, Neville

2nd Supervisor

Stranges, Saverio

Co-Supervisor

Abstract

Introduction: Transient ischemic attack (TIA) is characterized by temporary neurological dysfunction and carries a short-term risk of stroke, hospitalization, and death. Cardiac rehabilitation and secondary prevention (CRSP) involving behavior change and exercise reduces morbidity and mortality among heart patients but is typically not offered after TIA, despite similarities in risk factors between coronary artery disease and stroke. Current stroke secondary prevention strategies are suboptimal.

Objectives: To quantify the relationship between exercise adherence and functional capacity at CRSP exit among exercise-trained TIA and mild non-disabling stroke (MNDS) patients and to determine if CRSP improves physical and psychological outcomes.

Methods: From 2004 to 2014, 115 exercise-trained TIA/MNDS across three studies were used for this study. Linear regression was used to analyze the primary objective and paired t-tests were used to compare intake and exit measures of the secondary objectives.

Results: There was a positive relationship between exercise attendance and improvement in functional capacity and the participants had clinically significant improvements in key cardiovascular risk factors and psychometrics.

Conclusion: This study illustrated a “dose-response like” relationship between exercise attendance and functional capacity that reached a clinically significant improvement of 0.5 METS (Canadian Cardiovascular Society quality indicator). Future work should investigate the long-term impact of CRSP for TIA/MNDS patients as well as cost-effectiveness analyses.

Summary for Lay Audience

A transient ischemic attack (TIA) often called a mini-stroke serves as an important warning sign for future vascular events. TIAs have a short-term risk of stroke, hospitalization and death. Current stroke prevention strategies are spread across multiple organizations and the clinical practice is variable. Cardiac rehabilitation and secondary prevention (CRSP) is a program offered to heart patients that is designed to improve their cardiovascular health. The problem is that cardiac rehabilitation is not typically offered to TIA patients despite the fact that they share similar risk factors. This study aimed to investigate the relationship between exercise attendance and exercise capacity among exercise-trained TIA and mild non-disabling stroke (MNDS) patients enrolled in CRSP. It also aimed to determine if CRSP for TIA/MNDS patients improves their physical and psychological outcomes. We selected 115 exercise-trained TIA/MNDS patients that were a part of three studies that occurred between 2004 and 2014 to conduct the statistical analyses. We found that there was a positive relationship between exercise attendance and improvement in exercise capacity. Additionally, exercise-trained TIA/MNDS patients had clinically significant improvements in cardiovascular risk factors and psychological outcomes. In conclusion, we observed a “dose-response like” relationship between exercise attendance and exercise capacity and we observed favourable outcomes that reached clinically significant improvements. Our findings suggest that CRSP may be a more effective means for secondary prevention for this patient population.

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