Abstract
Early exercise engagement elicits meaningful changes in peripheral blood pressure in patients diagnosed with transient ischaemic attack (TIA) or minor stroke. However, central hemodynamic markers may provide clinicians with important diagnostic and prognostic information beyond that provided by peripheral blood pressure readings. The purpose of this single-centre, randomized, parallel-group clinical trial was to determine the effect of a 12-week aerobic exercise intervention on central and peripheral hemodynamic variables in patients with TIA or minor stroke. In this study, 47 participants (66±10 years) completed a baseline assessment, which involved the measurement of central and peripheral hemodynamic parameters, undertaken in the morning, in a fasted state. Participants were randomized to either a 12-week exercise or control group on completion of the baseline assessment. An identical follow-up assessment was completed post intervention. Central hemodynamic variables were assessed using an oscillometric device at both assessments. Analysis of covariance demonstrated a significant interaction for central and peripheral blood pressure and augmentation index (all P<0.05; ηp2.09–.11), with the exercise group presenting lower values than the control group post intervention (118±17 vs 132±28 mm Hg for central blood pressure; 125±19 vs 138±28 mm Hg for peripheral blood pressure; 104±49 vs 115±67% for augmentation index). The present study demonstrates that participation in an exercise program soon after stroke/TIA diagnosis may elicit significant beneficial changes to a patient’s central systolic blood pressure and augmentation index. This may positively impact upon the treatment strategies implemented by clinicians in the care of patients with TIA and minor stroke.
Highlights
Blood pressure is an important risk factor for stroke,[1] and is widely cited as a marker that needs to be controlled post stroke by pharmacological and lifestyle management.[2]
A significant interaction was observed for peripheral pulse pressure and central pulse. This is the first study to demonstrate that central systolic blood pressure (cSBP) and augmentation index (AIx) are significantly reduced in participants with minor stroke and high-risk transient ischaemic attack (TIA) following participation in an exercise intervention, soon after diagnosis
Despite similarities in baseline demographics, the 7% improvement in cSBP following participation in a 12-week exercise program equated to a large effect size (η2p = 0.11)
Summary
Blood pressure is an important risk factor for stroke,[1] and is widely cited as a marker that needs to be controlled post stroke by pharmacological and lifestyle management.[2] A recent metaanalysis with stroke and transient ischaemic attack (TIA) patients has shown that significant reductions in peripheral blood pressure responses may be evident following participation in behavioural interventions (that is, exercise, lifestyle management programs).[3]. Peripheral blood pressures may not accurately reflect the effects of peak arterial blood pressure on centrally located organs such as the heart and brain.[4] This is important because individuals who experience a stroke or TIA are at heightened risk of experiencing subsequent vascular events, whether from a cerebrovascular (that is, stroke/TIA) or cardiovascular (that is, myocardial infarction) origin.[5,6] the assessment of cSBP is important as it reflects the stress and loading on the left ventricle and coronary arteries.[7,8] Yet to date, the effects of secondary prevention behavioural interventions on central blood pressure responses in stroke or TIA patients have not been assessed. As behavioural interventions which have incorporated exercise training, counseling and lifestyle education reduce the risk of subsequent cardiac events in patients with stroke,[3] further research is necessary to elucidate the underlying central hemodynamic response to these types of intervention for patients with stroke or TIA
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