Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention.

Olive Lennon,Catherine Blake,Patricia Hall

doi:10.3390/ijerph18094666

Abstract

The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men.

Highlights

Ischaemic stroke is a leading cause of death and adult-acquired disability [1]
While the health behaviours reported and the proportion of study participants categorised as overweight and obese by body mass index (BMI) category in this study were equivalent to the available population normative data for a similar age range [47], this study suggests that little behaviour change occurred following stroke and presents clear opportunities to enhance secondary prevention after stroke
Where the regression models employed in the current study identified predictors of one or more lifestyle-related, modifiable risk factor for recurrent events, the authors discuss these in detail below and further present a proposed decision tree for interventions to guide clinicians based on the findings of this study (Figure 2)

Summary

Introduction

Ischaemic stroke is a leading cause of death and adult-acquired disability [1]. Over67.5 million people globally are living following an ischaemic stroke event [2]. Ischaemic stroke is a leading cause of death and adult-acquired disability [1]. Secondary prevention is critical as recurrent stroke risk is 6- to 15-fold higher than the risk of stroke in the general population [3,4]. Recurrent stroke is associated with higher mortality rates and increased disability levels [3,5,6,7]. First-ever ischaemic stroke is further associated with an increased risk of incident heart disease [8] and future non-stroke vascular death and myocardial infarct [9,10]. Compliance with multiple low-risk lifestyle behaviours relating to smoking, BMI, physical activity, alcohol consumption, and diet reduces the risk of ischaemic stroke by up to 80% [19]

Objectives

Discussion

Conclusion