A Comparison of Cardiac Rehabilitation for Non-Disabling Stroke and Cardiac Conditions: Outcomes and Healthcare Professionals’ Perceptions

Perspectives and Experiences of Cardiac Rehabilitation after Stroke—A Qualitative Study

“…Study participants valued the comradery of exercising in a group setting, felt safe in initiating exercise, and gained a sense of confidence to exercise independently, perspectives previously reported in individuals both with stroke [ 4 , 28 ] and cardiac conditions [ 51 , 52 , 53 ]. The study offers further ancillary evidence of subjective improvement in physical fitness to support physical and physiological fitness parameters reported in stroke participants following CR [ 19 , 22 , 23 , 24 ].…”

“…It was here that focus-group participants’ difficulties with cognitive functions, namely memory, thinking, attention, and sequencing, mainly surfaced and were discussed, along with mood problems, which were predominantly those of depression. A previous study identified that cardiac-rehabilitation professionals perceive individuals with stroke to have more cognitive difficulties and greater depressive symptoms than cardiac patients and identified that they were more likely to miss appointments and engage less with the educational components [ 24 ]. The recent national audit of stroke in Ireland [ 58 ] identified that, in the acute hospital setting, only 4% of individuals with stroke were assessed by a psychologist and 22% had their mood screened, suggesting that many of these issues may go undiagnosed.…”

“…Exercise and lifestyle-based interventions modelled on cardiac rehabilitation (CR) have been proposed for physical conditioning to improve habitual PA for survivors of stroke and to reduce lifestyle risk factors after stroke [ 19 ]. CR is a proven and established secondary prevention programme in coronary heart disease [ 20 , 21 ], and results from across Europe and North America suggest that CR is not only feasible to provide after stroke, but it is a safe, effective, and integrated approach for risk-factor reduction and to improve cardiorespiratory fitness [ 4 , 22 , 23 , 24 , 25 ]. Notably, stroke participants are reported to make similar improvements to cardiac patients during CR in cardiorespiratory fitness; risk-factor reduction; and physiological markers, including lipid profiles and blood pressure [ 24 ].…”

“…Despite promising findings for CR as a stroke secondary prevention programme, suboptimal (55–57%) uptake rates and dropout rates of more than double that of cardiac counterparts are reported for people with stroke when referred to cardiac rehabilitation [ 24 , 25 ]. Higher uptake rates (71%) are reported in individuals who already attend outpatient stroke rehabilitation [ 26 , 27 ], where the barriers recorded included lack of interest and transportation issues [ 26 ].…”

“…Higher uptake rates (71%) are reported in individuals who already attend outpatient stroke rehabilitation [ 26 , 27 ], where the barriers recorded included lack of interest and transportation issues [ 26 ]. CR health professionals with experience in providing CR after stroke provide alternative insights, citing concerns about cognition and program engagement in participants with stroke that warrant greater consideration [ 24 ]. During a focus-group discussion, they noted that, during CR, individuals with stroke were more likely to miss appointments and engage less with risk-factor education in comparison to the cardiac participants [ 24 ].…”