A randomized controlled trial to assess the central hemodynamic response to exercise in patients with transient ischaemic attack and minor stroke

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.

Effect of aerobic training on vascular and metabolic risk factors for recurrent stroke: a meta-analysis

“…The outcomes of two articles [31,32] were only reported once and therefore could not be pooled in a meta-analysis. Hence, nine articles were included in the meta-analysis (Figure 1) [20][21][22][23][33][34][35][36][37]. Reasons for exclusion were: combined therapies (N ¼ 22); no RCT study design (N ¼ 7); no relevant outcome measures (N ¼ 5) and no full-text article available (N ¼ 1).…”

“…The methodological quality of included studies ranged from four to eight out of ten on the PEDro scale ( Table 1). None of the studies were rated as poor methodological quality, four studies were rated as fair methodological quality [20,21,36,37], and five studies were rated as high methodological quality [22,23,[33][34][35]. Most common causes for risk of bias in individual studies were lack of concealed allocation, lack of blinding of subjects, therapists or assessors, relatively large amounts of missing data within key outcomes and no reported intention-to-treat analysis.…”

“…Sample size ranged from 20 to 128 participants with a total included sample of 527 participants. Time after stroke Faulkner et al [22] þ þ þ þ À À À þ þ þ þ 7/10 Ivey et al [36] þ þ À þ À À À À À þ þ 4/10 Jin et al [21] þ þ þ þ À À À À À þ þ 5/10 Katz-Leurer et al [23] þ þ þ þ À À À þ À þ þ 6/10 Ofori et al [37] þ þ À þ À À À À À þ þ 4/10 Potempa et al [20] þ þ À þ À À À À À þ þ 4/10 Tang et al [34] À þ þ þ À À þ þ þ þ þ 8/10 Wang et al [33] þ þ þ þ À þ À þ þ þ þ 8/10 Wang et al [35] þ þ þ þ À þ þ À À þ þ 7/10 1. Eligibility criteria were specified; 2.…”

“…In total, nine studies (N ¼ 527) [20][21][22][23][33][34][35][36][37] were included in the meta-analysis. We identified a total of 44 vascular or metabolic outcome variables that were reported in the eligible studies.…”

“…Aerobic training is proofed to have a positive effect on blood pressure in hypertensive patients without comorbidities [19]. Furthermore, several clinical trials have analyzed the effect of solely aerobic training on risk factors after stroke [20][21][22][23]. The findings of these trials suggest that aerobic training could have a risk reducing effect on several vascular or metabolic risk factors (e.g., blood pressure, heart rate, insulin or lipid profiles).…”