The cardiac model of rehabilitation for reducing cardiovascular risk factors post transient ischaemic attack and stroke: a randomized controlled trial

Objective: To evaluate the feasibility and effectiveness of a standard National Health Service cardiac rehabilitation programme on risk factor reduction for patients after a minor stroke and transient ischaemic attack. Design: Single-blind randomized controlled trial. Setting: Cardiac rehabilitation classes. Subjects: Twenty-four patients. Intervention: All participants received standard care. In addition, the intervention group undertook an eight-week cardiac rehabilitation programme consisting of weekly exercise and education classes. Outcome measures: Cardiovascular disease risk score; lipid profiles; resting blood pressure; C-reactive protein (measured with a high sensitive assay) and fibrinogen levels; blood glucose; obesity; physical activity levels; subjective health status (SF-36); Hospital Anxiety and Depression Scale. Results: Group comparison with independent t-tests showed a significantly greater improvement in the cardiovascular disease risk score for participants in the intervention group compared to standard care (intervention 25.7 +/- 22.8 to 23.15 +/- 18.3, control 25.03 +/- 15.4 to 27.12 +/- 16.1, t = -1.81, P < 0.05). There were also significant improvements for the intervention group in activity levels (intervention 9.41 +/- 7.7 to 8.08 +/- 5.7, control 14.50 +/- 5.5 to 9.83 +/- 6.6, t = -2.00, P < 0.05) and the SF-36 domains of physical functioning (intervention 70 +/- 24.6 to 75.4 +/- 11.1, control 90.00 +/- 12.4 to 83.16 +/- 17.3, t = -2.72, P < 0.05) and mental health (intervention 84 +/- 40 to 92 +/- 40, control 88.00 +/- 60 to 84 +/- 44, z = -2.06, P < 0.05). Conclusion: The results suggest that standard cardiac rehabilitation programmes are a feasible and effective means of reducing the risk of future cardiovascular events for patients after minor stroke and transient ischaemic attack.