title: Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke.
abstract: Participation in exercise and education programs following transient ischemic attack (TIA) or minor stroke may decrease cardiovascular disease risk. The purpose of this study was to assess the long-term effect (3.5 years) of an exercise and education program administered soon after TIA or minor stroke diagnosis on clinical outcome measures (stroke classification and number, patient deaths, hospital/emergency department admission) and cost implications obtained from standard hospital records. Hospital records were screened for 60 adults (male, n = 31; 71 ± 10 years), diagnosed with TIA or non-disabling stroke, who had previously been randomised and completed either an 8-week exercise and education program, or usual care control. Follow-up clinical outcomes and cost implications were obtained 3.5 ± 0.3 years post-exercise. Participants randomised to the exercise and education program had significantly fewer recurrent stroke/TIAs (n = 3 vs. n = 13, Cohen's d = 0.79) than the control group (P ≤ 0.003). Similar finding were reported for patient deaths (n = 0 vs. n = 4, d = 0.53), and hospital admissions (n = 48 vs. n = 102, d = 0.54), although these findings were only approaching statistical significance. The relative risk (mean; 95%CI) of death, stroke/TIAs and hospital admissions were 0.11 (0.01 to 1.98), 0.23 (0.07 to 0.72) and 0.79 (0.57 to 1.09), respectively. Hospital admission costs were significantly lower for the exercise group ($9041 ± 15,080 NZD [~$6000 ± 10,000 USD]) than the control group ($21,750 ± 22,973 NZD [~$14,000 ± 15,000 USD]) during the follow-up period (P < 0.05, d = 0.69). The present study demonstrates the long-term patient benefit and economic importance of providing secondary prevention, exercise and education programs for patients with TIA and minor stroke. URL: http://www.anzctr.org.au/ ; Trial Registration Number: ACTRN12611000630910.
authors.affiliation: Department of Sport and Exercise, University of Winchester, Winchester, UK. James.Faulkner@winchester.ac.uk.
authors.forename: James
authors.initials: J
authors.lastname: Faulkner
authors.affiliation: Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Stoner
authors.affiliation: Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Lanford
authors.affiliation: Wellington Regional Hospital, Wellington, New Zealand.
authors.forename: Evan
authors.initials: E
authors.lastname: Jolliffe
authors.affiliation: Department of Sport and Exercise, University of Winchester, Winchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mitchelmore
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Lambrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D055502:Secondary Prevention / Q000191:economics / Q000379:methods; D020521:Stroke / Q000150:complications*; D013995:Time
keywords: Education; Hospital admissions; Physical activity; Secondary prevention; Stroke prevention; Transient ischaemic attack