Individuals diagnosed with a transient ischemic attack (TIA) or mild/non-disabling stroke are at high risk of cardiovascular or recurrent cerebrovascular (stroke, TIA) events. Pharmacological intervention is considered the cornerstone of secondary prevention care for this population group. However, recent research has explored the utility of non-pharmacological interventions (eg exercise, diet, education) in improving health outcomes and reducing the risk of secondary events in patients with TIA or mild/non-disabling stroke (Faulkner, et all).

A new commentary discussing the efficacy of implementing exercise interventions for acute and non-acute TIA and stroke patients was described in the recent Rehabilitation Process and Outcome paper. Dr James Faulkner discusses the background and findings of his research paper Physical Activity and Exercise for Patients with TIA:

How did you become interested in studying exercise engagement in patients diagnosed with transient ischemic attack?

My first foray into the world of exercise rehabilitation for stroke survivors was during my Ph.D during which I co-ordinated a charity called ‘Action After Stroke’. This organisation provided regular exercise sessions to stroke survivors in my local area. The opportunity to work with patients, family members and care givers was inspirational and encouraged me to undertake research with this population group. Following my appointment at Massey University I made a concerted effort to meet with Neurologists at Wellington Hospital to foster potential collaborative links. It was evident that the provision of secondary care for TIA patients, including the utility of physical activity, was one which required further consideration. As meta-analyses have shown that TIA patients have a short-term risk of stroke after TIA to be up-to 10 % at 2 days and between 9 % and 17 % at 90 days, I thought this was a population group which required further research and attention.

What was previously known about interventions in reducing the risk of secondary events in patients with TIA?  How has your work in this area advanced understanding of it?

Recent research has considered the utility of physical activity as a secondary prevention strategy for non-acute ischaemic stroke patients (Lennon et al., 2008) and TIA patients (Prior et al., 2011). These research studies demonstrated improvements in aerobic capacity and vascular risk factors following either a 10 week (Lennon & Blake, 2008) or 6 month (Prior et al., 2011) exercise programme. However, these programmes were implemented in the non-acute phase. Accordingly, we were interested in identifying the effect of early exercise engagement on vascular health, aerobic fitness and recurrence of vascular complications, particularly as early mobilization and better blood pres¬sure control has been suggested to be the highest contributors to improved health outcomes in this population group. We believe that recent research investigations from our laboratory have demonstrated the importance of engaging participants in exercise within 2 weeks of TIA diagnosis.

What do regard as being the most important aspect of the results of your research?

The most encouraging aspect from this line of research is that regular exercise participation, whether undertaken soon after TIA diagnosis or a little later, appears to elicit significant benefits in physiological health (i.e., reducing cardiovascular disease risk factors; blood pressure, blood lipid profile) and improvements in aerobic fitness. However, we need to develop a body of evidence to demonstrate whether early exercise engagement, for example, elicits a reduction in recurrent vascular events for this population group, and whether the short-term benefits observed are sustained over a longer period of time.

What was the greatest difficulty you encountered while conducting this studying?

Recent research from our laboratory has been labour intensive and undertaken on a very small budget. The drive, effort and enthusiasm of the physicians and clinical nurses at the Hospital, the academics and researchers at the University, and the health and exercise practitioners, is the primary reason as to why research in this area has been a success. Managing the various roles of the research team has been particularly challenging, especially when considering that these randomized controlled trials have been undertaken in addition to individual’s every-day work commitments.

Dr James Faulkner is a Senior Lecturer in Exercise Prescription at Massey University. To contact or find out more about Dr Faulkner’s research please visit the Massey University departmental page.

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