Healthy Lifestyle and the Risk of Stroke in Women Reducing Recurrent Stroke: Methodology of the Motivational Interviewing in Stroke (MIST) Randomized Clinical Trial Preventive effects of multiple domain interventions on lifestyle and risk factor changes in stroke survivors: Evidence from a two-year randomized trial A telehealth intervention to promote healthy lifestyles after stroke: The Stroke Coach protocol Primary Prevention of Stroke by Healthy Lifestyle Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Utility of electronic patient records in primary care for stroke secondary prevention trials [The lifestyle modification coaching program for secondary stroke prevention]. Alcohol and Risk for Ischemic Stroke in Men: The Role of Drinking Patterns and Usual Beverage Lifestyle factors on the risks of ischemic and hemorrhagic stroke. Effectiveness of community-based comprehensive healthy lifestyle promotion on cardiovascular disease risk factors in a rural Vietnamese population: a quasi-experimental study An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Prevention of Poststroke Cognitive Decline: ASPIS – a Multicenter, Randomized, Observer-Blind, Parallel Group Clinical Trial to Evaluate Multiple Lifestyle Interventions – Study Design and Baseline Characteristics Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial Stop Stroke: development of an innovative intervention to improve risk factor management after stroke. Secondary Prevention of New Vascular Events with Lifestyle Intervention in Patients with Noncardioembolic Mild Ischemic Stroke: A Single-Center Randomized Controlled Trial Relation of Consumption of Vitamin E, Vitamin C, and Carotenoids to Risk for Stroke among Men in the United States Lifestyle Factors and Risk of Cerebrovascular Disease in Women: The Copenhagen City Heart Study Preventing Recurrence of Thromboembolic Events through Coordinated Treatment in the District of Columbia Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trial Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. Impact of enhanced secondary prevention on health behaviour in patients following minor stroke and transient ischaemic attack: a randomized controlled trial
BACKGROUND Healthy lifestyle has been associated with decreased risk of coronary heart disease . In contrast , little is known about its association with stroke risk . METHODS This is a prospect i ve cohort study among 37 636 women 45 years or older participating in the Women 's Health Study . Stroke was self-reported and confirmed by means of medical record review . We considered the following self-reported lifestyle factors : smoking , alcohol consumption , exercise , body mass index , and diet . The health index was calculated from these variables by assigning scores from 0 to 4 to the respective variable categories , with a higher score indicating healthier behavior . Healthy behavior was defined as never smoking , alcohol consumption between 4 and 10.5 drinks per week , exercise 4 or more times per week , body mass index ( calculated as weight in kilograms divided by the square of height in meters ) less than 22 , and a diet high in cereal fiber , folate , and omega-3 fatty acids , with a high ratio of polyunsaturated to saturated fat , and low in trans fat and glycemic load . RESULTS During 10 years of follow-up , 450 strokes ( 356 ischemic , 90 hemorrhagic , and 4 undefined ) were confirmed . Compared with participants with 0 to 4 health index points ( 4.3 % ) , women with 17 to 20 health index points ( 4.7 % ) had multivariable-adjusted hazard ratios ( 95 % confidence interval ) of 0.45 ( 0.24 - 0.83 ; P<.001 for trend ) for total stroke , 0.29 ( 0.14 - 0.63 ; P<.001 for trend ) for ischemic stroke , and 1.27 ( 0.37 - 4.29 ; P = .62 for trend ) for hemorrhagic stroke . CONCLUSIONS In this large prospect i ve cohort of apparently healthy women , a healthy lifestyle consisting of abstinence from smoking , low body mass index , moderate alcohol consumption , regular exercise , and healthy diet was associated with a significantly reduced risk of total and ischemic stroke but not of hemorrhagic stroke . Our findings underscore the importance of healthy behaviors in the prevention of stroke Rationale Recurrent stroke is prevalent in both developed and developing countries , contributing significantly to disability and death . Recurrent stroke rates can be reduced by adequate risk factor management . However , adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor , leading to a large number of preventable recurrent strokes . Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke . Aims and /or hypothesis The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke . Design Recruitment of 430 first-ever stroke participants will occur in the Auckl and and Waikato regions . R and omization will be to intervention or usual care groups . Participants r and omized to intervention will receive four motivational interviews and five follow-up assessment s over 12 months . Nonintervention participants will be assessed at the same time points . Study outcomes Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke . Secondary outcomes include self-reported adherence and barriers to prescribed medications , new cardiovascular events ( including stroke ) , changes in quality of life , and mood . Discussion The results of the motivational interviewing in stroke trial will add to our underst and ing of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant Background and aim Behavioral and lifestyle interventions in stroke patients need to be intense enough to result in sustainable treatment differences among groups of a r and omized trial . Therefore , we report the effects of multidomain interventions on lifestyle and laboratory parameters after 12 and 24 months from a trial that examined whether intensive risk factor management can prevent cognitive decline in ischemic stroke patients . Methods This prospect i ve r and omized , open-label , blinded endpoint trial recruited patients within three months after acute stroke in five Austrian neurological clinics during June 2010 and November 2012 . One hundred and one patients were r and omized into multidomain intervention and 101 into st and ard care . Lifestyle interventions were individualized to match predefined targets of regular physical activity , healthy diet , and adequate physiological risk factor control . Results A total of 167 participants ( 80 intervention , 87 control ) completed the 12-month visit and 155 ( 76 intervention , 79 control ) the 24-month visit . During the first 12 months , adherence to healthy lifestyle and adequately controlled physiological parameters ( measured by summary scores ) improved significantly in the intervention group compared to controls ( p < 0.01 ) . The consumption of reduced-fat milk ( p = 0.031 ) , reduced-fat spreads ( p = 0.007 ) , and fish ( p = 0.021 ) increased in the intervention group from baseline to 12 months but not in controls . After 24 months , the group difference was significant for the lifestyle summary score but no longer for the combined laboratory lifestyle score . Conclusions These results demonstrate that intensified individualized multidomain lifestyle interventions in stroke patients are effective in promoting healthy lifestyle in stroke care Rationale Recurrent stroke is prevalent and associated with high mortality rates , disability , and social and economic costs . Adequate management of risk factors may reduce recurrent stroke ; however , many stroke survivors have poor control of risk factors . We have developed a theoretically sound and evidence -based lifestyle modification program called the Stroke Coach , a telephone-based self-management program to improve control of risk factors . Hypothesis Individuals who participate in Stroke Coach will achieve more lifestyle improvements than individuals in an attention controlled Memory Training Program . Design In this single blind r and omized controlled trial , 126 community-living stroke survivors will be r and omized to Stroke Coach or the attention control group . Participants r and omized to the six-month Stroke Coach will receive seven telephone lifestyle coaching sessions , self-management education and practice , and a self-monitoring kit , comprised of a health report card , with blood pressure and activity monitors . Study Outcomes The primary outcome will be measured using the Health Promoting Lifestyle Profile II . Secondary outcomes include behavioral and physiological risk factors , quality of life , cognitive status , health and social service use . Measurements will be taken at baseline , immediately after the intervention and six-month post-intervention . Summary The results of this trial will add to our underst and ing of the use of self-management to improve control of risk factors , and may facilitate the development of a larger trial evaluating the effect of Stroke Coach on endpoints such as recurrent stroke or cardiac events as the primary outcome Background — The combination of healthy lifestyle factors is associated with lower risk of coronary heart disease , diabetes , and total cardiovascular disease . Little is known about the impact of multiple lifestyle factors on the risk of stroke . Methods and Results — We conducted a prospect i ve cohort study among 43 685 men from the Health Professionals Follow-up Study and 71 243 women from the Nurses ’ Health Study .  Diet and other lifestyle factors  were up date d from self-reported question naires . We defined a low-risk lifestyle as not smoking , a body mass index < 25 kg/m2 , ≥30 min/d of moderate activity , modest alcohol consumption ( men , 5 to 30 g/d ; women , 5 to 15 g/d ) , and scoring within the top 40 % of a healthy diet score . We documented 1559 strokes ( 853 ischemic , 278 hemorrhagic ) among women and 994 strokes ( 600 ischemic , 161 hemorrhagic ) among men during follow-up . Women with all 5 low-risk factors had a relative risk of 0.21 ( 95 % confidence interval [ CI ] , 0.12 , 0.36 ) for total and 0.19 ( 95 % CI , 0.09 , 0.40 ) for ischemic stroke compared with women who had none of these factors . Among men , the relative risks were 0.31 ( 95 % CI , 0.19 , 0.53 ) for total and 0.20 ( 95 % CI , 0.10 , 0.42 ) for ischemic stroke for the same comparison . Among the women , 47 % ( 95 % CI , 18 to 69 ) of total and 54 % ( 95 % CI , 15 to 78 % ) of ischemic stroke cases were attributable to lack of adherence to a low-risk lifestyle ; among the men , 35 % ( 95 % CI , 7 to 58 ) of total and 52 % ( 95 % CI , 19 to 75 ) of ischemic stroke may have been prevented . Conclusion — A low-risk lifestyle that is associated with a reduced risk of multiple chronic diseases also may be beneficial in the prevention of stroke , especially ischemic stroke Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Background This study aim ed to inform the design of a pragmatic trial of stroke prevention in primary care by evaluating data recorded in electronic patient records ( EPRs ) as potential outcome measures . The study also evaluated achievement of recommended st and ards of care ; variation between family practice s ; and changes in risk factor values from before to after stroke . Methods Data from the UK General Practice Research Data base ( GPRD ) were analysed for 22,730 participants with an index first stroke between 2003 and 2006 from 414 family practice s. For each subject , the EPR was evaluated for the 12 months before and after stroke . Measures relevant to stroke secondary prevention were analysed including blood pressure ( BP ) , cholesterol , smoking , alcohol use , body mass index ( BMI ) , atrial fibrillation , utilisation of antihypertensive , antiplatelet and cholesterol lowering drugs . Intraclass correlation coefficients ( ICC ) were estimated by family practice . R and om effects models were fitted to evaluate changes in risk factor values over time . Results In the 12 months following stroke , BP was recorded for 90 % , cholesterol for 70 % and body mass index ( BMI ) for 47 % . ICCs by family practice ranged from 0.02 for BP and BMI to 0.05 for LDL and HDL cholesterol . For subjects with records available both before and after stroke , the mean reductions from before to after stroke were : mean systolic BP , 6.02 mm Hg ; diastolic BP , 2.78 mm Hg ; total cholesterol , 0.60 mmol/l ; BMI , 0.34 Kg/m2 . There was an absolute reduction in smokers of 5 % and heavy drinkers of 4 % . The proportion of stroke patients within the recommended guidelines varied from less than a third ( 29 % ) for systolic BP , just over half for BMI ( 54 % ) , and over 90 % ( 92 % ) on alcohol consumption . Conclusions Electronic patient records have potential for evaluation of outcomes in pragmatic trials of stroke secondary prevention . Stroke prevention interventions in primary care remain suboptimal but important reductions in vascular risk factor values were observed following stroke . Better recording of lifestyle factors in the GPRD has the potential to exp and the scope of the GPRD for health care research and practice PURPOSE The purpose of this study was to investigate the effects of the lifestyle modification coaching program on self efficacy , lifestyle and physiologic indexes related to the recurrence of stroke in patients with stroke . METHODS Sixty-one patients with stroke registered with a stroke center participated in this study . Of the participants , 32 were assigned to the experimental group and 29 to the control group .  Self efficacy , alcohol drinking , smoking , physical activity , BMI ( body mass index ) , WHR ( waist-hip ratio ) , blood lipid level , and blood pressure were measured both for the baseline , as well as after intervention . The lifestyle modification coaching program consisted of an 8-week telecoaching session following face-to-face education . The control group received only the face-to-face education . RESULTS There were significant differences in physical activities , WHR , blood pressure within and between groups after intervention . The lifestyle modification coaching program had significant influences on blood pressure even after gender , age , and physical activity had been adjusted . CONCLUSION The results of the study indicate that lifestyle modification coaching program is effective for physical activity , abdominal obesity and blood pressure . Therefore it can be used by nurses in hospitals and communities as one of the secondary stroke prevention programs for patients with stroke Context Past studies do n't clearly show that alcohol consumption affects the risk for ischemic stroke . Contribution This prospect i ve cohort study involving 38156 male health professionals followed for 14 years found that consuming more than 2 drinks daily was associated with an increased risk for ischemic stroke . Two drinks or fewer were not associated with increased risk .  Consuming red wine , but not other beverage types , was associated with a lower risk . Caution s The study had limited power to determine the precise drinking patterns that were associated with stroke risk . Implication s These findings support public health recommendations to avoid consuming more than 2 drinks daily . The Editors Although epidemiologic studies consistently link moderate alcohol consumption with a lower risk for myocardial infa rct ion ( 1 ) , the relationship between alcohol consumption and ischemic stroke is less clear . However , previous studies of alcohol consumption and ischemic stroke have often had important limitations , including failure to assess drinking pattern , assessment s of alcohol intake that have not been vali date d , failure to distinguish stroke subtypes , insufficient follow-up to incorporate changes in alcohol use over time , and lack of control for various healthy lifestyle features associated with moderate drinking ( 2 , 3 ) . Another area of controversy is the role of beverage type . Red wine contains specific phenolic compounds that may prevent oxidation of low-density lipoprotein cholesterol and inhibit smooth-muscle cell proliferation ( 4 , 5 ) . In keeping with these experimental findings , the Copenhagen City Heart Study reported that consumption of wine , but not of beer or liquor , was associated with a lower risk for stroke ( mostly ischemic ) ( 6 ) . However , a healthier lifestyle among wine drinkers , rather than the nonalcoholic components of wine , may explain the apparent benefits attributable to wine ( 7 ) . Most previous studies of alcohol and ischemic stroke did not account for dietary and other lifestyle differences among wine drinkers , drinkers of other alcoholic beverages , and abstainers . To address these questions , we studied the relationship between alcohol consumption and incident ischemic stroke over a 14-year period among 38156 participants of the Health Professionals Follow-up Study ( 8) , a prospect i ve cohort of male health professionals in the United States . In these analyses , we assessed how drinking pattern , baseline and up date d measures of alcohol consumption , and individual beverage types influence the association of alcohol consumption with risk for ischemic stroke . Methods The Health Professionals Follow-up Study enrolled 51529 U.S. male dentists , veterinarians , optometrists , pharmacists , osteopathic physicians , and podiatrists 40 to 75 years of age who returned a mailed question naire regarding diet and medical history in 1986 . Follow-up question naires were sent biennially to up date information on exposures and newly diagnosed illnesses . For this analysis , we excluded 5544 men who reported a baseline history of cardiovascular disease or cancer ( other than nonmelanoma skin cancer ) , 1706 who had missing or implausible nutritional information at baseline ( including missing alcohol consumption , 70 missing food items , or estimated daily energy intake 800 or 4200 kcal ) , and 89 whose initial question naires had other technical problems . To minimize the inclusion of sick quitters , we also excluded 6034 men who consumed no alcohol at baseline but who reported that they had consumed alcohol in the previous 10 years , leaving 38156 men eligible for analysis . We assessed alcohol consumption within a 131-item semi-quantitative food-frequency question naire . The question naire included separate items about beer , white wine , red wine , and liquor . We specified st and ard portions as a glass , bottle , or can of beer ; a 4-ounce glass of wine ; and a shot of liquor . For each beverage , participants were asked how often , on average over the past year , they consumed that amount . We calculated ethanol intake by multiplying the frequency of consumption of each beverage by the alcohol content of the specified portion size ( 12.8 g for beer , 11.0 g for wine , and 14.0 g for liquor ) and summing across beverages ( 9 ) . This process was repeated in 1990 , 1994 , and 1998 , with an added item about light beer in 1994 . In 1986 , men also reported the number of days per week that they typically drank any form of alcohol . We previously assessed the validity of alcohol consumption estimated with the food-frequency question naire by comparing it with intake from two 1-week dietary records collected approximately 6 months apart among 136 participants residing in eastern Massachusetts ( 10 , 11 ) ; the Spearman correlation coefficient between these 2 measures was 0.86 . Estimated mean alcohol intake was 12.8 g/d using dietary records and 12.5 g/d with the food-frequency question naire , with no evidence of apparent systematic bias . The correlation coefficient for drinking frequency between our question naire and diet records was 0.79 . Alcohol consumption estimated from the question naires also correlated well with serum high-density lipoprotein cholesterol concentrations , with a Spearman correlation coefficient of 0.31 to 0.35 . We wrote to participants who reported an incident stroke on the follow-up question naires to confirm the report and request permission to review medical records . We defined a stroke as confirmed if it produced a typical neurologic deficit of rapid or sudden onset lasting 24 hours or more and was attributable to a cerebrovascular event . Physicians blinded to risk factor status conducted the medical record review . We defined a stroke as probable if we could not obtain medical records but the participant required hospitalization and the diagnosis was corroborated by supplementary correspondence ; only 1.2 % of included cases were considered probable rather than confirmed , and their exclusion did not affect our results . We categorized stroke types according to National Survey of Stroke criteria ( 12 ) , with categories of ischemic ( embolic or thrombotic ) , hemorrhagic ( subarachnoid or intracerebral ) , and unknown . We confirmed fatal strokes by using medical records ( 84 % ) , autopsy reports ( 2 % ) , or death certificates supplemented by confirmatory evidence from family members or previously collected medical history when medical records and autopsy reports were unavailable ( 14 % ) . There were too few cases of hemorrhagic stroke to study it separately in these analyses . Deaths were reported by families and postal officials and through the National Death Index . Follow-up for deaths was over 98 % complete when these sources were combined in a similar study among women ( 13 ) . Covariate information was generally derived from biennial question naires . Nutritional information ( energy , saturated fat , trans fatty acids , folate , vitamin E , magnesium , potassium , -3 fatty acids , dietary fiber , and caffeine ) was derived from food-frequency question naires administered every 4 years . Participants reported the presence of cardiovascular risk factors ( physician-diagnosed hypertension , diabetes , and hypercholesterolemia ; cigarette smoking ; and parental history of myocardial infa rct ion ) . Aspirin use included use of aspirin and aspirin-containing products at least twice weekly . Nutritional variables , anthropomorphic measures , aspirin use , and self-reported cardiovascular risk factors have been vali date d ( 14 - 19 ) . We calculated person-years for each participant from the date of return of the 1986 question naire to the date of the first stroke , the date of death , or January 2000 . We calculated incidence rates by dividing the number of ischemic strokes in each category by person-years of follow-up in that category . The relative risk was computed as the rate in a specific category of alcohol consumption divided by the rate in abstainers , with direct adjustment for age in 5-year categories and smoking in 6 categories ( never , former , 1 to 14 cigarettes/d , 15 to 24 cigarettes/d , 25 cigarettes/d , and missing ) . As in previous multivariate analyses ( 20 ) , we used pooled logistic regression and up date d covariates ( 21 ) . We simultaneously controlled for age ; smoking ; body mass index ( in quintiles ) ; aspirin use ; diabetes ; hypercholesterolemia ; average daily exertion ( in 5 categories ) ; energy intake ( in quintiles ) ; parental history of myocardial infa rct ion at or before age 60 years ; and energy-adjusted intake of saturated fat , trans fatty acids , folate , vitamin E , and dietary fiber ( each in quintiles ) , along with geographic region ( in 4 categories ) ( 22 ) and energy-adjusted intake of magnesium and potassium ( 23 ) and -3 fatty acids ( 24 ) . We did not include hypertension as a covariate in primary analyses but included it in sensitivity analyses to assess the degree to which it may mediate a positive association between alcohol use and risk for stroke . Dietary variables  were up date d every 4 years ; other potential confounding variables were up date d every 2 years . We assigned indicator variables where smoking or exercise information was missing , accounting for 12 % and 15 % of cumulative person-time , respectively . We stopped updating alcohol use at development of cancer ( other than nonmelanoma skin cancer ) , cardiovascular disease ( other than stroke ) , or hypertension ; analyses that censored participants at diagnosis of cancer or cardiovascular disease yielded similar results ( Appendix Table 1 ) . We conducted tests of linear trend across increasing categories of alcohol consumption by treating the midpoints of consumption in categories as a continuous variable . In most analyses , we categorized participants as abstainers , light drinkers ( 0.1 to 9.9 g/d ) , moderate drinkers ( 10 to 29.9 g/d ) , and heavier drinkers ( 30.0 g/d ) . These categories approximately correspond to average intake of no alcohol , less than 1 st and ard drink per day , 1 to 2 drinks per day , and more than 2 drinks per day . We performed primary analyses by BACKGROUND The joint effects of different lifestyle factors on stroke risk are still to some extent unclear , especially regarding hemorrhagic stroke . METHODS We prospect ively investigated the association of different indicators of lifestyle ( smoking , body mass index , physical activity , and vegetable and alcohol consumption )  with total and type-specific stroke incidence among 36 686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline . RESULTS During a mean follow-up period of 13.7 years , 1478 people developed an incident stroke event ( 1167 ischemic and 311 hemorrhagic ) . The multivariate-adjusted ( age , sex , education , family history of stroke , history of diabetes mellitus , systolic blood pressure , and serum total cholesterol level ) hazard ratios associated with adherence to 0 to 1 ( reference group ) , 2 , 3 , 4 , and 5 healthy lifestyle indicators were 1 , 0.66 , 0.57 , 0.51 , and 0.33 ( P < .001 for trend ) for total stroke ; 1 , 0.67 , 0.60 , 0.50 , and 0.30 ( P < .001 for trend ) for ischemic stroke ; and 1 , 0.63 , 0.49 , 0.49 , and 0.40 ( P < .001 for trend ) for hemorrhagic stroke , respectively . These inverse associations were similar in both men and women . The partial population attributable risk percentages associated with adherence to 3 , 4 , and 5 healthy lifestyle indicators were 26.3 % , 43.8 % , and 54.6 % for total stroke ; 22.7 % , 45.3 % , and 59.7 % for ischemic stroke ; and 35.0 % , 35.0 % , and 36.1 % for hemorrhagic stroke , respectively . CONCLUSION Healthy lifestyle factors are associated with a lower risk of stroke , and there is a grade d inverse association between the number of healthy lifestyle indicators and the risks of total , ischemic , and hemorrhagic stroke Background Health promotion is a key component for primary prevention of cardiovascular disease ( CVD ) . This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors ( CVDRF )  in the general population in the context of a community-based programme on hypertension management . Methods A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009 . In the intervention commune , a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated , while no new programme , apart from conventional healthcare services , was provided in the reference commune . Health promotion campaigns focused on smoking cessation , reducing alcohol consumption , encouraging physical activity and reducing salty diets . Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure ( BP ) and behavioural CVDRFs ( smoking , alcohol consumption , physical inactivity and salty diet ) in both communes before and after the 3-year intervention . Results Overall 4,650 adults above 25 years old were surveyed , in four r and omly independent sample s covering both communes at baseline and after the 3-year intervention . Although physical inactivity and obesity increased over time in the intervention commune , there was a significant reduction in systolic and diastolic BP ( 3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively ) in the general population at the intervention commune . Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption . Conclusion Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span . Limited effects on a context -bound CVDRF like smoking suggested that higher intensity of intervention , a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention BACKGROUND Rates of physical inactivity and poor nutrition , which are 2 of the most important modifiable risk factors for cardiovascular disease in women , are substantial . Even so , studies of interventions design ed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas . OBJECTIVE To evaluate the effect of Choose to Move on increasing women 's physical activity , improving their knowledge of heart disease and stroke , and improving their nutrition . PARTICIPANTS AND METHODS A prospect i ve , nonr and omized , 12-week educational intervention design ed by the American Heart Association for women across the United States . Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change . Women ( N = 23 171 ) aged 25 years or older were recruited by direct mail , the media , health care providers , and other means . Follow-up evaluations were returned from 6389 women at 2 weeks , 5338 at 4 weeks , 4209 at 8 weeks , 3916 at 10 weeks , and 3775 at 12 weeks . Participants self-reported their physical activity , diet , and knowledge about heart disease , stroke , and related symptoms . RESULTS Ninety percent of the participants were white and 56 % were aged between 35 and 54 years . Among the participants who completed the week 12 follow-up evaluation , the percentage who reported being active ( at least moderate exercise > or = 5 times per week or > 2(1/2 ) hours per week for the past 1 to 6 months ) increased from 32 % at baseline to 67 % at the program 's end ( P = .001 ) . Participants currently limiting excess calories or fat increased from 72 % to 91 % at week 10 follow-up evaluation ( P = .001 ) . The proportion correctly identifying heart disease as the leading cause of death increased from 84 % to 91 % at week 10 follow-up evaluation ( P<.001 ) . CONCLUSIONS Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity , reduced their consumption of high-fat foods , and increased their knowledge and awareness of cardiovascular disease risk and its symptoms . This program provides an important model for public health , voluntary , and other health organizations of population -based , targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity , nutrition , and cardiovascular health Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background Cognitive impairment after stroke is a considerable burden to patients and their caregivers and occurs in one-third of stroke survivors . No strategy to prevent cognitive decline after stroke exists thus far . Established vascular risk factors have been associated with cognitive decline and may be a target for therapeutic interventions in stroke survivors . Aim To test whether intensive multifactorial non-pharmacologic interventions based on lifestyle modification can reduce the risk of cognitive decline in patients who recently suffered ischemic stroke . Methods A r and omized , controlled , multicenter , observer-blind trial was design ed . The reference group obtains stroke care according to st and ard guidelines . The intervention group additionally receives intensive control and motivation for better compliance with prescribed evidence -based medication , regular blood pressure measurements , healthy diet , regular physical activity and cognitive training . Primary outcomes are the rate of cognitive decline at 24 months , assessed by a neuropsychological test battery and the cognitive subscale of the Alzheimer 's Disease Assessment Scale . Results 202 patients ( 29 % women ) , aged 62 ± 9 years , were recruited during 2010 to 2012 . Stroke related impairment at inclusion was low ( mean National Institutes of Health Stroke Scale : 1.9±1.8 , median modified Rankin Scale : 1 ( 0 - 1 ) ) . At baseline , groups did not differ significantly in demographic , clinical or lifestyle characteristics . Conclusion The recruitment was successful and the groups are balanced regarding potential confounding variables . The study will provide essential data about the feasibility and efficacy of lifestyle intervention after stroke in order to develop a new approach to prevent cognitive decline in patients with mild ischemic stroke Objective To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level . Design R and omised controlled community based trial . Setting Suburbs of Copenhagen , Denmark Participants 59 616 people aged 30 - 60 years r and omised with different age and sex r and omisation ratios to an intervention group ( n=11 629 ) and a control group ( n=47 987 ) . Intervention The intervention group was invited for screening , risk assessment , and lifestyle counselling up to four times over a five year period . All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits ( at baseline and after one and three years ) ; those at high risk of ischaemic heart disease , according to predefined criteria , were furthermore offered six sessions of group based lifestyle counselling on smoking cessation , diet , and physical activity . After five years all were invited for a final counselling session . Participants were referred to their general practitioner for medical treatment , if relevant . The control group was not invited for screening . Main outcome measures The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group .  Secondary outcome measures were stroke , combined events ( ischaemic heart disease , stroke , or both ) , and mortality . Results 6091 ( 52.4 % ) people in the intervention group participated at baseline . Among 5978 people eligible at five year follow-up ( 59 died and 54 emigrated ) , 4028 ( 67.4 % ) attended . A total of 3163 people died in the 10 year follow-up period . Among 58 308 without a history of ischaemic heart disease at baseline , 2782 developed ischaemic heart disease . Among 58 940 without a history of stroke at baseline , 1726 developed stroke . No significant difference was seen between the intervention and control groups in the primary end point ( hazard ratio for ischaemic heart disease 1.03 , 95 % confidence interval 0.94 to 1.13 ) or in the secondary endpoints ( stroke 0.98 , 0.87 to 1.11 ; combined endpoint 1.01 , 0.93 to 1.09 ; total mortality 1.00 , 0.91 to 1.09 ) . Conclusion A community based , individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease , stroke , or mortality at the population level after 10 years . Trial registration Clinical trials NCT00289237 OBJECTIVE Stroke survivors are at high risk of stroke recurrence yet current strategies to reduce recurrence risk are sub-optimal . The UK Medical Research Council ( MRC ) have proposed a framework for developing and evaluating complex interventions , such as community management of stroke secondary prevention . The Framework outlines a five-phased approach from theory through to implementation of effective interventions . This paper reports Phases I-III of the development of a novel intervention to improve risk factor management after stroke . METHODS The pre- clinical /theoretical phase entailed review ing the literature and undertaking quantitative and qualitative studies to identify current practice s and barriers to secondary prevention . In Phase I ( modelling ) , findings were used to design an intervention with the potential to overcome barriers to effective stroke secondary prevention management . The feasibility of delivering the intervention and its acceptability were tested in the Phase II exploratory trial involving 25 stroke survivors and their general practitioners . RESULTS This led to the development of the definitive risk factor management  intervention . This comprises multiple components and involves using an on-going population stroke register to target patients , carers and health care professionals with tailored secondary prevention advice . Clinical , socio-demographic and service use data collected by the stroke register are transformed to provide an individualised secondary prevention package for patients , carers and health care professionals at three time points : within 10 weeks , 3 and 6 months post-stroke . CONCLUSION The intervention is currently being evaluated in a r and omised controlled trial . Further research is needed to test generalisability to other aspects of stroke management and for other chronic diseases . PRACTICE IMPLICATION S The MRC Framework for complex interventions provides a structured approach to guide the development of novel interventions in public health . Implication s for practice in stroke secondary prevention will emerge when the results of our r and omised controlled trial are published Background : Lifestyle modification is associated with a substantially decreased risk of cardiovascular events . However , the role of lifestyle intervention for secondary prevention in patients with noncardioembolic ischemic stroke is inadequately defined . We assessed the hypothesis that lifestyle intervention can reduce the onset of new vascular events in patients with noncardioembolic mild ischemic stroke . Methods : We conducted an observer-blind r and omized controlled trial that enrolled 70 patients ( 48 men , mean age 63.5 years ) with acute noncardioembolic mild ischemic stroke . The patients were allocated in equal numbers to a lifestyle intervention group or a control group . We performed lifestyle interventions , which comprised exercise training , salt restriction and nutrition advice for 24 weeks . Then all patients were prospect ively followed up for occurrence of the primary endpoints , including hospitalization due to stroke recurrence and the onset of other vascular events . We also evaluated systolic blood pressure ( SBP ) at the clinic and at home , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , hemoglobin A1c ( HbA1c ) and high-sensitivity C-reactive protein ( hs-CRP ) to compare the efficacy of the lifestyle interventions . Results : This trial was terminated earlier than expected because of the prespecified early stopping rule for efficacy . After the 24-week intervention period , the intervention group showed a significant increase in daily physical activity and a significant decrease in salt intake ( physical activity , p = 0.012 ; salt intake , p < 0.001 ) , with a significant difference between the r and omized groups ( physical activity , p < 0.001 ; salt intake , p = 0.018 ) . Similarly , blood pressure was decreased and the HDL-C levels were increased in the intervention group ( SBP , p < 0.001 ; HDL-C , p = 0.018 ) , with significant differences between the r and omized groups ( SBP , p < 0.001 ; HDL-C , p = 0.022 ) . In contrast , LDL-C , HbA1c and hs-CRP tended to decrease in the intervention group , but this decrease did not achieve significance . After a median follow-up period of 2.9 years , 12 patients allocated to the control group and 1 patient in the lifestyle intervention group experienced at least 1 vascular event . A sequential plans analysis indicated the superiority of the lifestyle intervention in interim analysis . Kaplan-Meier survival curves after the log-rank test showed a significant prognostic difference between the r and omized groups ( p = 0.005 ) . Conclusions : Lifestyle intervention with appropriate medication is beneficial for reducing the incidence of new vascular events and improving vascular risk factors in patients with noncardioembolic mild ischemic stroke Considerable evidence supports the hypothesis that vitamin E reduces the risk for atherosclerosis ( 1 ) . Vitamin E inhibits the proliferation of smooth-muscle cells in vitro ( 2 ) and increases the resistance of low-density lipoprotein to oxidation when it is added to plasma or administered to humans ( 3 , 4 ) . Furthermore , platelets from persons taking vitamin E supplements  had markedly reduced adhesiveness to collagen ( 5 ) . Consistent with these findings , vitamin E intake has been inversely associated with risk for coronary heart disease ( 6 - 8 ) and for peripheral arterial disease ( 9 ) and with carotid artery wall thickness ( 10 , 11 ) . Risk for ischemic stroke also increases with atherosclerosis and might therefore be reduced by vitamin E. However , few studies have addressed the relation between vitamin E and risk for ischemic stroke , and those that have been done were small , had little variation in vitamin E intake , or did not distinguish between ischemic and hemorrhagic stroke ( 12 - 15 ) . Risk for hemorrhagic stroke is unlikely to be reduced by high doses of vitamin E and could even be increased by the reduced platelet adhesion that these doses cause ( 5 ) . The most informative previous studies a large r and omized trial in men ( 16 , 17 ) and a prospect i ve investigation in women (6)supported a modest beneficial effect of vitamin E with respect to ischemic stroke , but the results were not statistically significant . Moreover , in the trial in men ( 16 ) , this apparent benefit was offset by an increased risk for hemorrhagic stroke . Like vitamin E , vitamin C and carotenoids have antioxidant properties ( 18 , 19 ) and have been hypothesized to reduce risk for stroke , but epidemiologic evidence to support these hypotheses is limited ( 14 - 17 , 20 - 22 ) . Of the carotenoids , we considered -carotene , -carotene , lutein , and lycopene because they are present in relatively large amounts in the diet and have distinct antioxidant properties ( 23 ) . Our primary hypothesis was that high intake of these antioxidants would reduce risk for ischemic stroke . We report here the associations between intakes of vitamin E , vitamin C , and specific carotenoids and risks for ischemic and hemorrhagic stroke in a large cohort of men in the United States . Methods Study Sample The Health Professionals Follow-up Study began in 1986 , when 51 529 health professionals 40 to 75 years of age [ 24 ] completed a 131-item food-frequency question naire and supplied information about medical history and lifestyle . Follow-up question naires were sent every 2 years so that we could up date information on potential risk factors , including use of vitamin supplements , and identify newly diagnosed cases of stroke and other diseases . We excluded from analysis 1595 men who did not have 1 ) a daily caloric intake between 800 and 4200 kcal and 2 ) fewer than 70 blanks ( among 131 listed food items ) on the food-frequency question naire . We also excluded men with previous myocardial infa rct ion , angina , coronary artery surgery , stroke , transient ischemic attack , peripheral arterial disease , or diabetes . We followed the 43 738 eligible men for incidence of stroke for 8 years . The average response rate for the 2-year follow-up cycles was more than 94 % . Nonresponding participants who were not matched to the National Death Index were assumed to be alive . This study was approved by the institutional review board of the Harvard School of Public Health . Assessment of Diet and Other Exposure Variables On the 1986 question naire , we asked about 1 ) the average frequency of intake over the previous year of specified portions of 131 foods and 2 ) the use of vitamin and mineral supplements . We specifically asked about dose and duration of use of multivitamin , vitamin E , and vitamin C supplements . Nutrient calculations took into account the specific br and s of breakfast cereal and multivitamin supplements reported by each participant . We assessed the question naire 's validity in a r and om sample of 127 men who completed two 1-week diet records ( 25 ) ; 121 of these men also provided blood sample s ( 26 , 27 ) . The correlations between the food-frequency assessment s of intake and plasma concentrations were 0.51 for -tocopherol , 0.47 for -carotene and lycopene , 0.35 for -carotene , and 0.40 for lutein . These correlations were similar to those seen between plasma levels of these nutrients and intake of these nutrients as estimated by the two 1-week diet records ( 25 ) , and they support the validity of the food-frequency question naire . Even if dietary measurements were perfect , vitamin intake and plasma levels would not be highly correlated because multiple factors contribute to between-person variations in plasma vitamin levels . The correlation between the food-frequency and diet-record assessment s was 0.92 for both vitamin C and vitamin E ( 25 ) . In 1986 , in addition to reporting on diet , participants were asked to report their usual systolic and diastolic blood pressures and whether they had physician-diagnosed hypertension . The validity of these variables has been documented ( 28 ) . Other potential risk factors for stroke that were assessed at baseline and in the follow-up question naire included smoking history , body mass index , history of hypercholesterolemia , physical activity , parental history of myocardial infa rct ion , and alcohol consumption . Events End points were fatal or nonfatal stroke occurring between the return of the baseline question naire and 31 January 1994 . If a participant reported an incident stroke on a follow-up question naire , we asked for permission to review that participant 's medical records . Strokes were confirmed if they were characterized by a typical neurologic defect of sudden or rapid onset that lasted at least 24 hours and was attributable to a cerebrovascular event . Strokes caused by infection or neoplasia were excluded . Review s were conducted by physicians who had no knowledge of participants ' risk factor status . Strokes were subclassified , according to the criteria of the National Survey of Stroke , as due to ischemia ( embolism or thrombosis ) , subarachnoid hemorrhage , intracerebral hemorrhage , or an unknown cause ( 29 ) . If no records could be obtained , a stroke was considered probable if it necessitated hospitalization and was corroborated by additional information provided in a letter or interview . Deaths were initially reported by next-of-kin , coworkers , postal authorities , or the National Death Index . Fatal strokes were confirmed by medical records ( 84 % ) or autopsy reports ( 2 % ) or were considered probable if medical records or autopsy reports could not be obtained and stroke was listed as the underlying cause of death on the death certificate ( 14 % ) . Statistical Analysis Participants contributed follow-up time from the return of the 1986 question naire to the occurrence of a confirmed stroke or death or 31 January 1994 . Men who had nonfatal myocardial infa rct ion or coronary surgery during the follow-up period were retained in the analysis . Intake of vitamin E and other nutrients was energy-adjusted to 2000 kcal/d ( 30 ) . Relative risks were calculated by dividing the incidence of stroke among men in each quintile of energy-adjusted vitamin E intake at baseline by the incidence of stroke among men in the lowest quintile of intake . Similar calculations were done for the other nutrients . Quintiles were used to avoid assumptions about the shape of the dose-response relation and to provide sufficient power to compare men in the extreme categories of intake . For vitamin E , vitamin C , and -carotene , additional analyses separately considered supplemental and dietary intake . We adjusted relative risks for age ( in 5-year categories ) ( 31 ) and used the Mantel extension test ( 32 ) to test for linear trends . To adjust for other risk factors , we used pooled logistic regression with 2-year intervals . Where the probability of an event within an interval is small , this method is equivalent to a Cox proportional-hazards analysis ( 33 ) . The multivariate models included the following as covariates : calendar time ( in 2-year intervals ) , total energy intake ( continuous variable ) , smoking ( current ; past ; or 1 to 14 , 15 to 24 , and 25 cigarettes/d ) , alcohol consumption ( < 5 , 5 to 9 , 10 to 14 , 15 to 29 , or 30 g/d ) , history of hypertension , history of hypercholesterolemia , parental history of myocardial infa rct ion before 65 years of age , profession , and quintiles of body mass index and physical activity . In these models , we evaluated monotonic trends by using the median value of each category and modeling it as a continuous variable . Analyses were also conducted to up date dietary intake and other covariates during follow-up . In these analyses , the incidence of stroke in 1986 - 1990 was related to vitamin and carotenoid intake reported in 1986 , whereas the incidence of stroke in 1990 - 1994 was related to the average intake reported in 1986 and 1990 . Because dietary changes made after the development of intermediate end points , such as coronary heart disease , peripheral arterial disease , transient ischemic attacks , diabetes , and hypercholesterolemia , may confound the associations between diet and disease ( 34 ) , we repeated the analyses without updating information on diet for men who reached an intermediate end point before completing the 1990 dietary question naire . All P values are two-sided . Role of the Funding Source The National Institutes of Health had no role in the collection , analysis , or interpretation of the data or in the decision to su bmi t the paper for publication . Results During 323 394 person-years of follow-up , we documented 328 strokes : 210 ischemic , 70 hemorrhagic , and 48 unclassified . Fifty of the 328 strokes were fatal . The distribution of risk factors for stroke differed somewhat by vitamin E , vitamin C , and -carotene intake ( Table 1 ) . Men in the top quintiles of vitamin E or vitamin C intakemost of whom used multivitamin or specific vitamin supplementswere less likely to smoke , were more likely to use aspirin , and were Background and Purpose The purpose of the present analysis was to determine how lifestyle influences the risk of cerebrovascular disease in women participating in the Copenhagen City Heart Study . Methods A r and om sample of a white , lower and middle-class , urban population selected in 1976 was invited to two cardiovascular examinations at 5-year intervals . The present analysis was based on 7060 women invited to an initial examination from 1976 through 1978 , aged 35 years or more , and without previous stroke or transient ischemic attack . At the initial examination , potential risk factors were recorded . The 265 first cases of stroke and transient ischemic attack were ascertained at a second examination 5 years later and through hospital records and death certificates through 1988 . The Cox regression model was used to estimate the influence of the factors recorded on the risk of cerebrovascular disease . Results The relative risks of cigarette smoking and lack of physical activity were 1.4 and 1.45 ; 95 % confidence limits , 1.02 to 1.94 and 1.01 to 2.08 , respectively ) . The relative risk of daily consumption of tranquilizers  was 1.25 ( 95 % confidence limits , 0.96 to 1.62 ) . No significant influence was found for number of cigarettes , body mass index , or alcohol intake . In postmenopausal women , there was a statistically significant interaction ( P < .041 ) between smoking and hormone replacement therapy .  Smokers receiving this therapy had a 28 % lower risk of cerebrovascular disease than smokers not receiving it . Conclusions The statistically significant and equally potent effects on the risk of cerebrovascular disease were found for cigarette smoking and lack of physical activity . The risk associated with smoking seemed to be influenced by hormonal replacement therapy Rationale PROTECT DC examines whether stroke navigators can improve cardiovascular risk factors in urban underserved individuals newly hospitalized for stroke or ischemic attack . Within one-year of hospital discharge , up to one-third of patients no longer adhere to secondary prevention behaviors . Adherence rates are lower in minority-underserved groups , contributing to health disparities . In-hospital programs increase use of stroke prevention therapies but may not be as successful in underserved individuals . In these groups , low literacy , limited healthcare access , and sparse community re sources may reduce adherence . Lay community health workers ( navigators ) improve adherence in other illnesses through education and assisting in overcoming barriers to achieving desired health behaviors and obtaining needed healthcare services . Aims and design PROTECT DC is a Phase II , single-blind , r and omized , controlled trial comparing in-hospital education plus stroke navigators to usual care .  Atherogenic ischemic stroke and transient ischemic attack survivors are recruited from Washington , DC hospitals .  Navigators meet with participants during the index hospitalization , perform home visits , and meet by phone . They focus on stroke education , medication compliance , and overcoming practical barriers to adherence . The interventions are driven by the theories of reasoned action and planned behavior . Study outcomes The primary dependent measure is a summary score of four objective measures of stroke risk factor control : systolic blood pressure , low-density lipoprotein , hemoglobin Hb A1C , and antiplatelet agent pill counts . Secondary outcomes include stroke knowledge , exercise , dietary modification , and smoking cessation . Conclusion PROTECT DC will determine whether a Phase III trial of stroke navigation for urban underserved individuals to improve adherence to secondary stroke prevention behaviors is warranted Background Despite lack of outward signs , most individuals after non-disabling stroke ( NDS ) and transient ischemic attack ( TIA ) have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke , hospitalization for other vascular events , or death . Most have multiple modifiable risk factors ( e.g. , hypertension , physical inactivity , hyperlipidaemia , diabetes , tobacco consumption , psychological stress ) . In addition , accelerated rates of depression , cognitive decline , and poor quality of sleep have been reported following TIA , which correlate with poor functional outcomes and reduced quality of life . Thus , NSD and TIA are important warning signs that should not be overlooked . The challenge is not unlike that facing other ' silent ' conditions - to identify a model of care that is effective in changing people 's current behaviors in order to avert further morbidity . Methods / Design A single blind , r and omized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA . 250 adults within 90 days of being diagnosed with NDS/TIA will be r and omly allocated to a 12-week program of exercise and education ( PREVENT ) or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated ( USUAL CARE ) . Primary outcome measures will include blood pressure , waist circumference , 12-hour fasting lipid profile , and 12-hour fasting glucose/hemoglobin A1c . Secondary measures will include exercise capacity , walking endurance , physical activity , cognitive function , depression , goal attainment and health-related quality of life . Outcome assessment will be conducted at baseline , post-intervention , and 6- and 12-month follow-ups . Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be compared . Ethical approval for the trial has been obtained from the relevant Human Research Ethics Boards . Discussion Whether timely delivery of an adapted cardiac rehabilitation model is effective in attaining and maintaining vascular risk reduction targets in adults after NDS/TIA is not yet known . We anticipate that the findings of this trial will make a meaningful contribution to the knowledge base regarding secondary stroke prevention . Trial registration This trial is registered with the Clinical Trials.gov Registry ( NCT00885456 ) BACKGROUND Limited data are available on the benefit of combining healthy dietary and lifestyle behaviors in the prevention of  myocardial infa rct ion ( MI ) in women . METHODS We used factor analysis to identify a low-risk behavior-based dietary pattern in 24 444 postmenopausal women from the population -based prospect i ve Swedish Mammography Cohort who were free of diagnosed cancer , cardiovascular disease , and diabetes mellitus at baseline ( September 15 , 1997 ) . We also defined 3 low-risk lifestyle factors : nonsmoking , waist-hip ratio less than the 75th percentile ( < 0.85 ) , and being physically active ( at least 40 minutes of daily walking or bicycling and 1 hour of weekly exercise ) . RESULTS During 6.2 years ( 151 434 person-years ) of follow-up , we ascertained 308 cases of primary MI . Two major identified dietary patterns , " healthy " and " alcohol , " were significantly associated with decreased risk of MI . The low-risk  diet  ( high scores for the healthy dietary pattern ) characterized by a high intake of vegetables , fruit , whole grains , fish , and legumes , in combination with moderate alcohol consumption ( > /= 5 g of alcohol per day ) , along with the 3 low-risk lifestyle behaviors , was associated with 92 % decreased risk ( 95 % confidence interval , 72%-98 % ) compared with findings in women without any low-risk diet and lifestyle factors . This combination of healthy behaviors , present in 5 % , may prevent 77 % of MIs in the study population . CONCLUSION Most MIs in women may be preventable by consuming a healthy diet and moderate amounts of alcohol , being physically active , not smoking , and maintaining a healthy weight Objective : To evaluate whether enhanced secondary prevention more significantly influences readiness to change health behaviour after minor stroke/transient ischaemic attack , compared with conventional stroke secondary prevention . Design : Single-blind r and omized control trial . Setting : Rural district general hospital outpatient clinic . Subjects : Fifteen women and 37 men with a mean age of 68.3 years with first minor stroke or transient ischaemic attack . Interventions : The intervention group received ‘ enhanced secondary prevention ’ ( additional advice , motivational interviewing and telephone support ) to change health behaviour . Both groups received ‘ conventional care ’ which included advice given during routine care . Main measures : The primary outcome was ‘ readiness to change behaviour ’ measured using a vali date d stroke specific score based on the transtheoretical model . Secondary outcomes were the Hospital Anxiety and Depression Scale , and self-reported alcohol consumption , smoking behaviour , exercise frequency , and fruit and vegetable consumption . Results : Analysis of the data for the 52 participants showed no statistical difference in the groups for the primary outcome of readiness to change behaviour . Statistically significant improvements for change in self-reported exercise were demonstrated ( P = 0.007 ) ; to 2—3 times per week in the intervention group compared to 0—1 times per week in the control group , and in fruit and vegetable consumption ( P = 0.033 ) ; to 10 portions of fruit and vegetables consumed per week in the intervention group compared to 1 or 2 portions a week for the control group . No evidence of a difference between groups was seen for alcohol consumption or Hospital Anxiety and Depression Scale . Conclusions : While no difference was demonstrated between the groups for readiness to change behaviour , a clinical ly significant effect in reported exercise behaviour and diet were demonstrated in the intervention group . This interesting finding indicates a dissonance between the behaviour scale and actual behaviour change , potentially indicating a lack of sensitivity of the scale to detect a change in this patient group
Conclusion Stroke secondary prevention lifestyle interventions are effective in terms of effecting positive change in lifestyle behaviors and secondary outcomes , and appear promising in relation to physiological outcomes .
There was insufficient evidence to determine the effect of intervention on incidence of stroke recurrence
Background A feature of stroke is that it recurs ( 25 % within five-years ) .
Risk factors for stroke and recurrent stroke include smoking , alcohol consumption , poor diet , and physical inactivity .
Aim To evaluate the effectiveness of secondary prevention lifestyle interventions design ed to change lifestyle behavior following stroke .
This short paper presents a summary of the systematic review process and findings .