Effects of Cardiac Rehabilitation for Individuals With Transient Ischemic Attack

Study Overview
=================
Brief Summary
-----------------
It is hypothesized that the addition of formal cardiac rehabilitation to standard care will result in long-term improvements in cardiovascular fitness and functional capacity in individuals who have suffered a transient ischemic attack (TIA) or minor stroke. Furthermore, it is proposed that the addition of cardiac rehabilitation will influence depressive symptoms and cognition.

Detailed Description
-----------------
A transient ischemic attack (TIA) is defined as an episode of neurological dysfunction caused by focal brain ischemia lasting less than 24 hours. Once an individual has suffered a TIA, preventative measures can be taken to target modifiable risk factors, one of which is physical inactivity. The current proposal focuses on the use of an established model of care (cardiac rehabilitation (CR)) and applies it to those who have suffered a TIA in order to maximize physical activity and minimize risk of future cardiovascular events. This will be a one-group pre/post design study with a 3 month non-intervention period. Participants will undergo measures at baseline and 3 months (non intervention period) then after 6 months of cardiac rehabilitation (cardiovascular fitness, 6 minute walk test, cognition, and depressive symptoms).

Official Title
-----------------
Effects of Cardiac Rehabilitation for Individuals With Transient Ischemic Attack

Conditions
-----------------
Transient Ischemic Attack

Intervention / Treatment
-----------------
* Behavioral: Cardiac Rehabilitation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Diagnosed with TIA Three months post-TIA Ability to understand the process and instructions for exercise training and provide informed consent Exclusion Criteria: Resting Blood Pressure greater than 160/100 despite medication Other cardiovascular morbidity which would limit exercise tolerance (heart failure, abnormal BP responses or STsegment depression > 2 mm, symptomatic aortic stenosis, complex arrhythmias) Current and extensive exercise participation Hypertrophic Cardiomyopathy Unstable Angina Orthostatic BP decrease of > 20 mm Hg with symptoms Other musculoskeletal impairments which would limit the participants ability to walk sufficient durations Pain or other co-morbidities (e.g., unclipped aneurysms, uncontrolled seizures etc.) which would preclude participation Cognitive or behavioural issues that would limit participation in exercise testing and training

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Exercise<br>Following a 3 month non intervention period, participants will participate in Cardiac Rehabilitation, carrying out an exercise program which will last 6 months and combine both resistance and aerobic training. | Behavioral: Cardiac Rehabilitation<br>* Individualized cardiac rehabilitation for 6 months, including health education sessions, as well as supervised exercise classes which include aerobic and resistance training.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional Walk Test | 6 minute walk test: the longest distance a person can walk for a duration of 6 minutes | Baseline, 3 months, 6 months (Six Minute Walk Distance) | 
| Cardiovascular Fitness (VO2peak) | To measure cardiovascular fitness, a stress test on either an upright cycle ergometer (Ergoselect 200P, Germany), or a treadmill (same modality pre- and post-training) was performed depending on patient balance and comfort. | Baseline (after the 3 month non-intervention period) and after 6 months of participation. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Center for Epidemiologic Studies Depression Scale (CES-D). | Depressive symptoms using the validated Center for Epidemiologic Studies Depression Scale (CES-D). This is a score from a 20 item questionnaire with minimum value of 0 and maximum value of 60 with higher numbers indicated greater depressive symptoms (worse). | Baseline and 3 months (non-intervention period), after 6 months of cardiac rehabilitation participation | 
| Cognition | Montreal Cognitive Assessment. The MoCA score ranges from 0 to 30 points with a higher score indicating better cognitive function. | Baseline and 3 months (non-intervention period), after 6 months of cardiac rehabilitation participation | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
cardiac rehab