Effects of Cardiac Rehabilitation for Individuals With Transient Ischemic Attack

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.

Study Overview

• Status: Completed
• Conditions: Transient Ischemic Attack
• Intervention / Treatment: Behavioral: Cardiac Rehabilitation

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).

• Study Type: Observational
• Enrollment (Actual): 20

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M4G 1R7
      • Toronto Rehabilitation Institute - Rumsey Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

TIA

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Exercise; 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; Individualized cardiac rehabilitation for 6 months, including health education sessions, as well as supervised exercise classes which include aerobic and resistance training.

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

Collaborators and Investigators

• Sponsor: Toronto Rehabilitation Institute
• Collaborators: Heart and Stroke Foundation of Canada
• Investigators: Principal Investigator: Dina Brooks, PhD, Toronto Rehabilitation Institute; Principal Investigator: William E McIllroy, PhD, University of Waterloo; Principal Investigator: Paul Oh, MD, Toronto Rehabilitation Institute; Principal Investigator: Sandra Black, MD, Sunnybrook and Women's College Health Centre

Study record dates

Study Major Dates

• Study Start: March 1, 2010
• Primary Completion (Actual): November 1, 2014
• Study Completion (Actual): November 1, 2014

Study Registration Dates

• First Submitted: June 29, 2009
• First Submitted That Met QC Criteria: June 29, 2009
• First Posted (Estimate): June 30, 2009

Study Record Updates

• Last Update Posted (Actual): April 23, 2019
• Last Update Submitted That Met QC Criteria: April 20, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: cardiac rehab
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Brain Ischemia; Ischemia; Ischemic Attack, Transient
• Other Study ID Numbers: Brooks - 001