Effects of Cardiac Rehabilitation for Individuals With Transient Ischemic Attack

Completed

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).

Recruitment & Eligibility

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

Arm && Interventions

Group	Intervention	Description
Exercise	Cardiac Rehabilitation	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.

Primary Outcome Measures

Name	Time	Method
Functional Walk Test	Baseline, 3 months, 6 months (Six Minute Walk Distance)	6 minute walk test: the longest distance a person can walk for a duration of 6 minutes
Cardiovascular Fitness (VO2peak)	Baseline (after the 3 month non-intervention period) and after 6 months of participation.	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.

Secondary Outcome Measures

Name	Time	Method
Cognition	Baseline and 3 months (non-intervention period), after 6 months of cardiac rehabilitation participation	Montreal Cognitive Assessment. The MoCA score ranges from 0 to 30 points with a higher score indicating better cognitive function.
Center for Epidemiologic Studies Depression Scale (CES-D).	Baseline and 3 months (non-intervention period), after 6 months of cardiac rehabilitation participation	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).