From business as usual to making changes: perceptions of physical activity and secondary stroke prevention after transient ischemic attack or mild stroke

People who had had a transient ischemic attack (TIA) or mild stroke have a high risk of recurrent stroke. While stroke clinical guidelines recommend long-term engagement in regular moderate to vigorous physical activity (MVPA) of at least 150 minutes per week to mitigate recurrent stroke risk, there is little understanding of people’s attitude toward, and experiences of, physical activity after a TIA or mild stroke. Although secondary stroke prevention programs conducted in research settings have been found to increase physical activity levels in this patient population, little is known of health-service delivered secondary stroke prevention from the patient perspective. Studies undertaken in this thesis were (a) systematic review of the effectiveness of secondary stroke prevention studies that aimed to support people with TIA and mild stroke increase the time they spent engaging in MVPA (Chapter 3); (b) Qualitative investigation of factors that influenced physical activity engagement after a TIA or mild stroke (Chapter 4), and aspects of secondary stroke prevention that participants perceived supported them to make changes to physical activity levels (Chapter 5), and (c) quantitative analysis of changes in device-measured physical activity levels following participation in a health-service delivered secondary stroke prevention program (Chapter 6). Completion of this work revealed that we have limited understanding of the most effective strategies and interventions for supporting people with TIA and mild stroke to make changes to physical activity levels (Chapter 3). Concerningly, most people adopted a business-as-usual attitude towards physical activity after their TIA or mild stroke and returned to previous habits (Chapter 4). Providing supportive and empathetic health professional guidance in a group setting, with a program tailored to meet individual needs were vital elements that participants perceived influenced their decisions to make changes to physical activity levels (Chapter 5). Secondary analysis of physical activity outcomes showed that participation in a health-service delivered secondary stroke prevention program is associated with non-significant changes to physical activity levels, however, these changes are not necessarily in line with stroke clinical guideline recommendations (Chapter 6). This thesis sets the foundation for further investigation of benefits associated with physical activity at lower levels than those recommended by stroke clinical guidelines in mitigating recurrent stroke risk in this patient population.