From co-production to practice: developing a telehealth delivered intervention to reduce stroke risk

Stroke recurrence rates are too high despite most stroke being preventable. Medical management alone is not sufficient to reduce stroke recurrence. Lifestyle factors are important to minimise the risk of stroke recurrence. Hypertension is the number one modifiable risk factor for stroke. Inadequate physical activity is a leading risk factor for stroke while increasing physical activity can prevent or treat hypertension. Preliminary evidence suggests supervised exercise combined with behaviour change support may reduce stroke recurrence risk. However, there is currently no standardised exercise programs aimed at reducing stroke recurrence risk and a lack of guidance on what the essential ingredients of this type of program should be. Concurrently, the prevalence of stroke is higher in regional compared with metropolitan communities in Australia, yet access to specialised stroke services may be reduced in these communities. Telehealth is emerging as a potential strategy to improve access to healthcare for people in rural communities. The elements of a telehealth-supervised exercise program to reduce stroke recurrence that may optimise success include: behaviour change support; peer support; support from caregivers; and appropriate screening and assessment procedures. Our research findings highlighted a one-size fits all approach to screening, assessment, support and safety was not appropriate if we want to mitigate barriers to physical activity and optimise safety for all people after stroke or TIA. We identified the need for formal adverse event reporting standards for interventions aimed at increasing physical activity after stroke and a risk stratification tool to determine the appropriate screening and assessment procedures and guide exercise prescription. We did not identify any serious safety concerns regarding supervised aerobic exercise delivered via telehealth. However, further research is needed to confirm the safety, effect of and optimal processes to support aerobic exercise after stroke.