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Heart Rehab Programs May Help Some Stroke Patients

People who have had heart attacks or certain types of heart surgery often participate in structured rehab programs that focus on improving diet, exercise and other lifestyle factors.

Sept. 23, 2011 -- People who have had heart attacks or certain types of heart surgery often participate in structured rehab programs that focus on improving diet, exercise, and other lifestyle factors.

Now new research shows that people who have had mini or mild strokes may also benefit from the same type of rehabilitation programs.A transient ischemic attack (TIA) is sometimes called a mini-stroke because the symptoms are like those of a stroke, but do not last long.

Heart disease and stroke share many of the same risk factors. These include smoking, high blood pressure, high cholesterol, lack of exercise, diabetes, and obesity.

The new findings appear in Stroke.

In the study, 110 people who had a TIA or a mild stroke that did not result in any lasting disability participated in the outpatient rehab program for 7.5 months. The program focused on nutrition, exercise, drug management, and smoking cessation and also addressed depression, stress, and anxiety. Eighty people completed the entire program.

And by and large, the rehab program was beneficial, the study showed. Participants showed a decrease in levels of total cholesterol and blood fats known as triglycerides. They also lost weight, had improvements in blood pressure, and many even quit smoking. Their ability to exercise improved by the end of the rehab program.

Mini Strokes Are Warning Signs

“It's difficult to say how they may have fared had they not been in the program,” says study author Peter L. Prior, PhD. But there were significant reductions in risk factors seen among people who had a TIA or mild stroke, he says. Prior is a clinical psychologist in the London Health Sciences Centre Cardiac Rehabilitation & Secondary Prevention Program in London, Ontario, Canada.

It stands to reason that if these changes were maintained over time, participants would be less likely to have another stroke, he says. “Typically, people may be tempted to blow off these minor events, but they are serious warning signs of potential catastrophe.”

Insurance Coverage May Be Barrier

Melissa Tracy, MD, directs the cardiac rehabilitation program at the Leonard M. Miller School of Medicine of the University of Miami in Florida.

She thinks cardiac rehab is a great fit for people who have had mini- or mild strokes.

“If these patients are discharged and go on their merry way, they would not be monitored and could end up getting worse,” she says.

“The infrastructure is already there, so we would be able to implement a program immediately,” Tracy says.

Insurance coverage may be a barrier. There are only certain events that are covered, and “right now, these strokes are not considered qualifying diagnoses,” she says.

Roger Bonomo, MD, director of stroke care at New York City's Lenox Hill Hospital, says many of the features of cardiac rehab would benefit people who have had mini or mild strokes.

But “you don't go to cardiac rehab because of a TIA,” he says. “We try to do the same kind of education in the short time that we have them in the hospital.”

It’s close to impossible to encourage successful and long-term smoking cessation during this time frame, Bonomo says. “The best of all possible worlds would be to have follow-up care that includes the same kind of program that is completed in cardiac rehab, namely education about diet, exercise, and adherence to [cholesterol-lowering] medications and smoking cessation.”

David Langer, MD,director of cerebrovascular research at the Cushing Neuroscience Institute of the North Shore-Long Island Jewish Health System in Manhasset, says that this type of program could absolutely benefit people who have had mini or mild strokes, not to mention those who have risk factors for these conditions.

“Ideally this program could help people even before they have a stroke, including people who smoke, have high cholesterol or high blood pressure, or other risk factors,” he says, but the issue is that insurers don’t pay for these services.

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