School of Public Health, Physiotherapy and Population Science, University College Dublin, Republic of Ireland
School of Physiotherapy, Royal College of Surgeons in Ireland, Republic of Ireland HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Republic of Ireland.
Eur J Prev Cardiol. 2014 Aug;21(8):1026-39. doi: 10.1177/2047487313481756. Epub 2013 Mar 11.
Secondary prevention in ischaemic stroke and transient ischaemic attack (TIA) is dominated by pharmacological interventions with evidence for non-pharmacological interventions being less robust. This systematic review and meta-analysis examines the impact of lifestyle interventions on secondary prevention in stroke or TIA.
A systematic literature search was performed. Randomised controlled trials (RCTs) examining the effectiveness of intervention packages incorporating any key component of health education/promotion/counselling on lifestyle and/or aerobic exercise compared to usual care ± a sham intervention in participants with ischaemic stroke or TIA were included. Outcomes of interest were mortality, cardiovascular disease (CVD) event rates, cardiovascular risk factors including blood pressure, lipid profiles and physical activity participation. Methodological quality was assessed. Statistical analyses determining treatment effect were conducted using Cochrane Review Manager Software.
Seventeen RCTs were included. Data pooled from eight studies with a total of 2478 patients, demonstrated no effect in favour of lifestyle interventions compared to routine or sham interventions on mortality (risk ratio (RR) = 1.13 (95% confidence interval (CI), 0.85-1.52), I(2) = 0%). Data relating to CVD events were pooled from four studies (1013 patients), demonstrated non-significant findings (RR = 1.16 (95% CI, 0.80--1.71), I(2) = 0%). Similar results were reported for total cholesterol. Physical activity participation demonstrated significant improvement [SMD 0.24 (95% CI, 0.08-0.41), l (2) = 47%]. Blood pressure reductions were noted but were non-significant when corrected for multimodal packages including enhanced pharmacotherapy compliance.
There is currently insufficient high quality research to support lifestyle interventions post-stroke or TIA on mortality, CVD event rates and cardio-metabolic risk factor profiles. Promising blood pressure reductions were noted in multimodal interventions which addressed lifestyle.
缺血性卒中及短暂性脑缺血发作（TIA）的二级预防主要依赖于药物干预，而非药物干预的证据则较为有限。本系统评价和荟萃分析旨在探讨生活方式干预对卒中或 TIA 二级预防的影响。
系统检索文献。纳入了比较包含健康教育/促进/咨询任何关键内容的干预方案与常规护理±假干预对缺血性卒中和 TIA 患者生活方式和/或有氧运动影响的随机对照试验（RCT）。主要结局指标为死亡率、心血管疾病（CVD）事件发生率、心血管危险因素（包括血压、血脂谱和体力活动参与度）。评估方法学质量。使用 Cochrane 评价管理软件进行统计学分析以确定治疗效果。
纳入了 17 项 RCT。对 8 项研究共 2478 例患者的数据进行汇总，结果显示与常规护理或假护理相比，生活方式干预对死亡率无影响（风险比（RR）=1.13（95%置信区间（CI），0.85-1.52），I²=0%）。对 4 项研究（1013 例患者）的数据进行汇总，结果显示 CVD 事件无显著差异（RR=1.16（95%CI，0.80-1.71），I²=0%）。总胆固醇的结果也相似。体力活动参与度显著改善[标准化均数差（SMD）0.24（95%CI，0.08-0.41），I²=47%]。虽然针对包括增强药物治疗依从性的多模式方案进行了校正，但降压效果仍不显著。
目前，尚无高质量的研究支持卒中或 TIA 后生活方式干预对死亡率、CVD 事件发生率和心血管代谢危险因素谱的影响。在多模式干预中注意到有 promising 的血压降低，这些干预措施解决了生活方式问题。
