Lawson Health Research Institution, London, Ontario, Canada.
St. Josephs Health Care Cardiac Rehabilitation and Secondary Prevention Program, London, Ontario, Canada.
Stroke Vasc Neurol. 2018 Jun 26;3(2):59-68. doi: 10.1136/svn-2018-000155. eCollection 2018 Jun.
We review evidence concerning exercise for stroke prevention. Plausible biological reasons suggest that exercise would be important in preventing stroke. While definitive randomised controlled trials evaluating the impact of physical activity (PA) and exercise on preventing stroke and mortality are lacking, observational studies, small randomised controlled trials and meta-analyses have provided evidence that PA and exercise favourably modify stroke risk factors, including hypertension, dyslipidaemia, diabetes, sedentary lifestyle, obesity, excessive alcohol consumption and tobacco use. It is, therefore, important to understand the factors associated with poststroke PA/exercise and cardiorespiratory fitness. Positively associated factors include self-efficacy, social support and quality of patients' relationships with health professionals. Negatively associated factors include logistical barriers, medical comorbidities, stroke-related deficits, negative exercise beliefs, fear of falling, poststroke fatigue, arthropathy/pain and depression. Definitive research is needed to specify efficacious behavioural approaches to increase poststroke exercise. Effective techniques probably include physician endorsement of exercise programmesto patients, enhancement of patient-professional relationships, providing patients an exercise rationale, motivational interviewing, collaborative goal-setting with patients, addressing logistical concerns, social support in programsmes, structured exercise programming, individualised behavioural instruction, behavioural diary recording, reviewing behavioural consequences of exercise efforts, reinforcing successful exercise performance. Exercise programming without counselling may increase short-term activity; simple advice or information-giving is probably ineffective. Older patients or those with cognitive impairment may need increased structure, with emphasis on behaviour per se, versus self-regulation skills. We support the latest American Heart Association/American Stroke Association guidelines (2014) recommending PA and exercise for stroke prevention, and referral to behaviourally oriented programmes to improve PA and exercise.
我们回顾了有关运动预防中风的证据。合理的生物学原因表明，运动对于预防中风非常重要。虽然缺乏评估体力活动（PA）和运动对预防中风和死亡率影响的明确随机对照试验，但观察性研究、小型随机对照试验和荟萃分析提供了证据，表明 PA 和运动可以有利地改变中风的危险因素，包括高血压、血脂异常、糖尿病、久坐的生活方式、肥胖、过量饮酒和吸烟。因此，了解与中风后 PA/运动和心肺适能相关的因素非常重要。与 PA/运动呈正相关的因素包括自我效能感、社会支持和患者与医务人员关系的质量。与 PA/运动呈负相关的因素包括后勤障碍、医疗合并症、中风相关缺陷、对运动的负面看法、害怕跌倒、中风后疲劳、关节炎/疼痛和抑郁。需要明确的研究来确定增加中风后运动的有效行为方法。有效的技术可能包括医生向患者推荐运动计划、增强患者与医务人员的关系、为患者提供运动理由、进行动机性访谈、与患者共同设定目标、解决后勤问题、在计划中提供社会支持、进行结构化运动计划、个性化行为指导、行为日记记录、审查运动努力的行为后果、强化成功的运动表现。没有咨询的运动计划可能会增加短期活动；简单的建议或信息提供可能无效。年龄较大的患者或认知障碍患者可能需要增加结构，重点是行为本身，而不是自我调节技能。我们支持美国心脏协会/美国中风协会（2014 年）的最新指南，建议进行 PA 和运动以预防中风，并转介至以行为为导向的计划，以提高 PA 和运动水平。
