Service change and Supporting Lifestyle and Activity Modification after Transient Ischaemic Attack (TIA) (and mild stroke)

Service change and Supporting Lifestyle and Activity Modification after TIA (S+SLAM-TIA) is a non-randomised controlled trial which seeks to determine the effect participation in a 18 week behaviour change program has in increasing time spent in Moderate to Vigorous Physical Activity (MVPA) for the purpose of improving patient cardiovascular health. The 18 week behaviour change program is currently delivered by the HNE LHD Community Stroke Team (CST). The 18 week program is designed to equip patients with knowledge, confidence and strategies to identify their modifiable risk factors for the purpose of changing health behaviours so as to improve their cardiovascular health and reduce the risk of cardiovascular events. There are two phases to the program. The first phase involves 6 weeks of group education and exercise delivered in a community gym. Education sessions are conducted face-to-face by a CST clinician, once per week for 30 minutes. Content comprises of information about stroke etiology, risk factors for stroke, lifestyle changes to reduce the risk factors and practical goal setting. Exercise sessions are 1 hour in duration and conducted twice weekly for 6 weeks; the first 9 sessions are facilitated in person by a CST physiotherapist and exercise instructor and the final 3 sessions are independent exercise sessions with telehealth support. Participants complete 20-30 minutes of continuous cardiovascular exercise (treadmill, bike or rower) and functional strengthening (sit-to-stands, step ups, arm weights) with prompting to exercise at moderate intensity on the Borg RPE scale. Heart rate is also monitored to guide intensity of exercise – participants are encouraged to aim for 60-80% of their heart rate reserve. Group attendance is monitored by CST clinicians and any barriers to attending are addressed, using behaviour change methodology techniques if appropriate. The second phase of the program is 12 weeks of fortnightly telehealth supported health coaching (5 sessions) delivered by HNE LHD Connecting Care via telephone with each individual. These sessions are approximately 15 minutes in duration. The purpose of the session is to discuss the participants goals and progress, discuss any barriers in achieving the goals and how to overcome these. Usual care within this program is the collection of clinical outcomes at entry into the program (initial assessment/baseline) and at the end of both component one and two. Clinical outcomes are collected at baseline, 6, and 18 weeks. All eligible patients participating in the SLAM-TIA program will be invited to participate in this research study as part of the intervention cohort. Control group participants will be recruited from a volunteer stroke register, via social media, and through word of mouth. Outcomes collected for the research study, S+SLAM-TIA, running in parallel to the CST SLAM-TIA will be collected at HMRI in the Clinical Trials Unit, or at the Community Stroke Service, at entry into the program (baseline) and at the end of both component one and two (6 and 18 weeks). To evaluate the effectiveness of the program on achieving sustainable behaviour change, research outcomes will also be collected three months after the CST SLAM-TIA program has ceased (30 weeks)