CardiacRehabPlus: Innovation to improve outcomes for TIA and cardiac rehabilitation patients

All participants will receive the standard 8 week cardiac rehabilitation program of physical activity and education delivered by cardiac rehab staff. Each weekly session consists of 30 minutes strength exercise, such as bicep curls or squats, and 30 minutes aerobic exercise, such as walking on a treadmill or riding an exercise bike. Intensity is monitored using the Borg RPE scale targeting a range of 12-14. Standard education modules include cardiac risk factor modification, stress management and mindfulness, medications and management, importance of physical exercise, blood sugar levels, healthy eating and food label reading. To encourage compliance participants receive a phone call should they not attend two sessions in a row. Graduation from the program only occurs once a participant attends eight sessions. The Plus component of the CardiacRehabPlus (CR+) program will comprise of additional balance and gait assessment performed by research staff for Transient Ischaemic Attack/minor stroke (TIA/mS) and cardiac cohorts at baseline and on completion of the program. For the TIA/minor stroke cohort, CR+ will also be additional education modules tailored to the TIA/mS cohort. Balance and agility exercises will be included in the program. The additional balance and agility exercise will be provided by research physiotherapists and will be based on the OtagoPlus program, which has been shown to be effective in improving mild balance/gait dysfunction. Between group sessions, participants will be encouraged to do a home exercise program five days per week (approximately 20–30 min each time). For the cardiac event cohort who consent be involved in the provision of balance and gait exercises, will receive in addition to the standard 8 week cardiac rehabilitation, an extra session per week for 8 weeks in parallel with the standard cardiac rehabilitation. The extra balance and agility exercise program will be 60 mins consisting of 30-40 mins of exercise with opportunities for rests – 5 min warm up, 30 minutes balance, agility and strength, 5 min cool down) with a maximum of 4 participants per session. Between group sessions, participants will be encouraged to do a home exercise program three days per week (approximately 20–30 min each time). For both cohorts, exercises will be selected by the intervention physiotherapist from the kits of the exercises from the Otago Exercise Program and/or the Visual Health Information—Health Promotion Resources Balance and Vestibular exercise kit. Examples of the exercises included tandem walks, tandem stances, figure 8 walking, backwards walking. Exercises will be prescribed based on assessment findings and clinical judgement so participants perform at moderate intensity that challenged participants' balance. Participants will be provided with an exercise diary and these will be checked weekly to assist adherence to the home program.