Cardiac Rehabilitation for transient ischaemic Attack and Mild-Stroke: the CRAMS randomised controlled trial.

Cardiovascular Rehabilitation (CVR) program The CVR program included in this study is typical of most contemporary phase II cardiac rehabilitation programs in Australia. The cardiac rehabilitation program is multidisciplinary, time-limited (once a week, 6-weeks), conducted in groups, health service-based, and has educational and supervised exercise components (one hour education plus one hour exercise). Members of the multidisciplinary team include exercise physiologists, physiotherapists, dietitians, psychologists, pharmacists and supervised university health students. The main aim of the exercise sessions will be to increase cardiovascular fitness or exercise capacity by exercising large muscle groups. The best predictor of an increased risk of death from any cause in men with cardiovascular disease is exercise capacity. For every 1-MET increase in exercise, there is a 9% improvement in survival. The exercise sessions will be conducted in the same way as a typical cardiac rehabilitation program as many cardiac rehabilitation participants have co-morbidities, including stroke. All exercise sessions will be individually tailored for each of the participants and supervised by a physiotherapist and/or exercise physiologist. Participants will be encouraged to exercise at a moderate intensity as recommended in cardiac rehabilitation guidelines. This will be monitored and measured using the modified Borg Rate of Perceived Exertion (RPE) scale, encouraging participants to exercise at an RPE of 4-6. The 'talk test' will also be used to monitor intensity of exercise, encouraging participants to exercise at a level where they can talk in full sentences but they cannot sing. Examples of the types of exercises they will be completing in the exercise class are walking on a treadmill, cycling on a stationary bike, stepping up and down on a set of steps, where appropriate. Members of the multi-disciplinary team will conduct group education sessions to increase the participant’s knowledge of their cardiovascular disease (CVD) condition and increase self-management skills for risk factor management. The education will be slightly modified compared to a typical cardiac rehabilitation program to include the anatomy and physiology of the brain, transient ischaemic attack (TIA) and ischemic stroke, and the management of stroke risk factors. The education sessions will cover: cardiac and brain anatomy and physiology; cardiac and stroke risk factors, modification and management of symptoms; how to deal with stress, anxiety and depression; cardiac and stroke medications; benefits of exercise and physical activity; and nutrition advice. The mode of delivery of these education sessions will be at the discretion of the health professional delivering each session. For example, they may involve multimedia presentations, informal group discussions and interactive activities. A CVR program attendance list will be maintained to record participants adherence to the 6 session program, including both the exercise and education session, which will be run in succession over a 2-hour period one day a week. People with heart disease will be recruited to this program to replicate a standard phase II cardiac rehabilitation program currently offered in Australia and to enable the integration of people with TIA, mild-stroke and heart disease in the same program. People with heart disease can be referred by cardiac rehabilitation health professionals, Cardiologists, General Practitioners or they can self-refer. All people with heart disease attending the program will complete initial and 6-week assessments and will take part in all exercise and education sessions. Although research outcomes will not be collected or analysed for this group as the evidence base for exercise-based cardiac rehabilitation for people with heart disease is well established.