The interventions that support lifestyle behavior change for secondary prevention of stroke: a scoping review

Abstract

Lifestyle behavioral change is a critical component for secondary prevention of stroke. Although evidence for the effectiveness of lifestyle behavior change is growing, methods to promote and maintain behavior change remain unclear. In this review, we aimed to synthesize the evidence for lifestyle behavior change interventions among patients living with stroke or transient ischemic attack (TIA). We searched seven databases to identify studies, including randomized controlled trials, quasi-experimental, and longitudinal studies examining changes in cardiovascular risk factors. Data were extracted regarding participant characteristics, intervention attributes (e.g., provider, behavior change techniques, modality), and effectiveness for control of risk factors. From 4620 records identified, 73 studies were included. Information regarding the type of behavior change theory applied were reported in 36% of studies. The social cognitive theory and transtheoretical models were the most commonly cited frameworks. Changes in physical activity (63%) and blood pressure (63%) were the most frequently assessed outcomes. Fewer than half of the studies assessed changes in weight (40%), blood cholesterol (40%), diet (34%), smoking cessation (33%), alcohol consumption (19%), and blood glucose (19%). No studies assessed sleep as a risk factor. Most studies had mixed effects or no change for the risk factor measured. No studies reported negative effects. Interventions associated with improvements were more commonly delivered by a multidisciplinary team and informed by behavior change techniques. Further research is required to identify the most effective methods to promote and sustain lifestyle behavior change among people living with stroke or TIA.