RESUMEN
BACKGROUND: Non-disabling stroke (NDS) and transient ischemic attack (TIA) herald the possibility of future, more debilitating vascular events. Evidence is conflicting about potency of exercise and education in reducing risk factors for second stroke. METHODS: Three-site, single-blinded, randomized controlled trial with 184 participants <3 months of NDS or TIA (mean age, 65 years; 66% male) randomized to usual care (UC) or UC + 12-week program of exercise and education (PREVENT). Primary (resting systolic blood pressure) and secondary outcomes (diastolic blood pressure [DBPrest], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], TC/HDL, triglycerides, fasting glucose, and body mass index) were assessed at baseline, post-intervention, and 6- and 12-month follow-up. Peak oxygen consumption (VO2peak) was measured at baseline, post-intervention, 12-month assessments. RESULTS: Significant between-group differences at post-intervention favored PREVENT group over UC: DBPrest (mean difference [MD]: -3.2 mmHg, 95% confidence interval [CI]: -6.3, -.2, P = .04) and LDL-C (MD: -.31 mmol/L, 95% CI: -.42, -.20, P = .02). Trends of improvement in PREVENT group were noted in several variables between baseline and 6-month follow-up but not sustained at 12-month follow-up. Of note, VO2 peak did not change over time in either group. CONCLUSION: Impact of PREVENT on vascular risk factor reduction was more modest than anticipated, possibly because several outcome variables approximated normative values at baseline and training intensity may have been sub-optimal. Further investigation is warranted to determine when exercise and education programs are viable adjuncts to pharmaceutical management for reduction of risk factors for second stroke.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: #NCT00885456.
Asunto(s)
Terapia por Ejercicio , Factores de Riesgo de Enfermedad Cardiaca , Ataque Isquémico Transitorio/rehabilitación , Educación del Paciente como Asunto , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Anciano , Terapia por Ejercicio/métodos , Femenino , Estudios de Seguimiento , Humanos , Ataque Isquémico Transitorio/sangre , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Gravedad del Paciente , Educación del Paciente como Asunto/métodos , Método Simple Ciego , Accidente Cerebrovascular/sangre , Rehabilitación de Accidente Cerebrovascular/métodosRESUMEN
PURPOSE: To determine whether fortification allowed older adults in the Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health area to obtain adequate amounts of food folate, and the proportion at risk of consuming more than the upper limit (UL) of folic acid (1,000 mcg). METHODS: Dietary intake of a convenience sample of 103 healthy, active older adults (age range: 65 to 95 years) was measured using three 24-hour recalls. Dietary folate pre- and post-fortification was estimated. RESULTS: Mean dietary folate increased from pre- to post-fortification, but 43.4% of women and 20% of men still consumed less than the Estimated Average Requirement of 320 mcg dietary folate equivalent. No intakes exceeded the UL. Participants whose diet met grain products and vegetable and fruit recommendations of Canada's Food Guide to Healthy Eating consumed significantly more folate. CONCLUSIONS: Despite fortification, some older adults in the KFL&A area may not be obtaining enough folate to meet their nutritional needs, and may be at risk for health problems associated with folate deficiency. However, without concomitant serum folate measurements, the proportion is not known. Dietitians need to continue promoting foods naturally rich in folate, along with folic acid-fortified foods. While none of the older adults consumed more than the UL, some could exceed this amount if folic acid supplements were added to a folic acid-rich diet.