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Stroke – reduced risk of further stroke

Evidence Summary
Evidence regarding the impact of physical activity on the risk of further stroke is limited. The recent Cochrane Systematic Review concluded that physical activity is a safe intervention for people following stroke but did not specifically look at prevention of further stroke. Having said that, the Cochrane review did demonstrate the positive impact of physical activity on vascular risk factors in people following stroke. In addition, an earlier systematic review demonstrated evidence of reduction in risk of further stroke when physical activity interventions were used as part of an overall strategy to reduce vascular risk factors, for example alongside dietary modification, anti-platelet, cholesterol lowering and anti-hypertensive therapy. Therefore, we believe that physical activity should be recommended as part of a lifestyle and medical management strategy for the reduction of further stroke risk.

Quality of Evidence
Grade B-This recommendation comes from the extrapolation of risk factor data from the Cochrane review, and a separate systematic review of 11 RCTs, as well as the opinion of both topic experts and patient stakeholders.

Strength of Recommendation
Grade 2- This recommendation comes from a synthesis of a single systematic review.

Alongside other lifestyle and medical management strategies, physical activity should be recommended to reduce the risk of further stroke.

• Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD003316. DOI: 10.1002/14651858.CD003316.pub7.
• Hackam DG, Spence D. Combining multiple approaches for the secondary prevention of vascular events after stroke a quantitative modelling study. Stroke, 2007;38:1881-85.