Potential effects on cardiometabolic risk factors and body composition by short message service (SMS)-guided training after recent minor stroke or transient ischaemic attack: post hoc analyses of the STROKEWALK randomised controlled trial

• Published in: BMJ open Vol. 11; no. 10; p. e054851
• Main Authors: Vahlberg, Birgit Maria, Lundström, Erik, Eriksson, Staffan, Holmback, Ulf, Cederholm, Tommy
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 18.10.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Blood pressure; Body composition; Cellular telephones; Cholesterol; Comorbidity; Exercise; Glucose; High density lipoprotein; Insulin; Intervention; Ischemia; Laboratories; Medical records; neurology; Physical fitness; Rehabilitation Medicine; Risk factors; Sarcopenia; Stroke; stroke medicine; Systematic review; Text messaging; Transient ischemic attack; Walking
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-054851

ObjectivesTo evaluate effects of mobile phone text-messaging exercise instructions on body composition, cardiometabolic risk markers and self-reported health at 3 months after stroke.DesignRandomised controlled intervention study with per-protocol analyses.SettingUniversity Hospital in Sweden.ParticipantsSeventy-nine patients (mean (SD) age 64 (10) years, 37% female) ≥18 years with good motor function (modified Rankin Scale ≤2) and capable to perform 6 min walking test at hospital discharge were randomised to either intervention (n=40) or control group (n=39). Key exclusion criteria: subarachnoid bleeding, uncontrolled hypertension, severe psychiatric problems or cognitive limitations.InterventionsThe intervention group received beyond standard care, daily mobile phone instructional text messages to perform regular outdoor walking and functional leg exercises. The control group received standard care.Main outcome measuresFat mass and fat-free mass were estimated by bioelectric impedance analysis. Cardiometabolic risk factors like blood lipids, glycated haemoglobin and blood glucose were analysed at baseline and after 3 months.ResultsBoth groups changed favourably in fat-free mass (1.83 kg, 95% CI 0.77 to 2.89; p=0.01, effect size (ES)=0.63 vs 1.22 kg, 95% CI 0.39 to 2.0; p=0.05, ES=0.54) and fat mass (−1.30 kg, 95% CI −2.45 to −0.14; p=0.029, ES=0.41 vs −0.76 kg, 95% CI −1.74 to 0.22; p=0.123, ES=0.28). Also, many cholesterol related biomarkers improved; for example, total cholesterol −0.65 mmol/L, 95% CI −1.10 to −0.2; p=0.06, ES: 0.5 vs −1.1 mmol/L, 95% CI −1.47 to −0.56; p>0.001, ES=0.8. However, there were no between-group differences. At 3 months, 94% and 86%, respectively, reported very good/fairly good health in the text messaging and control groups.ConclusionsNo clear effect of 3 months daily mobile phone delivered training instructions was detected on body composition, cardiovascular biochemical risk factors or self-perceived health. Further research is needed to evaluate secondary prevention efforts in larger populations after recent stroke.Trial registration numberNCT02902367.