Patient discussions

Encourage patients to continue rehabilitation in a specialized stroke facility. Rehabilitation often focuses on activities of daily living, mobility skills, communication skills, and psychological functioning, and over time will help with improvement of initial symptoms.[231]

Explain to patients that depression may occur after stroke, and if not treated is likely to interfere with recovery; seeking help at the sign of any key symptoms is important.

Encourage lifestyle changes and offer to refer to smoking and alcohol cessation programs as necessary.[102] Counseling with or without drug therapy (nicotine replacement, bupropion, or varenicline) is recommended to assist in stopping smoking to reduce risk of recurrent stroke. Avoidance of environmental (passive) tobacco smoke is also recommended.[102]

Patients with ischemic stroke who drink >2 alcoholic drinks a day (men) or >1 alcoholic drink a day (women) should be counseled to eliminate or reduce their consumption of alcohol to reduce stroke risk.[102]

Stroke Association: life after stroke Opens in new window

All patients who have had ischemic stroke or transient ischemic attack (TIA) who are capable of physical exercise should be strongly advised to participate in at least moderate-intensity aerobic activity for a minimum of 10 minutes four times a week, or vigorous-intensity aerobic activity for a minimum of 20 minutes twice a week. This is to decrease their risk factors for recurrent stroke.[102] [ Cochrane Clinical Answers logo ] [ Cochrane Clinical Answers logo ] In patients with stroke or TIA who are able and willing to increase physical activity, engaging in an exercise class that includes counseling to change physical activity behavior can be beneficial for reducing cardiometabolic risk factors and increasing leisure time physical activity participation.[102] When this is not possible, the patient’s physical activity goals should be customized to their exercise tolerance, stage of recovery, environment, available social support, physical activity preferences, and specific impairments, activity limitations, and participation restrictions.[102] Refer stroke patients with residual disability to physical therapists or cardiac rehabilitation professionals for supervised and goal-oriented rehabilitation.[102] [ Cochrane Clinical Answers logo ] In patients with stroke or TIA who sit for long periods of uninterrupted time during the day, it may be reasonable to recommend breaking up sedentary time with intervals as short as 3 minutes of standing or light exercise every 30 minutes for their cardiovascular health.[102]

In patients with stroke and TIA, it is reasonable to counsel individuals to follow a Mediterranean-type diet, typically with emphasis on monounsaturated fat, plant-based foods, and fish consumption, with either high extra virgin olive oil or nut supplementation, in preference to a low-fat diet, to reduce risk of recurrent stroke.[102]

For patients with stroke and hypertension who are not currently restricting their dietary sodium intake, it is reasonable to recommend that individuals reduce their sodium intake by at least 1 g/d sodium (2.5 g/d salt) to reduce the risk of cardiovascular disease events (including stroke).[102]

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