Discussion
The main focus of PREVENT Trial is to investigate the
role of aerobic exercise, education and lifestyle counselling
in reducing vascular risk factors of people after TIA
or NDS. This trial will contribute much needed evidence
to begin answering important clinical questions regarding
the role of non-pharmacological interventions, modelled
after cardiac rehabilitation programs, in preventing second
stroke in the often under-served patient populations
involved in this trial. Although the trial is not sufficiently
powered to determine the effectiveness of PREVENT on
hard clinical outcomes such as second vascular events or
death, we will compare occurrence rates between groups
in order to inform future, larger scale trials.
This multi-site RCT will also explore the impact of
the PREVENT program on cardiovascular fitness, walking
tolerance, fatigue, cognition, mental health, quality
of sleep, medication adherence, tobacco use, and healthrelated
quality of life, which may be mitigating factors in
reducing vascular risk factors, and, ultimately, stroke
recurrence. As well, comparison of the direct health
costs of the PREVENT and USUAL CARE groups over
the course of the study will provide important preliminary
information related to cost effectiveness and sustainability
of multi-modal, behavioral interventions such as
PREVENT.