A feasibility study to identify attitudes, determine outcome measures and develop an intervention to inform a definitive trial that will determine the effectiveness of adapted cardiac rehabilitation for sub-acute stroke and TIA patients.

Stroke leads to reduced cardiorespiratory fitness (CRf) and increased risk of future cardiovascular events. Cardiac rehabilitation (CR), has been shown to reduce the risk of future cardiovascular events in cardiac patients. The use of CR for the stroke population has only been explored in one study in England. This study provided CR for stroke patients for 30 weeks and focussed on people with very mild severity stroke.

The overall aim of this thesis was to establish the feasibility of conducting a definitive study investigating the effect of six weeks of adapted CR on CRf, blood pressure, heart rate, activity levels, quality of life, fatigue, tone, falls, body mass index, anxiety and depression for people with mild to moderate stroke in the sub-acute stage of recovery. Feasibility was determined by: acceptability, ability to recruit, adherence to the programme, identifying outcome measures and adverse events. This mixed-methods thesis reports firstly on the attitudes and knowledge of healthy lifestyles in people post stroke and their thoughts on attending CR. Secondly, it identifies the attitudes of stroke and CR teams towards people with stroke attending CR and the adaptations that would be needed. These two phases informed the design of the final cohort study by identifying the CR adaptations needed and the recruitment strategies to be used.

The third phase of this thesis reports on the results of a validity and reliability study which aimed to identify the most valid and reliable clinical test of CRf in people with mild-to-moderate severity stroke. The Incremental Shuttle walk test (ISWT) was shown to have modest validity (r=0.58, 95% confidence intervals (CI) 0.34-0.75, p=0.001) and strong reliability (ICC of 0.99, 95% CI 0.96-0.99) for measuring CRf in people post-stroke and this measure was used in the final phase of the thesis. Finally, this thesis reports on the results of a mixed-methods cohort study that integrated people with stroke into CR programmes in the sub-acute phase of recovery.

It was found that adapted CR: was acceptable to people with NIHSS <3, the stroke and cardiac teams if suitable support and training provided, and the cardiac patients; had acceptable recruitment; had high adherence and only one adverse event; and identified outcome measures that could measure change. It concludes that a definitive study to explore CR for a very mild stroke population (NIHSS <3) is feasible with appropriate adaptations and support.