Table 9 Non-pharmacological interventions recommended by the included CPGs for Stroke
Intervention types | Recommended self-managed non-pharmacological interventions | COR/LOE | Grading system used | Guidelines |
|---|---|---|---|---|
Physical Activity | For patients experiencing stroke or TIA and are physically able, it is recommended to participate in aerobic exercises regularly. For example, engaging in moderate-intensity aerobic activity four times a week, with each session lasting at least 10 min; vigorous-intensity aerobic activity twice a week, with each session lasting at least 20 min. Form: Moderate / vigorous-intensity aerobic activity Duration/Frequency: Moderate > 10 min, 4 times/week; vigorous > 20 min, twice/week | 1/C-LD | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Physical Activity | Content: To improve their cardiovascular health, individuals can enhance their sedentary routines by incorporating short breaks, such as standing or engaging in light exercise for as little as 3 min every half an hour. Form: standing or light exercise Duration/Frequency: NR | 2b/B-NR | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Physical activity | Minimize inactive habits and time spent being sedentary, while progressively striving for higher activity levels that are manageable and achievable. Form: NR Duration/Frequency: NR | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Physical activity | Regular exercise program. Form: Incorporate aerobic exercise regular daily living activities. Duration/Frequency: Engage in sessions lasting 10 min each, aiming for 4 to 7 sessions per week, to reach the activity time a minimum of 150 min/week | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Physical activity | Form: Practice specific tasks to improve function in the upper and lower extremities, as well as improve gait, posture, and other daily living activities. Duration/Frequency: NR | Strong/Moderate | GRADE methodology | VA/DoD Stroke Rehab (2019) |
Physical activity | Form: Engaging in cardiovascular exercises can help enhance the maximum walking speed following a stroke. Duration/Frequency: NR | Strong/Moderate | GRADE methodology | VA/DoD Stroke Rehab (2019) |
Physical activity | Incorporating rhythmic auditory cueing into multimodal interventions can enhance walking speed Duration/Frequency: NR | Weak/Low | GRADE methodology | VA/DoD Stroke Rehab (2019) |
Physical activity | Current evidence is inconclusive to make a recommendation for or against the use of mirror therapy for improving limb function. | Neither for nor against /Low | GRADE methodology | VA/DoD Stroke Rehab (2019) |
Smoking cessation | Begins with a decrease in smoking and advances toward complete cessation. | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Smoking cessation | Avoid passive smoking | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Smoking Cessation | Stop smoking or reduce their daily smoking | 1/B-NR | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Smoking Cessation | Avoid passive smoking | 1/B-NR | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Diet | Follow Mediterranean-type diet | 2a/B-R | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Diet | Retrict daily sodium intake by at least 1 g (salt 2.5 g) | 2a/B-R | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Diet | Follow Mediterranean-type or DASH (Dietary Approach to Stop Hypertension) diet | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Diet | The objective is to limit the daily consumption of sodium to a maximum of 2000 mg (equivalent to table salt 5 g or sodium 87 mmol) | Evidence Level A | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Alcohol consumption | Individuals who consume two alcoholic beverages daily (for men) or more than one alcoholic drink daily (for women) should consider reducing or discontinuing their alcohol intake. | 1/B-NR | ACC/AHA Clinical Practice Guideline Recommendation Classification System (Updated May 2019) | AHA/ASA Stroke (2021) |
Alcohol consumption | Avoid heavy alcohol use, to follow Canada's Low-Risk Alcohol Drinking Guidelines (2018). | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) | |
Weight management | Achieve and maintain a waist circumference of less than 88 cm for women and 102 cm for men or maintain a BMI with the range of 18.5 to 24.9 kg/m2 | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Weight management | Overweight patients to establish realistic and healthy weight loss objectives and develop personalized plans to attain goals. | Evidence Level B | CSBPR writing group assigned level of evidence, GOR included in the LOE | CSBPR (2020) |
Mental health therapy | Using exercise as supplementary treatment for post-stroke patients withdepression or anxiety. | Weak/very low | GRADE methodology | VA/DoD Stroke Rehab (2019) |
Mental health therapy | Use adjunctive therapy mind–body activities (e.g., tai chi, yoga, qigong) for post-stroke patients with depression or anxiety. | Weak/very low | GRADE methodology | VA/DoD Stroke Rehab (2019) |