Program of Rehabilitative Exercise and Education to Avert Vascular Events After Non-Disabling Stroke or Transient Ischemic Attack (PREVENT Trial): A Randomized Controlled Trial.

The planned sample was not reached: enrollment was stopped at 184 randomized participants instead of 196, and total attrition was 25%, more than the anticipated 10%. The trial was not powered for hard outcomes such as recurrent TIA, stroke, cardiac events, or death. The intervention was a combined package of exercise, education, goal setting, health passports, positive reinforcement, adult learning, and usual care, so the contribution of any single component cannot be separated. Many participants already had risk factors within or near normative ranges at baseline, limiting room for improvement. Exercise intensity during sessions was not fully documented, and post-intervention physical activity and adherence were not tracked. Group exercise used therapist-participant ratios as high as 1:5, which may have made it difficult to sustain prescribed intensity. The control group also received substantial usual care, including neurovascular clinic visits, counselling, medication adjustments, and referrals, so the comparison was not exercise versus no care.

No potential conflicts of interest were declared. The study was jointly funded by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada.

Do not conclude that this program reliably lowers systolic blood pressure or prevents recurrent stroke. The primary systolic blood pressure outcome showed no significant between-group difference, and the secondary diastolic blood pressure and LDL cholesterol changes were not supported by a significant group-by-time interaction over follow-up. The trial was not powered for recurrent stroke or death, and the combined program included exercise, education, goal setting, health passports, positive reinforcement, adult learning, and usual care, so the effect of any single component cannot be separated.