Discussion
stroke, cardiovascular disease
STROKE, RECRUITMENT, RECRUITMENT, CARDIOVASCULAR DISEASE
Telehealth-delivered PA and diet interventions were feasible and safe to deliver, and led to statistically significant, and clinically meaningful improvements in PA, diet quality, and quality of life. While not powered to detect statistically significant between-group differences, we also found a trend toward lower blood pressure associated with the diet intervention.Conducting a complex clinical trial for people with stroke entirely via telehealth is novel, and we found it to be feasible. Telehealth delivery was not a barrier to recruitment; only one person was unable to participate due to inadequate Internet connection. Adherence to the intervention sessions was high, and percentage of missing outcome data low. Recruitment was our greatest challenge; we were unable to reach our target sample of n = 80 within the funding and time available. While not quantifiable, the pandemic likely impacted recruitment rates via hospital-based stroke clinics and rehabilitation services. Like many other trials of health behavior change, the people included in our trial lacked diversity and may not represent those at greatest need for the interventions. Most were young, lived in metropolitan areas, were normotensive and had a moderate to high degree of self-efficacy for exercise at baseline. We also had to exclude a large number of people who were already sufficiently physically active. Future trials should include strategies for recruitment to ensure people in most need are represented.Our safety and feasibility trial was not powered to detect statistically significant results. However, both the PA and DIET interventions led to improvements in PA levels and diet quality, respectively. This, combined with positive trends in blood pressure, suggest our interventions may reduce cardiovascular disease and recurrent stroke risk. Therefore, we plan to further test these interventions within a fully powered trial.