Preventing stroke through coaching
Each year, stroke shortens the lives of millions of people across the globe – it is the second most common cause of death and disability worldwide. But according to BRNZ investigators, Dr Rita Krishnamurthi and MacDiarmid Medal winner, Prof. Valery Feigin, the overwhelming majority (up to 90%) of strokes are preventable.
“We know that the most effective way to prevent someone from having a stroke is to manage the modifiable risk factors, like blood pressure and diet,” says Valery. “They’re called ‘modifiable’ because it’s possible to change them, largely through adjusting your lifestyle.” Such management strategies are well-established, but as anyone who has ever made a New Year’s resolution knows, lifestyle changes don’t always stick. Rita and Valery felt that a more targeted approach like health wellness coaching could lead to longer-term benefits, but internationally, there was a lack of evidence-based research on such interventions.
This is why the AUT team set up a remarkable clinical trial called PreventS. It aims to determine if personalised coaching could be an effective tool for stroke prevention in people with an elevated risk of cardiovascular disease and stroke. The cohort of 320 includes Māori, Pasifika, New Zealand European and Asian participants. “The multi-ethnic nature of this trial is really important, because some of these communities have particularly elevated risk of stroke,” says Rita. “For example, Māori and Pasifika tend to suffer stroke at a much earlier age than New Zealand Europeans, and we still don’t understand all of the contributing factors.”
In their trial, which was funded by the Ageing Well National Science Challenge (NSC), each participant was randomly assigned to one of two groups – they’d either receive ‘usual care’ (i.e. assessment only) or 15 sessions with a trained health wellness coach, over a period of nine months. For Valery, the key to keeping participants motivated is that, “…the goals are set by the person themselves. Everyone is different, so by working directly with a coach, they get the support that suits them.” This motivational approach complements another aspect of Valery’s work – the Stroke Riskometer™ app, which now has 160,000 users worldwide.
The promising results of the PreventS trial has led to further funding from BRNZ. “This additional support will allow us to revisit our participants three years after randomisation, so that we can explore the long-term effectiveness of health wellness coaching,” says Valery. The involvement of BRNZ also offers the team a unique opportunity to increase the scope of the study. “International evidence suggests that people with very poor cardiovascular health have a higher risk of developing mild cognitive impairment,” Rita explains. “So, under the guidance of Associate Prof. Lynette Tippett, we’ve added initial cognitive screening. If as a result of the screening, a patient wants to undergo a more extensive assessment and follow-up, we can connect them to Lynette and her team at the Dementia Prevention Research Clinics. It’s a true collaboration.”