People who have had a TIA or minor stroke are at greater risk of having another TIA or stroke. High blood pressure is often (though not always) one of the problems people need to address. Lifestyle changes can help to reduce the risks, these include:
- quitting smoking,
- reducing alcohol intake,
- maintaining a healthy weight,
- eating a healthy diet and
- taking regular exercise.
Most of the people we interviewed spoke about changes that they had made to their day to day lives which they hoped would help prevent them from having another episode, or a more serious stroke. Some people had been told by their consultant or GP that they ought to make changes, and other people took their own decision to change because they already knew about the risk factors, or had obtained information about reducing risk of further stroke from other sources e.g. internet, support organisations (see ‘
Support and information’). However, others could not remember being given any or much advice about risk factors and lifestyle. Many people said that having a TIA or minor stroke had been a ‘wake-up call’ which had led to them thinking more about their future. For some people, changing their lifestyle also meant taking a step back from work commitments and attempting to reduce stress (see ‘
Work’).
Diet
A number of people had been advised to lose some weight, and others were told that it was important to eat a healthy diet including cutting down on salt, sugar and fats, and eating plenty of fruit and vegetables. A good diet can help control blood pressure and reduce cholesterol levels.
Rich was told he needed to cut down his cholesterol levels and is now careful about what he eats, but on the whole he says he still lives a normal life
Rich was told he needed to cut down his cholesterol levels and is now careful about what he eats, but on the whole he says he still lives a normal life
Age at interview: 66
Sex: Male
Age at diagnosis: 62
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I had a word with the dietician because I was, my cholesterol was a little high. It wasn’t outrageous and I soon got it down by following, you know, following the rules for want of a, but there again it’s not as though I abused it. I didn’t smoke, I didn’t, all right there were things I, I love cheese which is a no-no. I can have it but, as a treat as they say, and, you know, fried food that I never used to indulge in, as , as far as I was concerned I don’t think I abused myself that much or my body.
So you adjusted your diet a bit for the cholesterol …
Yeah, I adjusted my diet ..
..side of things…
And there, there wasn’t many things that I had to cut out. I think probably cheese was the, the major thing. We don’t have a lot of butter, we don’t have a lot of bread, bread and butter here. You know, anything that’s cooked bacon and eggs, it’s cooked, poached or it’s grilled …
...you know. I’m limited to, I think its two eggs a week [laughs].
And did you cholesterol, has it gone down …?
It’s gone…
Right.
.. It’s about 5.4. They’d like to see it under 5 but it’s manageable and I’m careful. I have the occasional treat. I eat Chinese Buffet on a Sat, Friday lunchtime. You know, apart from that, no, you know. I just lead a normal life.
Many people said they felt that they already ate reasonably healthily, but most were able to make small changes. A number of men said that their wives or partners helped them to keep their diet healthy which made it easier for them to stick to it.
Phillip eats a reasonably healthy diet most of the time but confessed that he really hasn't made that many changes, although he says that as he has got older his tastes have changed and he eats less anyway
Phillip eats a reasonably healthy diet most of the time but confessed that he really hasn't made that many changes, although he says that as he has got older his tastes have changed and he eats less anyway
Age at interview: 72
Sex: Male
Age at diagnosis: 71
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And you haven’t had to make any changes in lifestyle as a result, then?
Yes, I have. I - well, I think the answer is probably no. I’m very bad at self-discipline like this, right? And periodically I clean up my diet more completely and then... But, you know, I’m, I meet all the vegetable requirements and salads and all this kind of stuff. And so I’m pretty good. But, you know, I do, I eat probably, I probably do a roast once a week and I probably have a English breakfast maybe once a month. And one of the advantages of getting older is your tastes change, and I’m slowly tending to go off those foods. So, but I just think I’m automatically just by the natural ageing process prefer eating less certainly. I certainly eat about half what I used to eat twenty years ago. And probably do half as much as well, see. And that might be a, that’s probably a big weight problem if I wasn’t rather lucky and my appetite’s gone down. Because if my appetite hadn’t gone down I’d be really in serious trouble with my metabolic balance. No, I haven’t really changed it. No, no, I know this is a very sad thing to say, this is really a very sad thing to say, but, no, I haven’t changed my, I haven’t changed my lifestyle significantly since then.
Angus thinks a little bit more about what he eats but generally he feels that he can live life pretty much as normal
Angus thinks a little bit more about what he eats but generally he feels that he can live life pretty much as normal
Age at interview: 61
Sex: Male
Age at diagnosis: 60
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I’m more conscious of my blood pressure now, because apparently this may be a contributing factor towards TIAs, mini strokes, and I subsequently keep it under control and watch what I eat, so I suppose in a way it has affected me that way, because I now make sure I don’t eat salty foods and things, don’t put salt and vinegar on my fish and chips and things like that, you know, because these things contribute or may contribute to it, you know. [dogs barking in background]
Other things I’m doing is I suppose – no, really, it really is food, making sure it’s more healthy than what I used to eat. Albeit I really didn’t really eat unhealthily before, I don’t smoke, I don’t drink that often. Perhaps when I do it’s probably a bit too much [laughs] but not very often. But the stroke it, the mini stroke, the TIA, it’s, it really hasn’t affected me to worry about it. And like I say I’m carrying on with my life now, hopefully, as normal, you know.
Martyn's wife helps and encourages him to keep to a healthy diet, and he feels that a good diet increases his sense of wellbeing
Martyn's wife helps and encourages him to keep to a healthy diet, and he feels that a good diet increases his sense of wellbeing
Age at interview: 64
Sex: Male
Age at diagnosis: 57
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Jean was very concerned obviously when it happened and has been very supportive in me maybe following the right sort of diet. So I guess we’re more careful in this house now on what we eat, bearing in mind we’re all cholesterol, got cholesterol at the back of our minds I suppose. And she’s very, she’s happy that I follow what you might call a healthy lifestyle, so I try to follow a healthy lifestyle. I hope it doesn’t sound too sanctimonious but this is what we’re advised to do and certainly it makes you feel good, doesn’t it?
Some people found change more difficult to achieve, and a small number found proposed lifestyle changes overly restrictive and could sometimes feel a bit resentful about it all.
Clare felt upset about the lifestyle changes that were recommended by her consultant as it felt as though she was being told what to do
Clare felt upset about the lifestyle changes that were recommended by her consultant as it felt as though she was being told what to do
Age at interview: 50
Sex: Female
Age at diagnosis: 48
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The one thing that I wanted, that did drive me bonkers was and, and understandable was that the consultant kept saying to me, “Lifestyle changes, lifestyle changes. You’ve got to make lifestyle changes.” That was what he said to me from the moment I got there to the moment I, I left. Which I can understand and appreciate that I was almost being brainwashed into having lifestyle changes. But I thought, “Well, this isn’t fair. I’m not obese. I haven’t got high blood pressure.” You know.
What kinds of lifestyle changes was he recommending then?
Giving, giving up smoking, taking more exercise reducing cholesterol in, in food and this, that and the, I think my cholesterol was six point something which is higher than the average, it’s what they want I know, but it’s not extortionate really.
You know, it’s not just about having the, the stroke. Because I can remember we went shopping shortly after having my stroke and I looked at all the foods, cheese, because I love cheese. All high cholesterol. You know, and don’t’ do this and don’t do that and be careful with this, don’t overdo it on that and that, it was wearing, it was upsetting. You know, and it just felt, you know, you take a, a step back and think, “Well, you know, I’m 48, I’ve had a stroke, I’ve read enough from the information on, on the internet to know that there, it’s usually a precursor to another stroke,” you know, which wasn’t a nice thought. And then you think, “What would, what, what if I was doing this…” And then in the end you, I burnt myself out basically because, you know, that was my way of dealing with it, you think about what would happen if this happened and what would happen.
Some people suggested that occasional treats could make it easier giving up the things you really love. A dietician may be able to advise on strategies to manage diet – though not everyone was offered this opportunity.
Rich asked to see a dietician whilst he was in hospital so that he could find out more about what kind of changes he might need to make to his diet
Rich asked to see a dietician whilst he was in hospital so that he could find out more about what kind of changes he might need to make to his diet
Age at interview: 66
Sex: Male
Age at diagnosis: 62
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The only, the only thing the only preventative measures that are, I was talked to about, and funnily enough I had to ask, about a week or so before I was, I came out of [ward name], I said “What about food? Dietician?” “Oh do you want to see one?” And basically a dietician was brought. It wasn’t part of the, let’s say the checklist, he’s done this, done that because I know some of the things, I was taken into a dummy kitchen in [name] ward to see, towards the end, before I was come out, just to see my kind of, let’s say, co-ordination and so forth.
But not once was I told, “There’s a dietician coming to see you”. I had to ask for that. And we went through it all. And there’s basically three columns, you can’t have this, you can, you can have this, you, in moderation, treat. In other words, one of the things, fish and chips, you can have once a week as a treat.
Not that I have fish and chips because I try not, much as I like fish, but, you know, I immediately think batter, fat, oil, chips, you know...
So you are, starting to think …
… that…
.. a little bit more in that way then?
Well, you know, I do that from day one, you know. Stay away from things like shellfish because I believe shellfish is high in bad cholesterol or something.
Right, so you’ve done your research?
I…
You know…
.. yeah, I’ve still got it out there, I’ve got the list and when I was last having my MOT, last January and I thanked the nurse only yesterday when I saw her. We were in there talking and my wife went in for some kind, kind of check and came and join, and she turned round to the nurse and said, “What about curries? Rich likes curries.” And said, “Yes” and she got up and I’ve got a superb book out there and I thanked her yesterday very much for it, because it’s all the things of what you can do your own curries but you don’t do, for instance you don’t use this ghee.
Ghee, yeah..
...which is ..
Clarified butter?
… you know, clarified butter. But it’s, it’s a, it’s a healthy way to do a curry. So, there are…
So you can find ways round it?
Oh yeah, you can find ways round it.
Smoking
Smoking causes the arteries to become narrowed and makes the blood more likely to clot, so giving up smoking is strongly recommended to avoid the risk of this happening Most of the people we interviewed who had been smokers before their TIA or minor stroke said that they gave up smoking almost immediately but one woman found it very difficult to give up because she had a bad reaction to smoking cessation medication.
Keith gave up smoking straight after he recovered from the TIA
Keith gave up smoking straight after he recovered from the TIA
Age at interview: 58
Sex: Male
Age at diagnosis: 58
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I used to smoke and that’s stopped instantly.
How did you find doing that? I mean, was that hard to …
Oh, it’s still hard, yeah. Yeah, yeah, extremely hard. Yeah. I didn’t think it would, I thought it was really, it’s a very strong motivating factor to have a stroke because I haven’t smoked since and it’s very, it, sometimes it’s exceedingly difficult but not that difficult really.
How long has it been since you …?
Well since the stroke on April 10th, so that’s well two months now, yeah. Yeah, which is a reason to celebrate really.
Jennifer found it difficult to give up smoking because she said she experienced bad side effects from a drug she was prescribed to help her quit
Jennifer found it difficult to give up smoking because she said she experienced bad side effects from a drug she was prescribed to help her quit
Age at interview: 55
Sex: Female
Age at diagnosis: 53
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They brought it up at the last, I’d just two months ago went for a stroke clinic down at my doctor’s surgery. Now that’s the first time I’ve been to the stroke clinic. And there they mentioned the smoking but, but they, they told me I’d be better to stop and I did try and but I had a bad reaction to Champix.
What?
Champix. It’s a, Champix is a tablet they can give you to help you stop smoking. But the side effects of the Champix have, they’re absolutely horrendous. I mean, you can, sleepiness. I it’s better than a sleeping tablet. You’re sleeping 24 hours a day practically. The nausea and really the side effects are horrendous. So I had to come back off, off them.
So I’m now due to go to smoking cessation clinic which that is because, because I’ve been, I’d attended a, it’s like a health “MOT” where they take you and they check your blood pressures, things like that. And, and give you advice on lifestyles. So I’m now, they, they’ve just started the smoking cessation clinic. That, that’s six months since I was at the health check. So I’m hoping to, to go to that in the next two to three weeks.
Jennifer has several different illnesses which have affected her way of life and sometimes feels smoking is ‘the only pleasure I’ve really got left’.
Alcohol
Reducing alcohol levels can help to lower blood pressure. Some people said they didn’t really drink very much or not at all so this wasn’t an issue for them but a number of people said that they had taken on board the advice to cut down on alcohol consumption. Most people took on board the message that they could drink in moderation rather than stop all together.
Brian was advised to cut down on alcohol which he feels is a sensible thing to do
Brian was advised to cut down on alcohol which he feels is a sensible thing to do
Age at interview: 85
Sex: Male
Age at diagnosis: 84
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Oh, they told, they told me to cut down on the drink.
Right.
[laughs] Well, of course, I mean, you know, what else can they say? Did they say anything else? Possibly taking regular exercise. So.
And are those things that you kind of take with a pinch of salt? It sounds like maybe…
No, I don’t.
No?
But they’re the sort of obvious things that it would be sensible to do. So I don’t drink as much although this weekend was an exception [laughs] No, and I take moderate exercise.
Roger was told by his consultant to be careful about how much alcohol he drinks which can sometimes be difficult as he works as an entertainer and drinking is a social aspect of the job
Roger was told by his consultant to be careful about how much alcohol he drinks which can sometimes be difficult as he works as an entertainer and drinking is a social aspect of the job
Age at interview: 67
Sex: Male
Age at diagnosis: 64
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I try to be careful with alcohol. Not too much alcohol. Although the consultant did say, if he had his way, he would put, put red wine, a glass of red wine on the drugs trolleys [laughs]. I mean it’s the sort of thing that.. a glass of red wine now and again. I mean I do like that. And a glass of home-made ale or something now and again. But I don’t smoke generally.
So when you’re talking about the alcohol, just going back to that is that something that you would have perhaps had a bit more of previously?
Yes, because as a pianist, entertainer - and yes, and you go somewhere, and people ask you, and you said yes, that’s right. And particularly things like, it’s a great shame, because they are very welcoming a bubbly glass of, a glass of fruits of bubbly or something, which people like to present, but particularly the bubbles- I understand they go to the brain or something... whether it’s an old wives tale I don’t know. [laughs] So yes, that sort of thing, and its [rrrrp] straight away and it affects you. But yes. I’ve had to watch it a bit, and I did wonder if some of the drinking may have contributed, one of the contributory factors to be honest.
All he said, the consultant and GP, all they said basically was, “Well watch the alcohol.”
Exercise
Regular exercise is recommended as a means of reducing the likelihood of further stroke because it can help lower blood pressure, helps you lose weight and can alter the balance of fats in the body. Thirty minutes of activity, five days a week is enough to reduce the risk of stroke. Most people said that they had been advised to take more exercise. Some said they found it relatively easy to incorporate some form of exercise in their lives especially where they now found themselves with more time on their hands through either giving up work or cutting down on the time they spent at work. Most people managed to make small changes such as walking a bit more instead of driving, and some made a conscious effort to go to gym or swimming groups but it could also be challenging for some people who were not great fans of exercise generally. Some people found it hard to keep up the momentum and said that after the first burst of enthusiasm it could be difficult to keep going with it on a regular basis. Very often someone’s wife or partner would help encourage the person to start or continue to take exercise. People who lived alone and did not have a partner to encourage them could find it more difficult to keep going. Ros (below) felt upset that nobody had acknowledged how well she was doing.
Martyn has now retired and has more time to himself. He and his wife have joined the local sports centre and he swims most days of the week. He says it enhances his sense of wellbeing
Martyn has now retired and has more time to himself. He and his wife have joined the local sports centre and he swims most days of the week. He says it enhances his sense of wellbeing
Age at interview: 64
Sex: Male
Age at diagnosis: 57
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I try to follow a healthy lifestyle. I hope it doesn’t sound too sanctimonious but this is what we’re advised to do and certainly it makes you feel good, doesn’t it? So we exercise. I exercise at the swimming pool. Jean exercises cleaning the house. So I don’t clean the house, she cleans the house. I go swimming. And that’s fine.
Is that a change …
And it works …
… from how things were before? Did you not maybe do quite so much of that sort of thing before? Or …
I did used, I used to swim and I used to love, and I, I walk because I love walking, I always have done etc. But I certainly do more of it now, well I’ve retired as well so I’ve got the chance to go swimming maybe four, five times a week. And I’ve been, like, so I joined the local swimming club. Club? Well sports centre. And so I trot off there.
Adrian is fearful of having another more serious stroke and this motivates him to take more regular exercise now
Adrian is fearful of having another more serious stroke and this motivates him to take more regular exercise now
Age at interview: 53
Sex: Male
Age at diagnosis: 53
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I thought I was leading quite a healthy lifestyle before, but I’ve almost completely stopped drinking alcohol. I’ve actually joined the gym, which was a joke but I have and I’ve actually been as well. So I’m going to do everything I possibly can to make sure it doesn’t happen again. I’ve also lost lots and lots of weight as well.
So you’ve made quite a few lifestyle changes?
Well yes, and I didn’t think I really needed to. But my partner was insistent that we joined a gym and got fit, or fitter, and actually I quite enjoy it. So … we have made a fair few lifestyle changes.
Were those things that were suggested to you by the health professionals that you saw?
No these were things, that after… we came back from the [hospital]. We sat down and decided what we’d do. Because I was very frightened and I just want to lessen my chance. So the more I do… The alcohol thing, was just a case of you get into a habit of having a glass of wine when you get in from work or whatever, then you suddenly realise how much you drink in a week. So I stopped it completely.
Physically there are absolutely no symptoms. No symptoms at all. The only thing that is staying with me is the fear. But I suppose I’m using that to my advantage because that’s now my inspiration and, and my drive to go to the gym to lose weight, to eat healthily.
Ros felt she would like more encouragement from other people about how well she had done at losing weight and taking more exercise
Ros felt she would like more encouragement from other people about how well she had done at losing weight and taking more exercise
Age at interview: 69
Sex: Female
Age at diagnosis: 69
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I changed my whole, whole life, I haven’t got a car any more. So I know if I haven’t got a car, then I have to walk. So, you know, I’ve really tried to help myself.
And do you have you found that you’ve got the impression that they haven’t kind of bought into that so much, or …
I don’t know. I don’t know really. Maybe I needed a bit more praise and saying, “Well, you’ve done well, you’ve, you know, you’ve really done well.”
Encouragement?
But no, nobody’s said that, they’ve just …
No.
.. left me to get on with it. I, that’s how I feel.
Yeah. I can see. So, you’re feeling a bit like, what you said earlier, not listened to and I suppose in a lot, for a lot of people encouragement is one of those ways …
Yes.
.. isn’t it, that we keep going, …
Yes.
..and move forward.
It seems all negative, you know. I’ve, I feel that I’ve done well but nobody said, “Oh well done” you know, “You’ve really done well, you’ve lost four stone”.
You have.
“You’re walking where you never walked before”. I got rid of my car so that I, I make myself walk, I have to walk.
Jennifer found the costs of going to gym or exercise classes were prohibitive, and commented that it could be unfair if people who had a heart condition were given free gym sessions as part of their rehabilitation.
Some people who were very active before their TIA or minor stroke found they were unable to be quite so physically active afterwards. Yvonne (below) was very fit and active before her minor stroke and found it difficult to have to be more mindful not to over exert herself, and Ken (below) felt lost when he wasn’t able to work on the allotment as frequently as he’d been used to. Not being able to exercise so much meant some people put on weight just at a time when they wanted to lose it.
'It's a macho thing.' Ken has to leave the heavy work on the allotment to other people and he feels embarrassed
'It's a macho thing.' Ken has to leave the heavy work on the allotment to other people and he feels embarrassed
Age at interview: 68
Sex: Male
Age at diagnosis: 68
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It really is hard. Especially when I’ve got a friend that lives with us, I’m in partnership with another friend who she had the allotments first. And I used to help her and then I, we had, she had two plots and we took on another two. So, you know, and I always used to be all the heavy work and now I have to sit back and let, well not sit back but ease back and they do all the hard work I’m doing the light work. And it’s, well embarrassing I suppose it’s a macho thing, I suppose. And well I just have to accept it at the moment but I’m, I’m sure it’s not going to be for long [laughs] I’m sure of that.
And I mean, have you actually checked out what you can, what you are and not allowed to do? Or is it just that you go, go on your gut instinct about how, what feels OK to be doing?
I do, well when it first started I was told to, I couldn’t do my allotment. But I did, when I saw the consultant he said to me “Can I have a look at your belt size?” I said, “Yes.” And he said, “Oh, you’ve put a lot of weight on.” Which I did because I weren’t doing exercise. And he said, “I think you’d better go back to your allotment.” And from there I just do what I can and I sit down when I feel out of breath I sit down, rest for a quarter of an hour and then go back to it. Another bit, sit down. And that’s what, that’s what it is all the time.
But it sounds like you’ve kind of reached a bit of a compromise with yourself because if you weren’t doing it at all…
Oh yeah.
.. now at least you’re doing some.
Oh, I couldn’t stay indoors. I’m, my wife will tell I’m out - nine o’clock in the morning and I’d, in the summer and I’m not home till about half past eight at night. Now I’m …
So that’s been quite a big change in your life really …
Yeah. Definitely
…at this, with this …
And now I’m home three o’clock now. Because I, I just haven’t got the energy to do it, you know. I do as much as I can when I’m there within breaks. And then by about two o’clock, half two I feel I’ve had enough and I come home.
Yvonne had to cut down on exercise and be more careful. She found it hard but has found ways round it
Yvonne had to cut down on exercise and be more careful. She found it hard but has found ways round it
Age at interview: 54
Sex: Female
Age at diagnosis: 54
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The only thing I found difficult is not being able to exercise. So. But I’ve had to try and find other ways of getting around that. So I will go for a walk for twenty minutes.
So you are still exercising but it’s different?
Yeah.
Yeah.
It’s different sometimes.
It’s interesting you say that because a lot of people that I speak to sort of say, “It’s really hard to have to do exercise, you know, because I haven’t really done much in my life before.”
Yeah.
And you’re saying it’s really hard not to exercise [laughs].
It is. [laughs] It is. But I’ve just had to find different things to do. You know. I want to go.
Just not to over exert.
Yeah. Yeah. So.
Work out what your boundaries are I suppose or limits.
Yeah. I mean, I’ve got an exercise bike out, outside so I said to my husband, “I think in a few weeks I’m going to start getting on that and just having, you know, put the resistance really low and just kind of build it maybe.”
Because I suppose, I mean, the exercise thing actually it makes you feel good in other ways doesn’t it?
Absolutely.
So for you to have to cut back on it must be difficult.
Yeah.
Yeah.
Yeah. It’s been horrendous to be honest with you.
Last reviewed June 2017.
Last updated June 2017.Copyright © 2024 University of Oxford. All rights reserved.
