Abstract WP229: H ealthy E ating and L ifestyle After S troke (HEALS): A Pilot Trial of a Lifestyle Intervention for Stroke Survivors in the Safety-Net

Background: Although healthy lifestyle practices mitigate stroke risk and mortality, few stroke survivors adhere to them, particularly among socioeconomically disadvantaged communities. We developed and pilot tested a lifestyle management intervention, HEALS, to improve stroke survivors’ diet and physical activity and tested it in a diverse population receiving care at a safety-net county facility. Methods: One hundred English- or Spanish-speaking participants with stroke or TIA were randomly assigned to a 6-week weekly occupational therapist-led group lifestyle intervention vs. usual care. Each 2 hour session included didactics, goal setting, activities, and peer exchange. Primary outcomes measured at baseline and 6 months were body mass index, abdominal obesity, fruit/vegetable intake, and physical activity. Secondary outcomes were blood pressure, high-density lipoprotein cholesterol, and glycosylated hemoglobin. Outcomes were compared with repeated measures analysis. Effect sizes for continuous variables were determined using partial eta-squared. A nested formative evaluation assessed facilitators and barriers to implementation, acceptance, and adherence to the intervention. Results: Mean age was 60 years, 62% were men, 68% were Hispanic, 60% were Spanish-speaking, 35% had ≤8 th grade education, 31% were working at enrollment, and 69% had modified Rankin scale <3. Seventy-three percent participated in at least one HEALS session. Over one third (37%) attended all 6 sessions. There were no significant changes in primary or secondary outcomes at 6-months, even after adjusting for number of sessions attended. Effect sizes for primary outcomes were small (<0.05). Focus group participants recommended more sessions for a longer treatment duration, additional information on diet and physical activity, and monetary incentives for participation. Providers agreed with a need for a longer treatment duration and suggested more robust provider training and fidelity checks to ensure standardized program delivery. Conclusions: The HEALS intervention was feasible in a safety-net setting, but the effect sizes were small. An RCT of a longer-duration intervention, with more formal provider training, may be warranted.