Cardiorespiratory responses to exercise related to post-stroke fatigue severity

Abstract

Physical deconditioning after stroke may induce post-stroke fatigue. However, research on this association is limited. Our primary objective was to investigate the associations of post-stroke fatigue severity with oxygen uptake ($$\dot{\mathrm{V}}$$ V ˙ O2) at peak exercise and the time constant of $$\dot{\mathrm{V}}$$ V ˙ O2 kinetics (τ$$\dot{\mathrm{V}}$$ V ˙ O2) at exercise onset. The secondary objective was to examine the associations between fatigue and cardiorespiratory variables potentially affecting $$\dot{\mathrm{V}}$$ V ˙ O2 during exercise. Twenty-three inpatients from a subacute rehabilitation ward were enrolled in this study. The median (interquartile range) Fatigue Severity Scale (FSS) score, as a measure of fatigue, was 32 (range 27–42) points. The FSS score was not associated with $$\dot{\mathrm{V}}$$ V ˙ O2 at peak exercise during a symptom-limited graded exercise test (rho = − 0.264; p = 0.224), whereas it was significantly associated with τ$$\dot{\mathrm{V}}$$ V ˙ O2 during a submaximal constant-load exercise test (rho = 0.530; p = 0.009). A higher FSS score also significantly correlated with a longer time constant of cardiac output (CO) kinetics (rho = 0.476; p = 0.022). Our findings suggest that severe post-stroke fatigue is associated with delayed increases in $$\dot{\mathrm{V}}$$ V ˙ O2 and CO at the onset of exercise. Our findings can contribute to the development of an appropriate rehabilitation programme for individuals with post-stroke fatigue.

Association of post-stroke fatigue with physical activity and physical fitness: A systematic review and meta-analysis

“… 21 One published protocol and one TRR described included studies. 23 , 24 The second TRR was ongoing. 25 Most studies were of cross-sectional design (n = 22), the others were longitudinal prospective studies (n = 7) or randomized controlled trials (RCTs; n = 2) ( Table S4 ).…”

“…The remaining seven studies (330 participants) reporting on associations between PSF and fitness could not be pooled because of differing statistics. 21 , 24 , 44 – 46 , 50 , 53 PSF was measured with FSS-9, 21 , 24 , 44 , 45 , 50 , 53 or modified Fatigue Impact Scale. 50 Fitness was measured with 10MGS, 21 , 31 , 45 , 50 community ambulation questionnaires, 44 , 53 or VO 2 -peak.…”

“… 50 Fitness was measured with 10MGS, 21 , 31 , 45 , 50 community ambulation questionnaires, 44 , 53 or VO 2 -peak. 24 Vote-counting showed 5 studies 21 , 24 , 44 , 45 , 53 had a negative direction of association (higher PSF-lower fitness) and one study 50 had a positive direction (higher PSF-higher fitness) ( Table S6 ). One study showed no association 31 and was excluded from the synthesis.…”

“…We extracted data for 34 PSF associations, 20 with PA 21,23,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] and 14 with fitness. 21,24,31,32,[44][45][46][47][48][49][50][51][52][53] Two studies 21,31 contributed an association for both outcomes and the rest for only one (n = 30). Three studies became eligible once the authors provided additional information regarding the regression coefficient 39 or direction of association.…”

“…As for limitations of our review, since most of the included studies did not have published protocols, we did not use protocols in conjunction with risk of bias assessment as we had planned. This decision did not affect the overall risk of bias in the two studies 23 , 24 concerned, nor did it affect the GRADE confidence in certainty of evidence. The PA meta-analysis estimate should be interpreted with caution due to high heterogeneity.…”