Maximal Cardiorespiratory Fitness Testing in Individuals With Chronic Stroke With Cognitive Impairment: Practice Test Effects and Test-Retest Reliability

Charles, Olivier; Doré, Jean; Blanchet, Sophie; Brooks, Dina; Richards, Carol L.; Martel, Guy; Robitaille, Nancy-Michelle; Maltais, Désirée B.

doi:10.1016/j.apmr.2013.03.016

Cited by 9 publications

(7 citation statements)

References 35 publications

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“…The ICC of 0.90 for HR peak in the present study is comparable to previous reports (0.74 to 0.97) for a cycle ergometer, a treadmill and a robotics-assisted treadmill [10, 24, 33, 35–38]. By way of comparison, and bearing in mind the differences in degrees of disability and testing devices, the ICCs for RER peak and WR peak of 0.78 and 0.94 found here can be contrasted with other reports in chronic stroke patients with mild to moderate disability using a cycle ergometer and a treadmill (0.72 for RER peak and 0.99 for work rate) [36, 37].…”

Section: Discussionsupporting

confidence: 91%

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table

et al. 2016

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BackgroundExercise testing devices for evaluating cardiopulmonary fitness in patients with severe disability after stroke are lacking, but we have adapted a robotics-assisted tilt table (RATT) for cardiopulmonary exercise testing (CPET). Using the RATT in a sample of patients after stroke, this study aimed to investigate test-retest reliability and repeatability of CPET and to prospectively investigate changes in cardiopulmonary outcomes over a period of four weeks.MethodsStroke patients with all degrees of disability underwent 3 separate CPET sessions: 2 tests at baseline (TB1 and TB2) and 1 test at follow up (TF). TB1 and TB2 were at least 24 h apart. TB2 and TF were 4 weeks apart. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and a real-time visual feedback system was used to guide the patients’ exercise work rate during CPET. Test-retest reliability and repeatability of CPET variables were analysed using paired t-tests, the intraclass correlation coefficient (ICC), the coefficient of variation (CoV), and Bland and Altman limits of agreement. Changes in cardiopulmonary fitness during four weeks were analysed using paired t-tests.ResultsSeventeen sub-acute and chronic stroke patients (age 62.7 ± 10.4 years [mean ± SD]; 8 females) completed the test sessions. The median time post stroke was 350 days. There were 4 severely disabled, 1 moderately disabled and 12 mildly disabled patients. For test-retest, there were no statistically significant differences between TB1 and TB2 for most CPET variables. Peak oxygen uptake, peak heart rate, peak work rate and oxygen uptake at the ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) showed good to excellent test-retest reliability (ICC 0.65–0.94). For all CPET variables, CoV was 4.1–14.5 %. The mean difference was close to zero in most of the CPET variables. There were no significant changes in most cardiopulmonary performance parameters during the 4-week period (TB2 vs TF).ConclusionsThese findings provide the first evidence of test-retest reliability and repeatability of the principal CPET variables using the novel RATT system and testing methodology, and high success rates in identification of VAT and RCP: good to excellent test-retest reliability and repeatability were found for all submaximal and maximal CPET variables. Reliability and repeatability of the main CPET parameters in stroke patients on the RATT were comparable to previous findings in stroke patients using standard exercise testing devices. The RATT has potential to be used as an alternative exercise testing device in patients who have limitations for use of standard exercise testing devices.

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Section: Discussionsupporting

confidence: 91%

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table

et al. 2016

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“…Most studies that examined test-retest reliability using CPET after stroke reported excellent relative reliability, whereas only Tang et al revealed fair to good associations between trials [ 10 , 14 , 15 , 17 , 18 ]. The present study using a novel robotics-assisted treadmill-based method for assessment of exercise capacity revealed good to excellent relative reliability for the major peak cardiopulmonary performance parameters.…”

Section: Discussionmentioning

confidence: 99%

“…Current research has investigated several modalities for cardiopulmonary exercise testing (CPET) in subacute stroke (6 days-6 months post-stroke) [ 3 , 4 , 9 – 13 ] and in chronic stroke (>6 months post-stroke) [ 14 – 19 ] using treadmill exercise [ 14 – 16 ], body weight supported treadmill exercise [ 3 ], leg cycle ergometry [ 4 , 9 – 11 , 15 , 17 , 18 ], and combined upper- and lower-limb ergometry [ 12 , 19 ]. The most common concepts, i.e.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability

Stoller

Bruin

Schindelholz

et al. 2014

Journal of NeuroEngineering and Rehabilitation

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BackgroundExercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke.Methods20 subjects (age 44–84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0–2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability.ResultsPeak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC =0.82), relative peak oxygen uptake (ICC =0.72), peak work rate (ICC =0.91), peak heart rate (ICC =0.80), absolute gas exchange threshold (ICC =0.91), relative gas exchange threshold (ICC =0.88), oxygen cost of work (ICC =0.87), oxygen pulse at peak oxygen uptake (ICC =0.92), ventilation rate versus carbon dioxide output slope (ICC =0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied.ConclusionsThis study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-145) contains supplementary material, which is available to authorized users.

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“…Dobrovolny et al (48) conducted an acclimatization treadmill trial without open-circuit spirometry, which may have eliminated any effect of practice. Olivier et al (55), on the other hand, reported that a practice test did not systematically affect maximum CPET results. The final choice of equipment depends on the goal of the test and the patient's ability.…”

Section: Test Procedures: Equipment and Protocolsmentioning

confidence: 97%

Systematic review of cardiopulmonary exercise testing post stroke: Are we adhering to practice recommendations?

Port¹,

Kwakkel²,

Wittink³

2015

J Rehabil Med

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Maximal Cardiorespiratory Fitness Testing in Individuals With Chronic Stroke With Cognitive Impairment: Practice Test Effects and Test-Retest Reliability

Cited by 9 publications

References 35 publications

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table

Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability

Systematic review of cardiopulmonary exercise testing post stroke: Are we adhering to practice recommendations?

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