Measurement properties of maximal cardiopulmonary exercise tests protocols in persons after stroke: A systematic review

Wittink, Harriët; Verschuren, Olaf; Terwee, Caroline B.; Groot, Janke F. de; Kwakkel, Gert; Port, Ingrid G. van de

doi:10.2340/16501977-2260

Cited by 11 publications

(12 citation statements)

References 36 publications

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“…However, with this approach, motor impairments in the paretic lower extremity may limit exercise test performance [ 13 – 15 ]. Considering the possibility that the reduced

O 2 at peak exercise in individuals with hemiparetic stroke reflects motor impairments in the paretic lower extremity, development of a cardiorespiratory fitness assessment that is not influenced by motor impairments is required [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Unilateral Arm Crank Exercise Test for Assessing Cardiorespiratory Fitness in Individuals with Hemiparetic Stroke

Oyake

Yamaguchi

Oda

et al. 2017

BioMed Research International

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Cardiorespiratory fitness assessment with leg cycle exercise testing may be influenced by motor impairments in the paretic lower extremity. Hence, this study examined the usefulness of a unilateral arm crank exercise test to assess cardiorespiratory fitness in individuals with stroke, including sixteen individuals with hemiparetic stroke (mean ± SD age, 56.4 ± 7.5 years) and 12 age- and sex-matched healthy controls. Participants performed the unilateral arm crank and leg cycle exercise tests to measure oxygen consumption (V˙O2) and heart rate at peak exercise. The V˙O2 at peak exercise during the unilateral arm crank exercise test was significantly lower in the stroke group than in the control group (p < 0.001). In the stroke group, the heart rate at peak exercise during the unilateral arm crank exercise test did not significantly correlate with the Brunnstrom recovery stages of the lower extremity (p = 0.137), whereas there was a significant correlation during the leg cycle exercise test (rho = 0.775, p < 0.001). The unilateral arm crank exercise test can detect the deterioration of cardiorespiratory fitness independently of lower extremity motor impairment severity in individuals with hemiparetic stroke. This study is registered with UMIN000014733.

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“…However, with this approach, motor impairments in the paretic lower extremity may limit exercise test performance [ 13 – 15 ]. Considering the possibility that the reduced

Section: Introductionmentioning

confidence: 99%

Unilateral Arm Crank Exercise Test for Assessing Cardiorespiratory Fitness in Individuals with Hemiparetic Stroke

Oyake

Yamaguchi

Oda

et al. 2017

BioMed Research International

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“…This is the first study to demonstrate reproducibility of a field-based cardiopulmonary capacity / fitness test in people with stroke [ 4 ]. However, our sample size was small and six participants (23%) of the initial sample were unable to perform the first level of the 10mST.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of maximal cardiopulmonary capacity in people with stroke is more challenging than in healthy subjects because they present with stroke-specific impairments such as muscle weakness, fatigue, poor balance, contractures and spasticity, which can compromise maximal cardiopulmonary exercise test outcome [ 2 , 3 ]. Given the reported difficulty of measuring VO 2max in people with stroke [ 4 ], we may need to consider alternatives, for instance, the determination of the first ventilatory threshold (1 st VT). The 1 st VT represents the intensity limit of prolonged exercise above which a transition to anaerobic metabolism begins [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility, reproducibility and validity of the 10 meter Shuttle Test in mild to moderately impaired people with stroke

et al. 2020

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Background There currently is no field test available for measuring maximal exercise capacity in people with stroke. Objective To determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke. Design Longitudinal study design. Setting Rehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation. Subjects People with subacute or chronic stroke. Interventions A standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST). Main measures Number of shuttles completed, 1 st Ventilatory Threshold (1 st VT). Results The associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO 2max ). Only 60% of participants were able to reach the 1 st VT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001). Conclusions The Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.

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“…To identify whether maximal effort was reached during the exercise test, at least 1 of the following criteria had to be met: (1) V̇O 2 increased less than 150 mL·min −1 for more than 1 min despite increased work rate, (2) respiratory exchange ratio achieved greater than 1.10, 1. (3) or heart rate achieved 85% of the age-predicted maximal heart rate (220 minus age) [23, 25].…”

Section: Methodsmentioning

confidence: 99%

Physiological determinants of the increase in oxygen consumption during exercise in individuals with stroke

Oyake

Baba

Ito

et al. 2019

Preprint

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2 3 Background: Understanding the physiological limitations of the increase in oxygen 2 4 consumption (V ሶ O 2 ) during exercise is essential to improve cardiorespiratory fitness in 2 5 individuals with stroke. However, the physiological determinants of the increase in V ሶ O 2 2 6 during exercise have not been examined using multivariate analysis in individuals with 2 7stroke. This study aimed to identify the physiological determinants of the increase in 2 8 V ሶ O 2 during a graded exercise in terms of the respiratory function, cardiac function, and 2 9ability of skeletal muscles to extract oxygen. 3 0 Methods: Eighteen individuals with stroke (60.1 ± 9.4 years of age, 67.1 ± 30.8 days 3 1 poststroke) underwent a graded exercise test for the assessment of cardiorespiratory 3 2 response to exercise. The increase in V ሶ O 2 from rest to ventilatory threshold and that 3 3 from rest to peak exercise were measured as a dependent variable. The increases in 3 4respiratory rate, tidal volume, heart rate, stroke volume, and arterial-venous oxygen 3 5 difference from rest to ventilatory threshold and those from rest to peak exercise were 3 6 measured as independent variables. 7Results: From rest to ventilatory threshold, the increases in heart rate (β = 0.546) and 3 8 arterial-venous oxygen difference (β = 0.398) were significant determinants of the 3 9 increase in V ሶ O 2 (adjusted R 2 = 0.703, p < 0.001). From rest to peak exercise, the 4 0 4 increases in tidal volume (β = 0.611) and heart rate (β = 0.353) were significant 4 1 determinants of the increase in V ሶ O 2 (adjusted R 2 = 0.702, p < 0.001). 4 2 Conclusion: V ሶ O 2 is well-known to increase nearly linearly with increasing heart rate; 4 3 however, our results suggest that arterial-venous oxygen difference and tidal volume are 4 4 also significant physiological determinants of the increase in V ሶ O 2 from rest to 4 5 ventilatory threshold and that from rest to peak exercise, respectively. Our findings 4 6 could potentially contribute to the development of appropriate therapies to improve 4 7 cardiorespiratory fitness in individuals with stroke. 4 8 4 9

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Measurement properties of maximal cardiopulmonary exercise tests protocols in persons after stroke: A systematic review

Abstract: No judgement could be made on which protocol is "best" for measuring VO2max in persons after stroke due to lack of high-quality studies on the measurement properties of the cardiopulmonary exercise test.

Cited by 11 publications

References 36 publications

Unilateral Arm Crank Exercise Test for Assessing Cardiorespiratory Fitness in Individuals with Hemiparetic Stroke

Unilateral Arm Crank Exercise Test for Assessing Cardiorespiratory Fitness in Individuals with Hemiparetic Stroke

Feasibility, reproducibility and validity of the 10 meter Shuttle Test in mild to moderately impaired people with stroke

Physiological determinants of the increase in oxygen consumption during exercise in individuals with stroke

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