Preliminary Study of Exercise Capacity in Post‐acute Stroke Survivors

Weng

The Kaohsiung J of Med Scie

et al. 2013

Self Cite

This study evaluated the impact of severity of hemiparesis on oxygen uptake (VO2) response in post-acute stroke patients. Sixty-four patients with a mean poststroke interval of 8.6 ± 3.8 days underwent a ramp cardiopulmonary exercise test on a cycling ergometer to volitional termination. Mean peak VO2 (VO2peak) and work efficiency (ΔVO2/ΔWR) were measured by open-circuit spirometry during standard upright ergometer cycling. Severity of the hemiparetic lower limb was assessed by Brunnstrom's motor recovery stages lower extremity (BMRSL). VO2peak was 10% lower in hemiparetic leg with BMRSL V than in that with BMRSL VI, 20% lower in BMRSL IV, and 50% lower in BMRSL III. ΔVO2/ΔWR was higher for the group with increased BMRSL. The relations were consistent after adjustment for age, sex, body mass index, stroke type, hemiparetic side, modified Ashworth Scale, time poststroke, comorbidities, and medications. Our findings revealed that O2peak is dependent on the severity of hemiparesis in leg, and along with ΔO2/ΔWR closely related to the severity of hemiparesis in post-acute stroke patients, regardless of the types and locations of lesion after stroke, as well as the differences in comorbidities and medications.

“…Impairments resulting from stroke, such as muscle weakness, pain, spasticity, and poor balance, can result in reduced tolerance to activity and poorer aerobic capacity. With mean

{\dot{normalV} O}_{2 peak}

values of 12.7 mL/kg/min, aerobic capacity is significantly compromised in the post‐acute period after stroke [3]. The published

{\dot{normalV} O}_{2 peak}

Section: Discussionmentioning

confidence: 99%

“…Although post‐acute stroke patients often have poor

{\dot{normalV} O}_{2 peak}

{\dot{normalV} O}_{2 peak}

experience greatest benefits in terms of cardiovascular conditioning, even at relatively modest levels of physical exercise [4].…”

Section: Introductionmentioning

confidence: 99%

{\dot{normalV} O}_{2}

response, including work rate‐

{\dot{normalV} O}_{2}

of work performance, and work efficiency (slope of the

{\dot{normalV} O}_{2}

‐WR relationship,

Δ {\dot{normalV} O}_{2} / Δ WR

)—oxygen (O 2 ) utilization by the muscle cells in relation to the quantity of external work performance [10].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oxygen uptake response to cycle ergometry in post‐acute stroke patients with different severity of hemiparesis

Weng

The Kaohsiung J of Med Scie

et al. 2013

Self Cite

“…This criterion was satisfied here in 82.4 % of all tests, even though severely disabled patients were included. This is considered a high proportion compared to previous reports of only 17.6 to 62.1 % in patients with sub-acute or chronic ambulatory stroke tested on a treadmill [44, 47, 48], 44 % of sub-acute stroke patients tested on a semi-recumbent cycle ergometer [24], and 78.9 % of sub-acute stroke patients using a cycle ergometer [49]. These differences in the proportion of patients who achieved the criterion for maximal effort points to the importance of the device employed for CPET.…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2016

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.

J of Clinical Hypertension

“…The level of fitness in patients after a stroke has previously been described in detail, but, to the best of our knowledge, this study is the first to describe both peak SBP levels and the prevalence of an exaggerated BP response, as well as the effects of randomization to an aerobic exercise program on peak BP, in patients in the subacute phase after a stroke. Interestingly, previous studies of patients free from cardiovascular disease, or at long‐term follow‐up after a stroke, have shown positive associations between randomization to aerobic exercise and reduced BP levels at fixed submaximal workloads.…”

Section: Discussionmentioning

confidence: 91%

The exaggerated blood pressure response to exercise in the sub‐acute phase after stroke is not affected by aerobic exercise

Wijkman

Sandberg

Kleist

et al. 2018

The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice-weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom-limited ergometer exercise test. At followup, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise.This response was not altered by participation in a 12-week program of aerobic exercise.