Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack

Johnson, Liam; Kramer, Sharon; Catanzariti, Gabriella; Kaffenberger, Tina; Cumming, Toby; Bernhardt, Julie

doi:10.1002/pmrj.12259

Cited by 10 publications

(28 citation statements)

References 44 publications

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“…The CPET was performed on a recumbent stepper (NuStep T4r, NuStep LLC, Ann Arbor, MI, United States), using an incremental protocol validated for individuals with stroke, beginning with a 4-min warm-up at approximately 20 watts, followed by incremental increases in resistance every 2 min for a maximum of 7 stages at a minimum cadence of 80 steps per minute (Billinger et al, 2008). This specific CPET protocol has been used by many (Nepveu et al, 2017;Wilson et al, 2017;Johnson et al, 2020) to accommodate a wide range of motor abilities in individuals with stroke. Peak oxygen consumption (VO 2 peak, mL/kg/min) was also collected using a metabolic mixing chamber system (model Quark CPET, COSMED SrI, Rome, Italy).…”

Section: Acute Exercise Stimulusmentioning

confidence: 99%

Prolonged Elevation of Arterial Stiffness Following Peak Aerobic Exercise in Individuals With Chronic Stroke

et al. 2021

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BackgroundStroke is a highly disabling condition and is the second leading cause of death globally. Engaging in aerobic exercise is important for the prevention of a recurrent stroke through improving markers of cardiovascular health such as blood pressure and arterial stiffness. While higher intensities of aerobic exercise generally elicit greater cardioprotective effects, little is known about the acute cardiovascular effects of a single session of high intensity aerobic exercise in people with stroke. The objective of this study was to model the recovery of arterial stiffness (carotid-femoral pulse wave velocity, cfPWV), heart rate and blood pressure following peak intensity aerobic exercise in individuals with chronic stroke.MethodsTen participants with chronic stroke (mean ± SD age = 56.9 ± 11.8 years, median [IQR] years post-stroke = 2.9 [1.9]) performed a symptom-limited cardiopulmonary exercise test (CPET) on a recumbent stepper. Before the CPET, resting cfPWV, heart rate and blood pressure were measured. Immediately following the CPET, all outcomes were measured again continuously for 20 min to use all available observations (n = 245 observations) and capture any potential non-linear changes. Mixed model analyses were then applied to model post-exercise changes of cfPWV, heart rate and blood pressure.ResultsCarotid-femoral pulse wave velocity was increased from rest following the CPET (9.0 ± 0.53 to 9.9 ± 0.52 m/s, p < 0.001) and remained elevated for 20 min into post-exercise recovery, independent of heart rate (p = 0.001). Heart rate also increased from baseline (71.2 ± 3.2 to 77.4 ± 3.1 bpm, p < 0.001) and remained elevated for 10 min post-exercise (p < 0.001). Finger systolic blood pressure was reduced from rest (117.3 ± 4.7 to 111.8 ± 4.6 mmHg, p < 0.001) and remained reduced for 15 min after exercise (p < 0.001). There were no significant differences in finger diastolic or mean arterial pressures from rest.ConclusionThis was the first study to capture continuous changes in cfPWV following peak aerobic exercise in any clinical population. The present study revealed that cfPWV is elevated for 20 min after peak aerobic exercise in individuals with stroke, which was independent of heart rate. These findings suggest there may be autonomic imbalances in large arteries following peak intensity aerobic exercise in individuals with stroke.

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Section: Acute Exercise Stimulusmentioning

confidence: 99%

Prolonged Elevation of Arterial Stiffness Following Peak Aerobic Exercise in Individuals With Chronic Stroke

et al. 2021

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“…Emerging studies suggest that the improvement of CRF may provide benefits for walking capacity ( 4 ) and long-term recovery in patients with subacute and chronic stroke ( 5 ). However, for various factors, such as physical inactivity ( 6 ) (updated) before and after stroke ( 7 ), effects of the stroke itself, and the hospital environment ( 8 ), the VO 2peak level of stroke survivors decreases by about 47% compared with age- and sex-matched healthy subjects ( 9 ). Insufficient CRF causes an obvious difficulty in motor function rehabilitation early after stroke because motor relearning and neural network reorganization rely on repetitive training ( 10 ), and patients with decreased CRF levels may be less able to tolerate the highly intensive task training due to fatigue and rapid exhaustion ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Exploring Alternative Measurements of Cardiorespiratory Fitness in Patients With Mild Ischemic Stroke at Acute Phase

Zhu

Wang

et al. 2022

Front. Neurol.

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BackgroundWhile emerging studies have suggested an association of cardiorespiratory fitness (CRF) with stroke risk and overall health outcomes, little is known regarding the optimum methods of CRF measurement in patients with mild acute ischemic stroke.ObjectiveThe aim of this study was to explore the association between the 6-min walk distance (6MWD) and other measurements related to CRF in patients with mild ischemic stroke at the acute stage.MethodsA total of 30 patients with stroke and 71 healthy subjects matched for age and grip strength (GS) were prospectively recruited. All patients were within 14 days after stroke onset and presented mild motor impairment (with a full score of Fugl-Meyer Motor Assessment). Demographic data of both groups and clinical information of the stroke group were documented, and the CRF comparison between the two groups was conducted. Each participant underwent a one-time assessment of 6MWD and a series of measurements related to CRF, including GS, 10-m walk test (10mWT), five-times sit-to-stand time (FTSST), functional reaching test (FRT), Berg Balance Scale (BBS), and waistline. Pearson's product-moment correlation coefficient test and multiple linear regression were performed to explore the indicators of CRF.ResultsSignificant moderate correlations (0.3 < r <0.6) were found between 6MWD and GS of left hand (GS-left) (r = 0.573, p = 0.001), GS of right hand (GS-right) (r = 0.524, p = 0.003), FTSST (r = −0.551, p = 0.002), 10mWT (r = 0.554, p = 0.001), and FRT (r = 0.449, p = 0.021) in the patient group. While 6MWD displayed significant moderate correlations with waistline (r = 0.364, p = 0.002), 10mWT (r = 0.512, p < 0.001), FTSST (r = −0.573, p < 0.001), and FRT (r = 0.550, p < 0.001) in the healthy group. All these dependent variables were entered into a stepwise multiple linear regression analysis to evaluate their values in estimating CRF as measured by 6MWD in each group. Analyses suggested that GS-left (p = 0.002) and FTSST (p = 0.003) were the indicators of CRF in the patient group with stroke and explained 51.4% of the variance of 6MWD (R2 = 0.514); FTSST (p < 0.001), 10mWT (p < 0.001), and FRT (p = 0.021) were the indicators of CRF in the healthy group and explained 58.9% of variance of 6MWD (R2 = 0.589).ConclusionsOur data confirmed that CRF is impaired in patients with mild ischemic stroke at the acute phase. Moreover, GS-left may be an optional indicator of CRF in patients with mild acute ischemic stroke, but not in healthy people.Clinical Trial Registrationwww.chictr.org.cn, identifier: ChiCTR2000031379.

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“…Few studies have tested the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase of stroke recovery. [13][14][15] However, these studies recruited people with predominantly mild stroke or transient ischemic attack with minimal stroke deficits. [13][14][15] Further studies are required to determine if cardiorespiratory fitness testing in the early subacute phase of stroke recovery is safe and feasible for people with a broader range of impairments.…”

Section: Introductionmentioning

confidence: 99%

The safety and feasibility of early cardiorespiratory fitness testing after stroke

Machado

Williams

Olver

et al. 2022

PM&R

Self Cite

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Background Cardiorespiratory fitness testing is recommended as part of a pre‐exercise evaluation to aid the programming of safe, tailored cardiorespiratory fitness training after stroke. But there is limited evidence for its safety and feasibility in people with stroke with varying impairment levels in the early subacute phase of stroke recovery. Objective To assess the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase after stroke. Design A sub‐study of a larger single service, multi‐site, prospective cohort feasibility study (Cardiac Rehabilitation in Stroke Survivors to Improve Survivorship [CRiSSIS]). Setting Private subacute inpatient rehabilitation facilities. Participants Consecutive admissions of people with ischemic stroke admitted to subacute rehabilitation facilities. Intervention Not applicable. Main Outcome(s) Safety was determined by the occurrence of adverse or serious adverse events. Feasibility was determined by assessing the (1) number of participants recruited and (2) number of participants able to complete the fitness test. Results Between April 2018 and December 2019, a total of 165 people with stroke were screened to participate; 109 were eligible and 65 were recruited. Of the 62 who completed testing, 41 participants were able to complete a submaximal fitness test at a median of 12 days post‐stroke. One minor adverse event was recorded. Of the 21 participants unable to complete the fitness test; 4 declined to complete the test, 9 were unable to commence the test, and 8 were unable to complete the first stage of the protocol due to stroke‐related impairments. Participants with mild stroke, greater motor and cognitive function, and fewer depressive symptoms were more likely to be able to complete the cardiorespiratory fitness test. Conclusion Cardiorespiratory fitness testing was safe for most people with mild‐to‐moderately severe ischemic stroke and transient ischemic attack in the early subacute phase, but only two‐thirds of the participants could complete the test.

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Safety of Performing a Graded Exercise Test Early after Stroke and Transient Ischemic Attack

Cited by 10 publications

References 44 publications

Prolonged Elevation of Arterial Stiffness Following Peak Aerobic Exercise in Individuals With Chronic Stroke

Prolonged Elevation of Arterial Stiffness Following Peak Aerobic Exercise in Individuals With Chronic Stroke

Exploring Alternative Measurements of Cardiorespiratory Fitness in Patients With Mild Ischemic Stroke at Acute Phase

The safety and feasibility of early cardiorespiratory fitness testing after stroke

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