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

Port, Ingrid G. L. van de; Kwakkel, Gert; Wittink, Harriët

doi:10.2340/16501977-2031

Cited by 41 publications

(20 citation statements)

References 85 publications

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“…Oxygen consumption (

O 2 ) at peak exercise measured during the leg cycle exercise test is commonly used to assess cardiorespiratory fitness in individuals with hemiparetic stroke [ 12 – 16 ]. However, with this approach, motor impairments in the paretic lower extremity may limit exercise test performance [ 13 – 15 ].…”

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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“…Oxygen consumption (

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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“…An RER peak of > 1.0 is a recommended corroboratory criterion for detection of maximal effort in stroke patients [46]. This criterion was satisfied here in 82.4 % of all tests, even though severely disabled patients were included.…”

Section: Discussionmentioning

confidence: 92%

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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“…Participants were instructed to refrain from eating for 3 hours and to avoid caffeine and vigorous physical activity for at least 6 and 24 hours, respectively, before the exercise test [21]. All participants performed a symptom-limited graded exercise test on a recumbent cycle ergometer (Strength Ergo 240; Mitsubishi Electric Engineering Co., Ltd., Tokyo, Japan) that can be precisely load-controlled (coefficient of variation, 5%) over a wide range of pedaling resistance (0-400 W).…”

Section: Methodsmentioning

confidence: 99%

“…Following a 3-min of rest period (in sitting position) on the recumbent cycle ergometer to establish a steady state, a warm-up was performed at 0 W for 3 min followed by 10 W increments every minute [21, 22]. Participants were instructed to maintain a target cadence of 50 rpm throughout the exercise [21, 22]. Blood pressure was monitored every minute from the non-paretic arm using an automated system (Tango; Sun Tech Medical Inc., NC, USA).…”

Section: Methodsmentioning

confidence: 99%

“…Physiological variables at rest were defined as the average value obtained during 1 min before exercise onset, and those at peak exercise were defined as the average value obtained during the last 30 s of exercise test [18, 21]. The ventilatory threshold was determined using a combination of the following criteria: (1) the point where the ventilatory equivalent of oxygen reaches its minimum or starts to increase, without an increase in the ventilatory equivalent of carbon dioxide; (2) the point at which the end-tidal oxygen fraction reaches a minimum or starts to increase, without a decline in the end-tidal carbon dioxide fraction; and (3) the point of deflection of carbon dioxide output versus V̇O 2 [29].…”

Section: Methodsmentioning

confidence: 99%

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

Abstract: Most studies did not adhere, or insufficiently adhered, to the existing cardiopulmonary exercise testing guidelines for exercise testing. Thus, the results of cardiopulmonary exercise testing protocols in stroke patients cannot be compared.

Cited by 41 publications

References 85 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

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

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

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