The Distance Covered in Field Tests is more Explained by Walking Capacity than by Cardiorespiratory Fitness after Stroke

Peniche, Paula da Cruz; Aguiar, Larissa Tavares; Reis, Maria Teresa; Oliveira, Daniela Matos Garcia; Scalzo, Paula Luciana; Faria, Christina Danielli Coelho de Morais

doi:10.1016/j.jstrokecerebrovasdis.2021.105995

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Another possible explanation for the lack of aerobic mediation of 6MWD changes is that neuromotor gait function might indeed be the main contributor to 6MWD performance for the average stroke survivor, as suggested by previous cross-sectional studies. [41][42][43][44] Another finding that deviated from our hypotheses was that net 6MWD gains from HIIT vs. MAT were not mediated by between-group differences in blood lactate elevation during training (3 meters [-3, 9]). We initially suspected that blood lactate elevation could be an important mediator of HIIT-induced 6MWD gains because lactate accumulation physiologically differentiates HIIT from MAT, 45 drives upregulation of circulating neurotrophins that support brain plasticity (e.g.…”

Section: Discussionmentioning

confidence: 75%

Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke

Boyne

Miller

Schwab

et al. 2023

Preprint

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Background: Locomotor high-intensity interval training (HIIT) has been shown to improve walking capacity more than moderate-intensity aerobic training (MAT) after stroke, but it is unclear which training parameter(s) should be prioritized (e.g. speed, heart rate, blood lactate, step count) and to what extent walking capacity gains are the result of neuromotor versus cardiorespiratory adaptations. Objective: Assess which training parameters and longitudinal adaptations most strongly mediate 6-minute walk distance (6MWD) gains from post-stroke HIIT. Methods: The HIT-Stroke Trial randomized 55 persons with chronic stroke and persistent walking limitations to HIIT or MAT and collected detailed training data. Blinded outcomes included 6MWD, plus measures of neuromotor gait function (e.g. fastest 10-meter gait speed) and aerobic capacity (e.g. ventilatory threshold). This ancillary analysis used structural equation models to compare mediating effects of different training parameters and longitudinal adaptations on 6MWD. Results: Net gains in 6MWD from HIIT versus MAT were primarily mediated by faster training speeds and longitudinal adaptations in neuromotor gait function. Training step count was also positively associated with 6MWD gains, but was lower with HIIT versus MAT, which decreased the net 6MWD gain. HIIT generated higher training heart rate and lactate than MAT, but aerobic capacity gains were similar between groups, and 6MWD changes were not associated with training heart rate, training lactate, or aerobic adaptations. Conclusions: To increase walking capacity with post-stroke HIIT, training speed and step count appear to be the most important parameters to prioritize.

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Section: Discussionmentioning

confidence: 75%

Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke

Boyne

Miller

Schwab

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Cardiorespiratory fitness is related to the capacity of offering oxygen during activities, which allows people to do exercises for a longer time. 1,2 There is evidence for the need to improve cardiorespiratory fitness in the general population 3,4 ; predominantly, in people with stroke, 5,6 chronic obstructive pulmonary disease, 7 multiple sclerosis, 8 and obesity. 9 As poor cardiorespiratory fitness is related to the development of those diseases, and mortality, 10,11 its evaluation is important for planning appropriate interventions that may help improve this outcome.…”

Section: Introductionmentioning

confidence: 99%

Procedures and measurement properties of the 6-min step test: A systematic review with clinical recommendations

Boening,

Scianni,

Martins

et al. 2024

Clin Rehabil

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Objective To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test. Data sources MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024). Review methods Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. Results Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91–0.98; n = 125), criterion validity (4 studies; r = 0.53; 95% CI 0.30–0.71; n = 307), and construct validity (4 studies; r = 0.63; 95% CI 0.52–0.73; n = 233). Conclusion This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity. Review Registration PROSPERO (CRD42022347744).

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Muscle Strength at Discharge as Predictor of Functional Outcome in Ischemic Stroke Patients Following Endovascular Therapy: Observational Study in Two Comprehensive Stroke Centers

Zhou,

Chen,

Tang

et al. 2024

Preprint

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Background Endovascular thrombectomy (EVT) has emerged within the last few years as a safe and efficacious method to achieve arterial recanalization in patients with acute ischemic stroke (AIS). However, there are few clinical methods to predict functional outcome. We aimed to investigate whether the muscle strength (MS) at discharge assessed by the Medical Research Council (MRC) scale for muscle strength/weakness predicted functional outcome in patients with AIS undergoing EVT. Methods We enrolled 264 consecutive patients from two large comprehensive stroke centers in China from 2018 to 2022. A total of 248 patients were analyzed. We measured and analyzed muscle strength by means of the MRC scale at discharge. Patients were divided in two groups: normal to mildly abnormal muscle strength (MRC ≥ 4), and markedly decreased muscle strength (MRC < 4). A poor outcome was defined as a modified Ranking Score (mRS) of 3–6 at 90-days. Results Logistic regression showed that older age (p = 0.014), higher pre-EVT NIHSS score (p = 0.006), greater ASPECTS (p = 0.052), longer door-to-recanalization time (p = 0.016) and post-EVT revascularization ≥ 2b (p = 0.025), were independently associated with MRC < 4. Patients with poor muscle strength at discharge (MRC < 4) had a significantly higher frequency of poor outcome at 90-days: 91.37% vs. 13.76% (p < 0.001). Both lower and upper limb strength in the most paretic side showed high accuracy in predicting the functional outcome at 90 days: area under the curve: 0.924 and 0.874, respectively. An MRC of 0 (plegia or complete paralysis), was associated with a 70% mortality rate within 3 months of AIS. Conclusion Muscle strength is a reliable, easy to assess and reproducible clinical method to predict functional outcome and mortality at 90-days in patients treated with EVT and it is influenced by age, NIHSS score, extend of tissue involvement and time for recanalization.

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The Distance Covered in Field Tests is more Explained by Walking Capacity than by Cardiorespiratory Fitness after Stroke

Cited by 3 publications

References 26 publications

Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke

Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke

Procedures and measurement properties of the 6-min step test: A systematic review with clinical recommendations

Muscle Strength at Discharge as Predictor of Functional Outcome in Ischemic Stroke Patients Following Endovascular Therapy: Observational Study in Two Comprehensive Stroke Centers

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