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

Abstract

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.

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

“…The results of correlation analyses may support previous studies suggesting that impaired tidal volume, heart rate, and arterial-venous oxygen difference at peak exercise limit cardiorespiratory fitness in individuals with stroke [12, 16-18, 31]. Contrary to our hypothesis, only the increase in heart rate was identified as one of the significant determinants of both the increases in V̇O 2 from rest to ventilatory threshold and that from rest to peak exercise, which can be explained by the fact that V̇O 2 increases nearly linearly with increasing heart rate during exercise [35].…”

“…Second, we used a recumbent cycle ergometer. A treadmill [6], a total-body recumbent steppe [43], a robotics-assisted tilt table [30], and an arm crank ergometer [31] are also used to assess cardiorespiratory fitness in individuals with stroke. Further studies are warranted to examine whether the major physiological determinant of the increase in V̇O 2 during exercise differs with the exercise devices.…”

“…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]. The first two methods were prioritized in case the three methods presented different results [30, 31]. The ventilatory threshold was determined as an average based on the values provided by two independent raters (NI and YS), when the difference in the V̇O 2 values of the corresponding points as determined by the two raters was less than 100 mL·min −1 [31, 32].…”

“…The first two methods were prioritized in case the three methods presented different results [30, 31]. The ventilatory threshold was determined as an average based on the values provided by two independent raters (NI and YS), when the difference in the V̇O 2 values of the corresponding points as determined by the two raters was less than 100 mL·min −1 [31, 32]. In case of any discrepancy, a third experienced rater (KO) judged the point, and the ventilatory threshold was taken as the average of the two closest values [30, 31].…”

Cardiorespiratory factors related to the increase in oxygen consumption during exercise in individuals with stroke

“…The first threshold was determined using a combination of the following criteria: (1) the time point where the ventilatory equivalent of oxygen reached its minimum or started to increase, without an increase in the ventilatory equivalent of carbon dioxide; (2) the time point at which the end-tidal oxygen fraction reached a minimum or started to increase, without a decline in the end-tidal carbon dioxide fraction; and (3) the time point of deflection of carbon dioxide output versus [11]. The first two methods were prioritized in case the three methods presented different results [36, 37]. The second threshold is the intensity at which the muscular lactate production rate begins to exceed the systemic lactate elimination rate [11].…”