Paretic knee extensor strength, gait velocity, and fat mass are major determinants of peak aerobic capacity in subacute stroke: observational cohort study

Abstract

the purpose of this study is to investigate major determinants of peak aerobic capacity in subacute stroke patients among body composition, balance function, walking capacity, and lower limb muscular strength. this was a retrospective observational cohort study. eighty-three subacute stroke patients were enrolled and their medical records were retrospectively reviewed in the study (47 males; mean age: 62.95 ± 13.9 years). Gait capacity was assessed by gait velocity (10 m walk velocity:10MWV) and gait endurance (6 min walk distance:6MWD). Balance function was evaluated with Berg Balance Scale (BBS). The isometric muscular strengths of bilateral knee extensors were measured with an isokinetic dynamometer. Cardiovascular fitness was evaluated with an expired gas analyzer. In backward linear regression analyses, paretic isometric extensor strength (p < 0.001), fat mass (p = 0.005) and 10MWV (p < 0.001) are significantly correlated with peak aerobic capacity (adjusted R 2 = 0.499) in all patients. Our results confirmed that paretic knee extensor strength, gait velocity, and fat mass were major determinants of peak aerobic capacity in subacute stroke. therefore, therapeutic approaches should focus on improving gait velocity and paretic knee extensor strength in the early stages of recovery from stroke. Stroke is one of the most common causes of death and, in survivors, often induces chronic residual deficits that impair walking ability and the basic activities of daily living (ADL) 1. Thus, the goals of stroke rehabilitation therapy at the subacute stage is to enhance locomotion and basic ADL skills 2. While 60-70% of subacute stroke patients can walk independently at discharge 3 , only 7% of stroke patients have sufficient capacity to maintain an independent gait in the community 3. The barriers to community ambulation are related to persistent functional deficits such as muscle weakness, poor balance, and reduced mobility, which result in decreased physical activity and cardiorespiratory fitness 1. Because cardiorespiratory fitness is significantly associated with baseline status and recovery of functional outcomes at the subacute stage, the reduced aerobic capacity might contribute to poor rehabilitation outcomes and exacerbate metabolic risk factors for recurrence of stroke, such as hypertension, obesity, and diabetes 4. In addition, several studies have reported an association between body composition and cardiorespiratory fitness 5. However, few studies in subacute stroke patients have comprehensively examined body composition and clinical functional outcome including gait performance, muscle strength, balance function, and cardiorespiratory fitness.

Utility of ultrasound as a promising diagnostic tool for stroke-related sarcopenia: A retrospective pilot study

“…[ 27 ] Similarly, another study reported that knee extensor strength is closely related to gait endurance of stroke survivors. [ 13 ] Between Group A and Group B, there were statistically significant differences of BBS, mRS, and MBI. This indicates that paretic knee extensor power has an influence on the standing balance and physical functions of stroke survivors.…”

“…Previous studies have noted that quadriceps is the main muscle responsible for ambulatory capacity, functional mobility, and would be a predictor of walking performance in stroke patients. [ 12 , 13 ] The earlier studies reported that a minimum of grade 3 of knee extensor strength is required for community ambulation. [ 22 , 23 ] Accordingly, we divided the patients into 2 groups based on the grade 3 of the paretic knee extensor power, and compared several parameters between the 2 groups.…”

“…[9][10][11] In addition, several studies have proved that the degree of quadriceps muscle power, as knee extensor, plays an important role in functional recovery in stroke patients. [12,13] Several research studies reported that ultrasonographic muscle thickness is positively correlated with the DXA-derived appendicular lean…”

“…[ 9 – 11 ] In addition, several studies have proved that the degree of quadriceps muscle power, as knee extensor, plays an important role in functional recovery in stroke patients. [ 12 , 13 ] Several research studies reported that ultrasonographic muscle thickness is positively correlated with the DXA-derived appendicular lean mass (ALM). [ 14 , 15 ] Although there are some researches suggesting an association between ultrasonographic QMT and DXA-derived lean body mass, no study has investigated the correlation for both paretic and non-paretic legs among acute hemiplegic stroke patients.…”