Recumbent Stepper Submaximal Test response is reliable in adults with and without stroke

Wilson, David R.; Mattlage, Anna E.; Seier, Nicole M.; Todd, Jonathan D.; Price, Brian; Kwapiszeski, Sarah J.; Vardey, Rakesh; Billinger, Sandra A.

doi:10.1371/journal.pone.0172294

Cited by 14 publications

(24 citation statements)

References 17 publications

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“…95% CI of the difference between the two visits was larger than ± 1MET based on the Bland–Altman plots. [ 3 ] In our study, 95% CI of the difference between the two peak VO 2 was smaller than 0.5 MET. Accordingly, the present study is the first research to study the CPET variables in detail using stepper in exercise testing.…”

Section: Discussioncontrasting

confidence: 50%

“…Essentially, no well-recognized modality is available for the hemiplegic patients who are incapable of riding the cycle ergometer. [ 1 – 3 ]…”

Section: Introductionmentioning

confidence: 99%

“…However, in the meantime, we speculated that there are pitfalls in the interpretation of the cardiopulmonary exercise testing (CPET) derived from the stepper, which requires clarification. Although a few studies employed recumbent stepper or combined upper- and lower-limb ergometer to do exercise testing for patients with hemiplegia, [ 1 – 3 ] no published literature delineated clearly the cardiopulmonary parameters and its notice in application using these unconventional modalities.…”

Section: Introductionmentioning

confidence: 99%

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Application of stepper in cardiopulmonary exercise test for patients with hemiplegia

Huang

Hsu

et al. 2020

Medicine

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A method to perform exercise testing for patients with hemiplegia is unavailable though over half of them have cardio-pulmonary disorders. We aimed to assess the reliability and validity of using a stepper in cardiopulmonary exercise testing (CPET) in this population. 14 stroke patients with hemiplegia who failed to ride the stationary bike were included. Exclusion criteria included manual muscle strength ≦1 in the lower extremity, and conventional contraindications of CPET. They underwent CPET twice by using a stepper to evaluate test–retest reliability and validity. Additionally, 10 healthy participants underwent CPET twice on the cycle ergometer and stepper respectively. In the test–retest, the ratio of two-time difference to mean was 5.0, 3, 11.3 and 12.0% on average for peak oxygen consumption, peak heart rate (HR), anaerobic threshold and minute ventilation - carbonic dioxide production slope respectively. Cronbach's alpha coefficient of peak oxygen consumption and anaerobic threshold were 0.992 and 0.919. In the stepper exercise testing of the hemiplegic participants, the ratio of peak HR to age-predicted maximal HR was 75% on average. Peak respiratory exchange ratio (mean ± standard deviation = 1.17 ± 0.08) was not different from that of healthy controls (1.21 ± 0.09). Notably, VO 2 trajectory in relation to work rate is nonlinear and different in the rest-retest. This is the first research to study CPET variables in detail using stepper in patients with hemiplegia. CPET variables associated with peak are valid and reliable; nonetheless, those with sub-maximum are not. The study provides a method to do exercise testing for the patients with hemiplegia and its notice in application.

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Section: Discussioncontrasting

confidence: 50%

“…Essentially, no well-recognized modality is available for the hemiplegic patients who are incapable of riding the cycle ergometer. [ 1 – 3 ]…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of stepper in cardiopulmonary exercise test for patients with hemiplegia

Huang

Hsu

et al. 2020

Medicine

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“…Participants performed the total body recumbent stepper (TBRS) submaximal exercise test(25, 26) to determine the estimated maximal workload. (13, 25, 26) Participants were fitted with a heart rate monitor (Polar Electro Inc, New York) and seated on a recumbent stepper (T5XR NuStep, Inc. Ann Arbor, MI).…”

Section: Methodsmentioning

confidence: 99%

Cerebrovascular Response to an Acute Bout of Short Interval High Intensity Interval Exercise and Recovery in Healthy Adults

Aaron

Kaufman

et al. 2021

Preprint

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Introduction: High intensity interval exercise (HIIE) is performed widely. However, the field possesses limited knowledge regarding the acute HIIE cerebrovascular response. Our objective was to characterize the middle cerebral artery blood velocity (MCAv) response during an acute bout of short interval HIIE in healthy adults. We hypothesized MCAv would decrease below BL 1) during HIIE, 2) following HIIE, 3) and 30-minutes after HIIE. As a secondary objective, we investigated sex differences in the MCAv response during HIIE. Methods: Fourteen healthy adults (7 male) completed the HIIE session. The 10-minute HIIE session included alternating 1-minute bouts of high-intensity and low-intensity intervals. MCAv, mean arterial pressure (MAP), heart rate (HR), and expired end tidal carbon dioxide (PETCO2), were recorded at BL, during HIIE, following HIIE, and 30-minutes after HIIE. Results: Contrary to our hypothesis, MCAv remained above BL for the HIIE duration. MCAv peaked at the third minute then decreased concomitantly with PETCO2. MCAv was lower than BL after HIIE (p=0.03). Thirty minutes after HIIE, MCAv returned to near BL values (p = 0.47). Women showed higher BL MCAv (x = 70.9 ± 8.1 cm/s) compared to men (x = 59.3 ± 5.8 cm/s, p = 0.01). A greater magnitude of MCAv response was observed in men resulting in non-significant differences during HIIE secondary to higher workload (p = 0.03). Conclusions: Collectively, these findings show that in healthy adults, MCAv remained above BL during a 10-minute short-interval HIIE and returned to resting values 30 minutes after exercise.

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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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Recumbent Stepper Submaximal Test response is reliable in adults with and without stroke

Cited by 14 publications

References 17 publications

Application of stepper in cardiopulmonary exercise test for patients with hemiplegia

Application of stepper in cardiopulmonary exercise test for patients with hemiplegia

Cerebrovascular Response to an Acute Bout of Short Interval High Intensity Interval Exercise and Recovery in Healthy Adults

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

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