Submaximal and Peak Cardiorespiratory Response After Moderate-High Intensity Exercise Training in Subacute Stroke

Mattlage, Anna E.; Ashenden, Abigail L.; Lentz, Angela; Rippee, Michael; Billinger, Sandra A.

doi:10.1097/01823246-201324030-00003

Cited by 32 publications

(44 citation statements)

References 26 publications

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“…We believe these findings are due to the focus on locomotor activities as the primary intervention, and assessment of metabolic function with a locomotor task. Conversely, many training studies performed on participants early post-stroke provide interventions focused on practice of multiple tasks 20,22 or on non-walking interventions (recumbent stepping 15,16 or ergometry 10–12,14 ), with metabolic assessments performed during other non-walking assessments. Minimal associations between metabolic and locomotor outcomes may be due to the lack of specificity of the metabolic testing protocol to trained activities or to walking assessments.…”

Section: Discussionmentioning

confidence: 99%

“…Most aerobic training strategies utilize lower extremity ergometry, 10–14 recumbent stepping, 15,16 treadmill training 2,9,17–19 or mixed interventions, 20–23 with targeted heart rate (HR) ranges between 60–85% of maximum age-predicted HR. However, the resultant changes in metabolic and functional measures vary.…”

Section: Introductionmentioning

confidence: 99%

“…In individuals with chronic (> 6 months) stroke 9,17,19 consistent improvements in VO 2 peak are observed with training as compared to those with subacute stroke, 14,15 although many of the former studies focus on treadmill training. However, in individuals with subacute stroke, many training strategies focus on non-stepping tasks 10–12,16,20 with inconsistent locomotor improvements. Conversely, and with limited exceptions (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke

Leddy

Connolly

Holleran

et al. 2016

Journal of Neurologic Physical Therapy

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Background and Purpose Impairments in metabolic capacity and economy (O2cost) are hallmark characteristics of locomotor dysfunction following stroke. High-intensity (aerobic) training has been shown to improve peak oxygen consumption in this population, with fewer reports of changes in O2cost. However, inconsistent gains in walking function are observed, particularly in persons with subacute stroke, with minimal associations with gains in metabolic parameters. The purpose of this study was to evaluate changes in aerobic exercise performance in participants with subacute stroke following high-intensity, variable stepping training as compared to conventional therapy. Methods A secondary analysis was performed from a randomized controlled trial (RCT ) comparing high-intensity training to conventional interventions, and a pilot study that formed the basis for the RCT. Participants 1–6 months post-stroke received ≤40 sessions of high intensity variable stepping training (n=21) or conventional interventions (n=12). Assessments were performed at baseline (BSL), post-training and 2–3 month follow-up, and included changes in submaximal VO2 (VO2submax) and O2cost at fastest possible treadmill speeds and peak speeds at BSL testing. Results Significant improvements were observed in VO2submax with less consistent decreases in O2cost, although individual responses varied substantially. Combined changes in both VO2submax and VO2 at matched peak BSL speeds revealed stronger correlations to improvements in walking function as compared to either measure alone. Conclusions High-intensity stepping training may elicit significant improvements in VO2submax, while changes in both peak capacity and economy better reflect gains in walking function. Providing such training to improve locomotor and aerobic exercise performance may increase the efficiency of rehabilitation sessions. See Video Abstract available for more insights from the authors (see supplemental digital content).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke

Leddy

Connolly

Holleran

et al. 2016

Journal of Neurologic Physical Therapy

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“…11,13 The CON was 10 community-dwelling, age- (± 5 years) and gender-matched sedentary 14 individuals who were identified from the Alzheimer's Prevention Program at the KU Alzheimer's Disease Center. We also gathered information regarding height, weight and medications since these variables could potentially affect exercise testing performance.…”

Section: Methodsmentioning

confidence: 99%

Decreased Tidal Volume May Limit Cardiopulmonary Performance During Exercise in Subacute Stroke

Sisante

Mattlage

Arena

et al. 2015

Journal of Cardiopulmonary Rehabilitation and Prevention

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PURPOSE The aim of this retrospective study was to determine whether pulmonary function was reduced at submaximal and peak exercise in subacute stroke (SG) when compared to sedentary adults (CON). METHODS Ten individuals with subacute stroke and 10 sedentary, age- and gender-matched adults performed cardiopulmonary exercise testing (CPET) using a recumbent stepper. We used independent t-tests to determine between-group differences at peak effort. We used repeated measures analysis of variance with Test Minute (minutes 1-6) as the within subject factor and Group (SG, CON) as the between subject factor to assess cardiopulmonary submaximal performance. RESULTS SG had significantly lower values (P <.05) for oxygen uptake, minute ventilation(V̇E) and tidal volume (Vt) compared to CON at peak effort of the CPET. During CPET submaximal effort, we report a significant main effect for Test Minute and Group for Vt and respiratory rate (RR) but no main effect of Group for V̇E. To maintain adequate V̇E during submaximal effort and decreased Vt, higher RR was observed. CONCLUSIONS These results suggest that diminished Vt in subacute stroke patients may limit performance during submaximal and peak effort of CPET. Rehabilitation professionals should consider methods for improving pulmonary function during stroke rehabilitation.

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“…We recognize that this may seem to be a systematic bias towards nonenrollment for those with mild stroke, which would bias the study towards accepting the null hypothesis. The reason for nonenrollment lies with the parent study, 40 for which we aimed to consent, perform baseline testing, and participants with equip accelerometers all within 48 hours of admission to the hospital. Participants also needed a confirmed diagnosis of stroke by neuroimaging.…”

Section: Discussionmentioning

confidence: 99%

Use of a Nonexercise Estimate for Prestroke Peak Vo 2 During the Acute Stroke Hospital Stay

Mattlage

Redlin

Rosterman

et al. 2016

Cardiopulm Phys Ther J

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Purpose For individuals with acute stroke, it is difficult to conduct an exercise test to assess peak oxygen consumption (peak Vo2). Therefore, the purpose of this study was to use a clinically feasible tool for assessing prestroke peak Vo2 using a nonexercise estimation equation to test whether estimated prestroke peak Vo2 was related to the functional outcome measures at discharge from the hospital in individuals after an acute stroke. We hypothesized that the estimated prestroke peak Vo2 would be significantly related to discharge Physical Performance Test (PPT), 6-minute walk test (6MWT), and lower extremity Fugl-Meyer (LEFM) assessment. Methods Estimated prestroke peak Vo2 was calculated using a previously validated prediction equation using the following variables: body mass index, age, sex, resting heart rate, and a self-reported measure of physical activity. Outcome measures were assessed 4 days after enrollment or immediately before discharge (whichever occurred first). Results Thirty-four participants (mean age = 56.0, SD = 12.6 years; 20 men) with acute stroke were enrolled within 48 hours of admission. For all individuals, mean estimated prestroke peak Vo2 was 27.3 (SD = 7.4) mL·kg−1·min−1 and had a weak, nonsignificant relationship with the PPT (r = 0.19; P = .28), 6MWT (r = 0.10; P = .56), and LEFM (r = 0.32; P = .06). However, when considering sex, women, but not men, had a significant relationship with LEFM (r = 0.73; P = .005) and moderate but nonsignificant relationship with PPT (r = 0.53; P = .06) and 6MWT (r = 0.47; P = .10). Conclusions Within 48 hours of stroke admission, we were able to administer a nonexercise equation to estimate prestroke peak Vo2. For the entire sample, functional measures conducted at discharge were not related to estimated prestroke peak Vo2. However, when considering sex, the relationship between prestroke Vo2 and the functional measures was strengthened.

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Submaximal and Peak Cardiorespiratory Response After Moderate-High Intensity Exercise Training in Subacute Stroke

Cited by 32 publications

References 26 publications

Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke

Alterations in Aerobic Exercise Performance and Gait Economy Following High-Intensity Dynamic Stepping Training in Persons With Subacute Stroke

Decreased Tidal Volume May Limit Cardiopulmonary Performance During Exercise in Subacute Stroke

Use of a Nonexercise Estimate for Prestroke Peak Vo 2 During the Acute Stroke Hospital Stay

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