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. 2023 Oct;15(10):1258-1265.
doi: 10.1002/pmrj.12940. Epub 2023 Feb 15.

A 3-minute recumbent stepper test in chronic stroke

Daniel L Carl  1 , Dustyn Whitesel  1 , Colleen Meyrose  1 , Jennifer Westover  1 , Jane Khoury  2 , Myron Gerson  3 , Brett Kissela  4 , Kari Dunning  1 , Pierce Boyne  1
Affiliations

A 3-minute recumbent stepper test in chronic stroke

Daniel L Carl et al. PM R. 2023 Oct.

Abstract

Background: Persons with stroke often have difficulty achieving target heart rate (HR) during graded exercise testing (GXT), which is known to limit test sensitivity for detecting clinically relevant cardiac conditions. A novel Recumbent Stepper 3-minute (RS 3Min) "all out" test may increase sensitivity of stress testing after stroke.

Objective: To determine the feasibility of adding the RS 3Min test after GXT among persons after stroke.

Design: A within-participant, nonrandomized, repeated measures design.

Setting: Rehabilitation research laboratory and cardiovascular stress laboratory PARTICIPANTS: Fifteen participants with chronic stroke (56.7 ± 9.6 years; 6.4 ± 4.3 years post stroke; 8 male).

Interventions: All participants randomly completed (1) a symptom-limited treadmill GXT and (2) a symptom-limited RS GXT followed by RS 3Min critical power test.

Main outcome measures: HR, ratings of perceived exertion, oxygen consumption, respiratory exchange ratio, and power output measured continuously during each test. Blood pressure measured every 2 minutes and or immediately post exercise. P value set at p < .05 from omnibus test for a significant difference among protocols.

Results: The RS 3Min test had a significantly higher rate of achieving target HR compared to the RS GXT (9/14 vs 4/14, p = .02) and was not significantly different from the treadmill GXT (9/14 vs 5/14, p = .09). Minimum power output during the RS 3Min was significantly higher than peak power output during the RS GXT (110 ± 41 W vs. 84 ± 22 W, p = .02) with 12/15 participants reaching a VO2 plateau.

Conclusions: Although additional studies with randomized designs are needed, a novel RS 3Min "all out" test appears to be a promising method for enhancing test sensitivity in cardiovascular screening after stroke, while providing a potentially valid measure of critical power.

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Conflict of interest statement

No conflicts of interest, financial or otherwise, are declared by the authors.

Figures

Figure 1.
Figure 1.
1A Individual participant and mean peak power outputs related to duration. 1B Individual participant and mean peak VO2 measurements relative to peak VO2 from the RS GXT. 1C Individual participant and HR measurements from the RS GXT. 1D Mean peak power and % peak VO2 without individual participants.
See this image and copyright information in PMC

References

    1. Billinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014; 45(8): 2532–53. doi: 10.1097/NPT.0000000000000177 - DOI - PubMed
    1. Winstein CJ, Stein J, Arena R, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2016. Jun; 47(6): e98–e169. doi: 10.1161/STR.0000000000000098 - DOI - PubMed
    1. Boyne P, Billinger SA, MacKay-Lyons M, Barney B, Khoury J, Dunning K. Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of United States Physical Therapists. J Neurol Phys Ther. 2017. Apr; 41(2): 119–128. doi: 10.1097/NPT.0000000000000177 - DOI - PMC - PubMed
    1. Gäverth J, Parker R, MacKay-Lyons M. Exercise stress testing after stroke or transient ischemic attack: a scoping review. Arch Phys Med Rehabil. 2015. Jul;96(7):1349–1359.e12. doi: 10.1016/j.apmr.2015.03.005 - DOI - PubMed
    1. Hlatky MA, Pryor DB, Harrell FE, Califf RM, Mark DB, Rosati RA. Factors affecting sensitivity and specificity of exercise electrocardiography. Multivariable analysis. Am J Med. 1984. Jul; 77(1): 64–71. doi: 10.1007/s11910-014-0519-8 - DOI - PubMed

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