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Is postexercise hypotension a method-dependent phenomenon in chronic stroke? A crossover randomized controlled trial.

Guilherme F Fonseca1, André C Michalski1, Arthur S Ferreira2

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Clinical Physiology and Functional Imaging
|January 16, 2023
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Summary

The most reliable method to detect postexercise hypotension (PEH) in chronic stroke survivors is by subtracting post-control session blood pressure from post-exercise blood pressure. Cut-off values did not significantly impact the identification of PEH responders.

Keywords:
blood pressurecircuit-based exerciseexercisepostexercise hypotensionreproducibility of resultsstroke

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Area of Science:

  • Cardiovascular Physiology
  • Neurology
  • Exercise Science

Background:

  • Assessing postexercise hypotension (PEH) reproducibility in chronic stroke survivors is crucial for understanding cardiovascular recovery.
  • Mixed circuit training (MCT) is a potential intervention, but reliable detection methods for PEH are needed.
  • Three calculation approaches, accounting for pre-exercise values and/or a control session (CTL), were evaluated for PEH detection.

Purpose of the Study:

  • To assess the reproducibility of postexercise hypotension (PEH) detection in individuals with chronic stroke.
  • To compare different methods for calculating PEH, including those using pre-exercise values and a control session.
  • To evaluate the impact of different cut-off values (4 mmHg vs. minimal detectable difference) on identifying PEH responders.

Main Methods:

  • Seven participants (chronic stroke) underwent two bouts of MCT and one CTL session.
  • Mixed circuit training involved 10 exercises, 3 sets of 15 repetitions maximum, with interspersed walking.
  • Systolic (SBP) and diastolic (DBP) blood pressures were measured before and every 10 minutes for 40 minutes after each session.

Main Results:

  • The most reproducible method for detecting PEH in chronic stroke involved subtracting post-CTL SBP/DBP from post-MCT SBP/DBP (ICC2,1 ranges: SBP 0.937-0.994, DBP 0.133-0.969).
  • The proportion of PEH responders was largely unaffected by using a 4 mmHg cut-off versus the minimal detectable difference (97% of analyses).
  • The standard error of measurement for SBP and DBP met or exceeded 4 mmHg in 40-47% of analyses, highlighting variability.

Conclusions:

  • Subtracting post-control session blood pressure from post-exercise blood pressure is the most reliable method for detecting PEH in chronic stroke.
  • The choice of cut-off value (4 mmHg or minimal detectable difference) did not significantly alter the identification of PEH responders.
  • Reliable detection of PEH in chronic stroke requires careful consideration of the calculation method and potential measurement variability.