A Whole-Body Exercise Test to Assess Cardiorespiratory Fitness across the Stroke Recovery Continuum

Area of Science:

• Rehabilitation Medicine
• Cardiopulmonary Physiology
• Neurology

Background:

• Cardiorespiratory fitness assessment is crucial for stroke patients undergoing cardiopulmonary exercise testing (CPET).
• Neuromuscular impairments post-stroke can disproportionately affect females, necessitating evaluation of CPET protocols.
• There's a need to understand sex-specific CPET responses across stroke recovery stages.

Purpose of the Study:

• To characterize sex-specific CPET responses in subacute and chronic stroke survivors.
• To evaluate a whole-body recumbent stepper CPET protocol using American College of Sports Medicine (ACSM) criteria.

Main Methods:

• 145 participants with subacute or chronic stroke underwent symptom-limited CPET on a recumbent stepper.
• Key metrics assessed included ventilatory threshold (VT) and peak oxygen uptake (V̇O2peak).
• ACSM criteria (RER, V̇O2 plateau, HR, RPE) were used to determine maximal effort, with sex and chronicity differences analyzed.

Main Results:

• In subacute stroke, no sex differences in VT or V̇O2peak were observed, but females were more likely to achieve a V̇O2 plateau.
• In chronic stroke, females exhibited lower V̇O2peak, though VT and maximal criteria showed no sex differences.
• Regardless of sex, achieving high ratings of perceived exertion (RPE) or respiratory exchange ratio (RER) were the most common ACSM criteria met.

Conclusions:

• The whole-body recumbent stepper CPET protocol effectively elicits peak and maximal efforts in stroke survivors.
• Clinicians should consider biological sex and stroke chronicity when interpreting CPET results.
• This approach supports tailored exercise prescription for individuals post-stroke.