Cardiopulmonary exercise tests in people with chronic stroke: Interpretation and clinical application.
Kiersten M McCartney, David Edwards, Ryan Pohlig and 5 others
PMID 39925095WHAT IT FOUND
Most treadmill exercise tests in chronic stroke stop due to walking problems, not heart or lung limits.
Only 1.9% met criteria for a true maximal effort. Peak oxygen consumption from these tests likely underestimates fitness. Consider alternative modalities or clinical judgment for training intensity.
Key findings
01Only 1.9% of treadmill cardiopulmonary exercise tests met both secondary criteria for a maximal aerobic effort (heart rate within 10 beats of age-predicted max and respiratory exchange ratio ≥ 1.1).
0240.7% of tests were stopped at the participant's request, and 25.2% were stopped due to biomechanical faults such as toe-catching or inability to maintain speed.
03There were no significant differences in peak oxygen consumption between participants who stopped for different reasons.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only included patients who could walk unaided at a self-selected speed of 0.3–1.0 m/s, so results do not apply to non-ambulatory patients or those with very mild impairments. The analysis was limited to treadmill walking; other modalities like cycling or recumbent stepping might yield different results. Rate of perceived exertion and blood lactate were not measured, so some standard criteria for maximal effort could not be assessed. This is a secondary analysis of a trial designed for a different primary purpose, though the dataset is large.
Declared interests
The study was supported by the National Institutes of Health/National Institute of Child Health and Human Development (R01HD085043). The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the low peak oxygen consumption values as evidence that chronic stroke patients have poor cardiorespiratory fitness. The tests mostly stopped because of walking difficulties or participant request, meaning the patients never reached their cardiovascular limit.