Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke
Abstract Background The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), wh...
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| Veröffentlicht in: | Physical therapy 2019-01, Vol.99 (1), p.86-97 |
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| creator | Woodward, Jane L Connolly, Mark Hennessy, Patrick W Holleran, Carey L Mahtani, Gordhan B Brazg, Gabrielle Fahey, Meghan Maganti, Kameswari Hornby, T George |
| description | Abstract
Background
The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs.
Objective
The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics.
Design
The study used a cross-sectional observational design.
Methods
Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics.
Results
Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance.
Limitations
In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke.
Conclusions
Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs. |
| doi_str_mv | 10.1093/ptj/pzy128 |
| format | Article |
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Background
The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs.
Objective
The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics.
Design
The study used a cross-sectional observational design.
Methods
Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics.
Results
Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance.
Limitations
In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke.
Conclusions
Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.</description><identifier>ISSN: 0031-9023</identifier><identifier>EISSN: 1538-6724</identifier><identifier>DOI: 10.1093/ptj/pzy128</identifier><identifier>PMID: 30476281</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Cardiac output ; Care and treatment ; Exercise tests ; Exercise therapy ; Gait ; Heart rate ; Medical research ; Medical schools ; Medicine, Experimental ; Methods ; Physiological aspects ; Pulmonary ventilation ; Rehabilitation ; Stroke ; Stroke patients</subject><ispartof>Physical therapy, 2019-01, Vol.99 (1), p.86-97</ispartof><rights>2018 American Physical Therapy Association 2019</rights><rights>COPYRIGHT 2019 Oxford University Press</rights><rights>COPYRIGHT 2019 Oxford University Press</rights><rights>2018 American Physical Therapy Association</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c626t-b1ae052f13123d183e5651d3efe2ed335d9fecbea30e64b24a8240d794d86f923</citedby><cites>FETCH-LOGICAL-c626t-b1ae052f13123d183e5651d3efe2ed335d9fecbea30e64b24a8240d794d86f923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30476281$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Woodward, Jane L</creatorcontrib><creatorcontrib>Connolly, Mark</creatorcontrib><creatorcontrib>Hennessy, Patrick W</creatorcontrib><creatorcontrib>Holleran, Carey L</creatorcontrib><creatorcontrib>Mahtani, Gordhan B</creatorcontrib><creatorcontrib>Brazg, Gabrielle</creatorcontrib><creatorcontrib>Fahey, Meghan</creatorcontrib><creatorcontrib>Maganti, Kameswari</creatorcontrib><creatorcontrib>Hornby, T George</creatorcontrib><title>Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke</title><title>Physical therapy</title><addtitle>Phys Ther</addtitle><description>Abstract
Background
The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs.
Objective
The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics.
Design
The study used a cross-sectional observational design.
Methods
Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics.
Results
Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance.
Limitations
In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke.
Conclusions
Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.</description><subject>Cardiac output</subject><subject>Care and treatment</subject><subject>Exercise tests</subject><subject>Exercise therapy</subject><subject>Gait</subject><subject>Heart rate</subject><subject>Medical research</subject><subject>Medical schools</subject><subject>Medicine, Experimental</subject><subject>Methods</subject><subject>Physiological aspects</subject><subject>Pulmonary ventilation</subject><subject>Rehabilitation</subject><subject>Stroke</subject><subject>Stroke patients</subject><issn>0031-9023</issn><issn>1538-6724</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNqV0l1rFDEUBuBBFLut3vgDZEAEFabN12Qzl8uoa2Gx0ipehuzMmWnWTDImGWj99absqqwsRclFIDznkMN5s-wZRqcYVfRsjJuz8cctJuJBNsMlFQWfE_YwmyFEcVEhQo-y4xA2CCE8Z9Xj7IgiNudE4FnW18q32o2TGZxV_ja_hDA6GyDkbyevbZ_XRlvdKJMr2-YrtXZeRZfgUumYL0KSYQAbQ65t_gncaCD_quN1Xl97lwrzq-jdN3iSPeqUCfB0d59kX96_-1x_KFYXy_N6sSoaTngs1lgBKkmHKSa0xYJCyUvcUuiAQEtp2VYdNGtQFAFna8KUIAy184q1gncVoSfZq23f0bvvE4QoBx0aMEZZcFOQBFPBGUelSPTFX3TjJm_T7yShiJeMEcL_qF4ZkNp2LnrV3DWVi1IQVImS0aSKA6oHC14ZZ6HT6XnPnx7w6bQw6OZgweu9gmQi3MReTSHI86vL_7Af_9mK5eq-IXe2ccZADzLtsb7Y92-2vvEuBA-dHL0eUsgkRvIuuTIlV26Tm_Dz3Tam9QDtb_orqgm83AI3jfc1-gmBBfF3</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Woodward, Jane L</creator><creator>Connolly, Mark</creator><creator>Hennessy, Patrick W</creator><creator>Holleran, Carey L</creator><creator>Mahtani, Gordhan B</creator><creator>Brazg, Gabrielle</creator><creator>Fahey, Meghan</creator><creator>Maganti, Kameswari</creator><creator>Hornby, T George</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>ISN</scope><scope>ISR</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20190101</creationdate><title>Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke</title><author>Woodward, Jane L ; Connolly, Mark ; Hennessy, Patrick W ; Holleran, Carey L ; Mahtani, Gordhan B ; Brazg, Gabrielle ; Fahey, Meghan ; Maganti, Kameswari ; Hornby, T George</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c626t-b1ae052f13123d183e5651d3efe2ed335d9fecbea30e64b24a8240d794d86f923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Cardiac output</topic><topic>Care and treatment</topic><topic>Exercise tests</topic><topic>Exercise therapy</topic><topic>Gait</topic><topic>Heart rate</topic><topic>Medical research</topic><topic>Medical schools</topic><topic>Medicine, Experimental</topic><topic>Methods</topic><topic>Physiological aspects</topic><topic>Pulmonary ventilation</topic><topic>Rehabilitation</topic><topic>Stroke</topic><topic>Stroke patients</topic><toplevel>online_resources</toplevel><creatorcontrib>Woodward, Jane L</creatorcontrib><creatorcontrib>Connolly, Mark</creatorcontrib><creatorcontrib>Hennessy, Patrick W</creatorcontrib><creatorcontrib>Holleran, Carey L</creatorcontrib><creatorcontrib>Mahtani, Gordhan B</creatorcontrib><creatorcontrib>Brazg, Gabrielle</creatorcontrib><creatorcontrib>Fahey, Meghan</creatorcontrib><creatorcontrib>Maganti, Kameswari</creatorcontrib><creatorcontrib>Hornby, T George</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Physical therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Woodward, Jane L</au><au>Connolly, Mark</au><au>Hennessy, Patrick W</au><au>Holleran, Carey L</au><au>Mahtani, Gordhan B</au><au>Brazg, Gabrielle</au><au>Fahey, Meghan</au><au>Maganti, Kameswari</au><au>Hornby, T George</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke</atitle><jtitle>Physical therapy</jtitle><addtitle>Phys Ther</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>99</volume><issue>1</issue><spage>86</spage><epage>97</epage><pages>86-97</pages><issn>0031-9023</issn><eissn>1538-6724</eissn><abstract>Abstract
Background
The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs.
Objective
The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics.
Design
The study used a cross-sectional observational design.
Methods
Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics.
Results
Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance.
Limitations
In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke.
Conclusions
Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>30476281</pmid><doi>10.1093/ptj/pzy128</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Physical therapy, 2019-01, Vol.99 (1), p.86-97 |
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| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Cardiac output Care and treatment Exercise tests Exercise therapy Gait Heart rate Medical research Medical schools Medicine, Experimental Methods Physiological aspects Pulmonary ventilation Rehabilitation Stroke Stroke patients |
| title | Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke |
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