老年慢性偏瘫性卒中患者跑步机运动试验的可靠性
Reliability of treadmill exercise testing in older patients with chronic hemiparetic stroke.
作者信息
Dobrovolny C Lynne, Ivey Frederick M, Rogers Marc A, Sorkin John D, Macko Richard F
机构信息
Division of Gerontology, University of Maryland School of Medicine, Baltimore, MD, 21201-1524, USA.
出版信息
Arch Phys Med Rehabil. 2003 Sep;84(9):1308-12. doi: 10.1016/s0003-9993(03)00150-3.
OBJECTIVE
To assess the test-retest reliability of cardiopulmonary measurements during peak effort and submaximal treadmill walking tests in older patients with gait-impaired chronic hemiparetic stroke.
DESIGN
Nonrandomized test-retest.
SETTING
Hospital geriatric research stress testing laboratory.
PARTICIPANTS
Fifty-three subjects (44 men, 9 women; mean age, 65+/-8y) with chronic hemiparetic gait after remote (>6mo) ischemic stroke. Patients had mild to moderate chronic hemiparetic gait deficits, making handrail support necessary during treadmill walking.
INTERVENTIONS
Peak effort and submaximal effort treadmill walking tests were conducted and then repeated on a separate day at least a week later. Main outcome measures Reliability coefficients (r) were calculated for heart rate, systolic blood pressure (SBP), oxygen consumption (Vo(2) [L/min]), Vo(2) (mL.kg(-1).min(-1)), respiratory exchange ratio (RER), rate-pressure product (RPP), and oxygen pulse during peak effort testing. The reliability coefficients for all but SBP and RPP data were calculated from the submaximal tests.
RESULTS
Heart rate (r=.87), Vo(2)peak (L/min) (r=.92), Vo(2)peak (mL.kg(-1).min(-1)) (r=.92), and oxygen pulse (r=93) were highly reliable parameters during maximal testing in this population. Submaximal testing produced highly reliable results for V.o(2) (L/min) (r=.89) and oxygen pulse (r=.85). All cardiopulmonary measures except RER had a reliability coefficient greater than.80 during submaximal testing in this population.
CONCLUSION
Our study provides the first evidence that peak effort treadmill testing provides highly reliable oxygen consumption measures in chronic hemiparetic stroke patients using minimal handrail support. The submaximal tests were at or near the threshold level of reliability for the 2 most important measures of V.o(2) (L/min) and V.o(2) (mL.kg(-1).min(-1)) (r=.89, r=.84, respectively), with the remaining measures falling above.70.
目的
评估步态受损的老年慢性偏瘫性卒中患者在全力运动和次极量平板步行试验期间心肺测量的重测信度。
设计
非随机重测。
地点
医院老年研究压力测试实验室。
参与者
53名受试者（44名男性，9名女性；平均年龄65±8岁），有陈旧性（>6个月）缺血性卒中后慢性偏瘫步态。患者有轻度至中度慢性偏瘫步态缺陷，在平板步行时需要扶手支撑。
干预措施
进行全力运动和次极量运动平板步行试验，至少在一周后的另一天重复进行。主要结局指标计算全力运动试验期间心率、收缩压（SBP）、耗氧量（Vo₂[L/min]）、Vo₂（mL·kg⁻¹·min⁻¹）、呼吸交换率（RER）、率压乘积（RPP）和氧脉搏的信度系数（r）。除SBP和RPP数据外，所有信度系数均根据次极量试验计算。
结果
在该人群的最大运动试验中，心率（r = 0.87）、峰值Vo₂（L/min）（r = 0.92）、峰值Vo₂（mL·kg⁻¹·min⁻¹）（r = 0.92）和氧脉搏（r = 0.93）是高度可靠的参数。次极量试验对Vo₂（L/min）（r = 0.89）和氧脉搏（r = 0.85）产生了高度可靠的结果。在该人群的次极量试验中，除RER外，所有心肺测量的信度系数均大于0.80。
结论
我们的研究首次证明，全力运动平板试验在使用最少扶手支撑的慢性偏瘫性卒中患者中提供了高度可靠的耗氧量测量。次极量试验对于Vo₂（L/min）和Vo₂（mL·kg⁻¹·min⁻¹）这两个最重要测量指标的信度处于或接近阈值水平（分别为r = 0.89，r = 0.84），其余测量指标的信度高于0.70。
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