Institute of Medical Science, University of Toronto, Toronto, Ontario Canada.
Stroke. 2012 Apr;43(4):1075-81. doi: 10.1161/STROKEAHA.111.635128. Epub 2012 Feb 9.
Despite the importance of exercise training in mitigating cardiovascular risk, the development of exercise programs for people poststroke has been limited by lack of feasibility data concerning cardiopulmonary exercise testing (CPET) to inform the exercise prescription. Therefore, we examined the feasibility of CPETs for developing an exercise prescription in people ≥3 months poststroke.
CPET results from 98 consecutively enrolled patients poststroke with motor impairments and 98 age- and sex-matched patients with coronary artery disease were examined at baseline and after 6 months of exercise training.
The proportion of patients with stroke and coronary artery disease attaining an intensity sufficient for prescribing exercise at baseline was 68.4% versus 82.7%, respectively (P=0.02) and 84.7% versus 83.8% (P=0.9) at 6 months. Women were less likely than men poststroke to achieve a sufficient intensity at baseline (40% versus 80.9%, P<0.001) but not at 6 months (78.3% versus 87.1, P=0.3). A clinically relevant abnormality occurred in 11.2% of stroke and 12.2% of patients with coronary artery disease on baseline CPETs (P=0.8) and 10.6% of stroke and 5.9% of patients with coronary artery disease on the 6-month CPET (P=0.4). No serious cardiovascular events occurred during 349 CPETs.
Most patients after stroke achieved a level of exertion during the CPET sufficient to inform an exercise prescription. At least 1 of 10 patients poststroke developed a clinically relevant abnormality on baseline and postprogram CPETs with no serious cardiovascular events. These data support the feasibility and safety of CPETs for prescribing exercise poststroke. Strategies to improve use of baseline CPETs for women poststroke require further investigation.
尽管运动训练对于减轻心血管风险非常重要，但由于缺乏心肺运动测试（CPET）来为运动处方提供信息，因此限制了针对脑卒中后人群的运动方案的发展。因此，我们研究了 CPET 在为脑卒中后患者制定运动处方方面的可行性。
我们在基线和 6 个月运动训练后，检查了 98 例连续入组的伴有运动障碍的脑卒中患者和 98 例年龄和性别匹配的冠心病患者的 CPET 结果。
脑卒中患者和冠心病患者在基线时达到足以开运动处方强度的比例分别为 68.4%和 82.7%（P=0.02），在 6 个月时分别为 84.7%和 83.8%（P=0.9）。脑卒中女性患者达到足够强度的可能性低于男性患者（40%比 80.9%，P<0.001），但在 6 个月时则无差异（78.3%比 87.1%，P=0.3）。在基线 CPET 中，脑卒中患者和冠心病患者各有 11.2%和 12.2%出现临床相关异常（P=0.8），在 6 个月 CPET 中则分别为 10.6%和 5.9%（P=0.4）。在 349 次 CPET 中没有发生严重心血管事件。
大多数脑卒中后患者在 CPET 中达到了足以制定运动处方的运动强度。至少有 1/10 的脑卒中患者在基线和方案后 CPET 中出现了临床相关异常，但没有发生严重心血管事件。这些数据支持 CPET 为脑卒中后患者制定运动处方的可行性和安全性。需要进一步研究改善脑卒中后女性患者使用基线 CPET 的策略。
