Division of Gerontology, Department of Medicine, and the Departments of Neurology and Physical Therapy, University of Maryland School of Medicine, Baltimore, MD; and the Geriatric Research, Education and Clinical Center (GRECC), Baltimore VA Medical Center, Baltimore, MD.
J Stroke Cerebrovasc Dis. 2000 Jul-Aug;9(4):185-91. doi: 10.1053/jscd.2000.7237.
Functional disability after hemiparetic stroke may be compounded by physical deconditioning and muscular wasting, factors related to disuse and advancing age. However, the role of body composition, severity, and chronicity of gait deficits as determinants of exercise fitness after stroke is unknown. The purpose of this study was to determine whether oxygen consumption during peak exercise (VO2 peak) is associated with body composition, the severity, or duration of gait deficits in chronic (>6 months) hemiparetic stroke patients. Twenty-six patients (22 men, 4 women), aged 66 ± 9 years (mean ± standard deviation [SD]), completed a progressive graded treadmill test until fatigue to measure VO2 peak (1.3 ± 0.4 L/minute). Timed 30-foot walks were used to determine self-selected floor walking velocity (0.63 ± 0.31 m/s), an index of gait deficit severity. Percent body fat (30.4% ± 10.6%), total lean mass (52.0 ± 9.3 kg), lean mass of the paretic and nonaffected legs (17.2 ± 3.7 kg), and lean mass of the paretic and nonaffected thighs (13.2 ± 2.7 kg) were determined by dual-energy x-ray absorptiometry. Total lean mass (r = 0.60), lean mass of both legs (r = 0.58), paretic leg lean mass (r = 0.55), lean mass of both thighs (r = 0.64), and self-selected floor walking velocity (r = 0.53, all P < .01) correlated with VO2 peak. In contrast, percent body fat and latency since index stroke were unrelated to VO2 peak. In a stepwise regression analysis, lean mass of both thighs (r = 0.64, P < .001) and self-selected walking velocity (cumulative r = 0.78, P < .001) were independent predictors of VO2 peak and explained 61% of the variance. These results suggest that hemiparetic stroke patients are profoundly deconditioned, regardless of the latency since stroke, and that lower lean thigh mass and greater gait deficit severity predict even poorer peak exercise capacity.
偏瘫患者的功能障碍可能因身体失健和肌肉萎缩而加重，这些因素与废用和年龄增长有关。然而，身体成分、步态缺陷的严重程度和慢性程度作为中风后运动适应性的决定因素尚不清楚。本研究的目的是确定在慢性（>6 个月）偏瘫中风患者中，运动峰值时的耗氧量（VO2peak）是否与身体成分、步态缺陷的严重程度或持续时间相关。26 名患者（22 名男性，4 名女性），年龄 66 ± 9 岁（平均值 ± 标准差[SD]），完成了一项渐进式跑步机测试，直到疲劳，以测量 VO2peak（1.3 ± 0.4 L/min）。30 英尺步行测试用于确定自我选择的地面行走速度（0.63 ± 0.31 m/s），这是步态缺陷严重程度的指标。通过双能 X 射线吸收法测定体脂百分比（30.4% ± 10.6%）、总瘦体重（52.0 ± 9.3 kg）、患侧和非患侧腿的瘦体重（17.2 ± 3.7 kg）以及患侧和非患侧大腿的瘦体重（13.2 ± 2.7 kg）。总瘦体重（r = 0.60）、双侧腿瘦体重（r = 0.58）、患侧腿瘦体重（r = 0.55）、双侧大腿瘦体重（r = 0.64）和自我选择的地面行走速度（r = 0.53，均 P <.01）与 VO2peak 相关。相比之下，体脂百分比和从指数中风到现在的时间与 VO2peak 无关。在逐步回归分析中，双侧大腿的瘦体重（r = 0.64，P <.001）和自我选择的步行速度（累积 r = 0.78，P <.001）是 VO2peak 的独立预测因子，解释了 61%的方差。这些结果表明，偏瘫患者的身体状况严重下降，无论从中风到现在的时间如何，瘦大腿质量较低和步态缺陷更严重预测运动峰值能力更差。
