Steen Krawcyk Rikke, Vinther Anders, Caesar Petersen Nicolas, Kruuse Christina
Department of Rehabilitation, Herlev Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Neurology, Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
Department of Rehabilitation, Herlev Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):494-499. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.004. Epub 2016 Dec 29.
Physical exercise is generally recommended as part of life style changes post stroke. Monitoring cardiovascular effects may help motivate patients for further exercise, and can be an instrument to assess intervention effects in clinical trials. In 1 of 4 stroke patients, the heart rate variability may challenge currently used cardiovascular monitoring. The Graded Cycling Test with Talk Test is a submaximal exercise test independent of heart rate variability, shown reliable for patients with cardiac disease.
Patients diagnosed with lacunar stroke according to TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria performed an incremental exercise test on a stationary bicycle with a 15 W (watt) increase in workload every minute. Toward the end of each incremental step, the patients recited a standardized text passage and subsequently were asked: "Are you still able to speak comfortably?" The test was stopped when the patients were no longer able to speak comfortably. Two consecutive tests were performed separated by 1 hour rest.
Sixty patients completed the study. The intraclass correlation coefficient (ICC) was as follows: .97 [95% CI: .95-.98] with only a minor measurement error: 12.9 W for groups of patients (standard error of measurement, SEM) and 18.3 W for individual patients (smallest real difference).
The "Graded Cycling Test with Talk Test" is feasible and reliable for monitoring exercise effects in patients with lacunar stroke. The high ICC and small measurement error suggest it to be a valuable outcome measurement in clinical practice.
体育锻炼通常被推荐为中风后生活方式改变的一部分。监测心血管效应可能有助于激励患者进一步锻炼，并且可以作为评估临床试验中干预效果的一种手段。在四分之一的中风患者中，心率变异性可能会对目前使用的心血管监测提出挑战。带言语测试的分级自行车测试是一种与心率变异性无关的次极量运动测试，已证明对心脏病患者可靠。
根据TOAST（急性中风治疗中Org 10172试验）标准诊断为腔隙性中风的患者在固定自行车上进行递增运动测试，每分钟工作量增加15瓦（瓦特）。在每个递增阶段结束时，患者背诵一段标准化的文本段落，随后被问到：“你还能轻松说话吗？”当患者不再能够轻松说话时，测试停止。连续进行两次测试，中间休息1小时。
60名患者完成了研究。组内相关系数（ICC）如下：.97[95%CI：.95-.98]，测量误差很小：患者组为12.9瓦（测量标准误差，SEM），个体患者为18.3瓦（最小实际差异）。
“带言语测试的分级自行车测试”对于监测腔隙性中风患者的运动效果是可行且可靠的。高ICC和小测量误差表明它在临床实践中是一种有价值的结果测量方法。
