Toronto Rehabilitation Institute, University Health Network-KITE Research Institute, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, 550 University Ave, Toronto, Ontario M5G 2A2, Canada.
Toronto Rehabilitation Institute, University Health Network-KITE Research Institute.
Phys Ther. 2020 Aug 31;100(9):1434-1443. doi: 10.1093/ptj/pzaa103.
The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities.
This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates.
The peak heart rate achieved was 65.4% (SD = 10.5%) of the predicted maximum heart rate or 29.1% (SD = 15.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93/195) than because of heart rate limits (60/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of ≥1 mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality.
A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise.
Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke.
It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.
众所周知，中风后进行有氧运动的益处，但对心血管风险的担忧是临床实施的障碍。推荐使用心电图（ECG）进行症状限制的运动测试，但并非总是可行。本研究旨在确定在亚最大运动测试中发生 ECG 异常的频率和相应的运动强度，这些异常会限制超过这些强度的安全运动处方。
这是一项对 195 名在中风康复期间完成亚最大运动测试的患者的 ECG 进行的回顾性分析。使用 5 或 12 导联 ECG 进行分级亚最大运动测试，并根据预定的终点标准（心率、感知用力、体征或症状）终止测试。对运动引起的异常及其相关心率进行回顾性审查。
达到的峰值心率为预测最大心率的 65.4%（SD=10.5%）或心率储备的 29.1%（SD=15.5%）（根据β受体阻滞剂药物进行调整）。由于感知用力（93/195）而不是因为心率限制（60/195），测试更频繁地终止。有 4 名患者（2.1%）表现出运动引起的水平或下斜 ST 段压低≥1mm。除 1 名患者外，测试终止时的心率与 ECG 异常发生时的心率相当。
不进行 ECG 但进行症状监测以及保守的心率和感知用力终点的分级亚最大运动测试可能有助于在中风后早期确定安全的运动强度。当进展到更高强度的运动时，仍建议进行 ECG 限制的运动测试。
对心血管风险的担忧是物理治疗师在中风康复中实施有氧运动的障碍。本研究表明，在无法进行 ECG 运动测试的情况下，使用保守的心率和感知用力终点以及症状监测的亚最大运动测试可以支持物理治疗师在中风后早期安全地开具有氧运动处方。
