亚急性脑卒中患者次最大有氧运动试验期间的不良事件：范围综述。

Adverse Events During Submaximal Aerobic Exercise Testing in People With Subacute Stroke: A Scoping Review.

机构信息

Rehabilitation Sciences Institute (J.M.L.M., E.L.I., A.N.T., N.C., S.M., N.M.S.) and Department of Physical Therapy (J.M.L.M., E.L.I., S.M., N.M.S), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The KITE Research Institute, Toronto Rehabilitation Institute (E.L.I., N.M.S), University Health Network, Toronto, Ontario, Canada; and School of Rehabilitation Therapy (S.M.), Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

出版信息

J Neurol Phys Ther. 2024 Jan 1;48(1):27-37. doi: 10.1097/NPT.0000000000000445. Epub 2023 May 15.

DOI:10.1097/NPT.0000000000000445

PMID:37184472

Abstract

BACKGROUND AND PURPOSE

Concern for adverse cardiovascular events and limited guidance regarding how to conduct aerobic exercise (AEx) testing for individuals poststroke are key barriers to implementation by physical therapists in stroke rehabilitation. This study aimed to describe the nature and safety of submaximal AEx testing protocols for people with subacute stroke (PwSS) and the nature of comorbidity of PwSS who underwent submaximal AEx testing.

METHODS

We conducted a scoping review and searched MEDLINE, EMBASE, PsycINFO, CINAHL, and SPORTDiscus from inception to October 29, 2020. Studies involving submaximal AEx testing with PwSS, reporting on participant comorbidity and on adverse events during testing, were eligible. Two reviewers independently conducted title and abstract and full-text screening. One reviewer extracted data; a second reviewer verified data.

RESULTS

Thirteen studies involving 452 participants and 19 submaximal AEx testing protocols (10 field test, 7 incremental, and 2 constant load) were included. Hypertension (41%), diabetes (31%), and dyslipidemia (27%) were the most common comorbidities reported. No protocols resulted in a serious adverse event. The most common test termination criterion was a heart rate (HR) limit (9 protocols); a limit of 85% age-predicted maximal HR (APM-HR) most frequently reported. Average APM-HR achieved, computed using mean age and mean peak HR, ranged from 59% to 88% across 13 protocols.

DISCUSSION AND CONCLUSION

Diverse submaximal AEx testing protocols with conservative test termination criteria can be safely implemented with PwSS. Results can inform clinical practice guidelines and address physical therapists' concerns with the occurrence of serious adverse events during submaximal AEx testing.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A430 ).

摘要

背景与目的

担心心血管不良事件以及缺乏关于如何为脑卒中后个体进行有氧运动（AEx）测试的指导，这是物理治疗师在脑卒中康复中实施的主要障碍。本研究旨在描述亚急性脑卒中患者（PwSS）进行亚最大 AEx 测试的方案的性质和安全性，以及进行亚最大 AEx 测试的 PwSS 的合并症的性质。

方法

我们进行了范围界定综述，从开始到 2020 年 10 月 29 日，在 MEDLINE、EMBASE、PsycINFO、CINAHL 和 SPORTDiscus 上进行了检索。符合条件的研究包括使用 PwSS 进行亚最大 AEx 测试，并报告参与者的合并症和测试期间的不良事件。两名评审员独立进行标题和摘要以及全文筛选。一名评审员提取数据；第二名评审员验证数据。

结果

共纳入 13 项研究，涉及 452 名参与者和 19 项亚最大 AEx 测试方案（10 项现场测试、7 项递增测试和 2 项恒负荷测试）。报告的最常见合并症为高血压（41%）、糖尿病（31%）和血脂异常（27%）。没有方案导致严重不良事件。最常见的测试终止标准是心率（HR）限制（9 项方案）；最常报告的限制是 85%年龄预测最大 HR（APM-HR）。使用平均年龄和平均峰值 HR 计算得出的 13 项方案中的平均 APM-HR 达到 59%至 88%。

讨论与结论

具有保守测试终止标准的不同亚最大 AEx 测试方案可以安全地用于 PwSS。结果可以为临床实践指南提供信息，并解决物理治疗师对亚最大 AEx 测试期间发生严重不良事件的担忧。视频摘要可提供作者的更多见解（请观看视频，补充数字内容 1 可在以下网址获得：http://links.lww.com/JNPT/A430）。