Susan Marzolini1, Paul Oh2, Dale Corbett3, Daryl Dooks4, Marcella Calouro4, Bradley J MacIntosh5, Rachel Goodman6, Dina Brooks7. 1. Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada. Electronic address: Susan.marzolini@uhn.ca. 2. Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada; Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada. 3. Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 4. Cardiovascular Prevention and Rehabilitation Program, Toronto Rehab/University Health Network, Toronto, Ontario, Canada. 5. Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 6. Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada. 7. Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments. METHODS: Sixty participants (male, 71.7%; 13.5 ± 22.5 [mean ± standard deviation] months post stroke; age 64.5 ± 12.5 years, with a Chedoke-McMaster Stroke Assessment score of 4.9 ± .9 of the leg) underwent 6MWT, CPET, balance, strength, and cognition assessments. RESULTS: 6MWT heart rate (hr) was significantly lower than VAT-hr (92.3 ± 14.8 beats⋅min(-1) versus 99.8 ± 15.7 beats⋅min(-1), respectively, P < .001; correlation r = .7, P < .001). Bland-Altman analysis revealed that the 6MWT underestimated the VAT-hr by 7.7 ± 11.5%. The 95% confidence interval of the mean bias was large (14.8% and -30.3%), reflecting poor agreement, with 71.7% (n = 43) of the participants unable to reach a walking intensity at or above the VAT-hr. Lower oxygen uptake at the VAT (β = .655, P = .004), higher 6MWT-hr (β = 1.07, P = .01), and better balance (β = 1.128, P = .04) were associated with greater utility of the 6MWT for prescribing exercise. CONCLUSIONS: The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included.
BACKGROUND: The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments. METHODS: Sixty participants (male, 71.7%; 13.5 ± 22.5 [mean ± standard deviation] months post stroke; age 64.5 ± 12.5 years, with a Chedoke-McMaster Stroke Assessment score of 4.9 ± .9 of the leg) underwent 6MWT, CPET, balance, strength, and cognition assessments. RESULTS: 6MWT heart rate (hr) was significantly lower than VAT-hr (92.3 ± 14.8 beats⋅min(-1) versus 99.8 ± 15.7 beats⋅min(-1), respectively, P < .001; correlation r = .7, P < .001). Bland-Altman analysis revealed that the 6MWT underestimated the VAT-hr by 7.7 ± 11.5%. The 95% confidence interval of the mean bias was large (14.8% and -30.3%), reflecting poor agreement, with 71.7% (n = 43) of the participants unable to reach a walking intensity at or above the VAT-hr. Lower oxygen uptake at the VAT (β = .655, P = .004), higher 6MWT-hr (β = 1.07, P = .01), and better balance (β = 1.128, P = .04) were associated with greater utility of the 6MWT for prescribing exercise. CONCLUSIONS: The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included.
Authors: Bradley J MacIntosh; Jodi D Edwards; Mani Kang; Hugo Cogo-Moreira; Joyce L Chen; George Mochizuki; Nathan Herrmann; Walter Swardfager Journal: Front Aging Neurosci Date: 2017-10-31 Impact factor: 5.750
Authors: Susan Marzolini; Andrew D Robertson; Paul Oh; Jack M Goodman; Dale Corbett; Xiaowei Du; Bradley J MacIntosh Journal: Front Neurol Date: 2019-11-15 Impact factor: 4.003
Authors: Susan Marzolini; Che-Yuan Wu; Rowaida Hussein; Lisa Y Xiong; Suban Kangatharan; Ardit Peni; Christopher R Cooper; Kylie S K Lau; Ghislaine Nzodjou Makhdoom; Maureen Pakosh; Stephanie A Zaban; Michelle M Nguyen; Mohammad Amin Banihashemi; Walter Swardfager Journal: J Am Heart Assoc Date: 2021-12-16 Impact factor: 6.106