(Stroke. 1997;28:988-992.)
© 1997 American Heart Association, Inc.
Articles |
Low-Velocity Graded Treadmill Stress Testing in Hemiparetic Stroke Patients
From the Geriatrics Service and the Geriatrics Research, Education, and Clinical Center (R.F.M., L.I.K., A.Y., L.D.T., C.A.D., D.R.D., K.H.S.), Baltimore Department of Veterans Affairs Medical Center, and Departments of Neurology (R.F.M., K.H.S.) and Physical Therapy (G.V.S.), University of Maryland School of Medicine, Baltimore, Md.
Correspondence to Richard F. Macko, MD, Department of Neurology, University of Maryland School of Medicine, 22 N Greene St, Baltimore, MD 21201-1595.
Background and Purpose Coronary artery disease is prevalent in stroke patients and is an important factor affecting rehabilitation and health outcomes. However, the presence of neurological deficits in gait and balance has discouraged systematic application of exercise testing and prescription in the stroke population. We evaluated a novel graded treadmill stress test in paretic stroke patients and tested floor walking as a predictor of adequate neurological function to perform the treadmill test.
Methods Patients (n=31) with residual paretic gait deficits after ischemic stroke were evaluated with graded treadmill at gait velocities individualized to functional mobility observed during an initial zero-incline treadmill tolerance test.
Results Most patients (30/31) tolerated testing, achieving
mean heart rates of 129±14 beats per minute (mean±SD),
representing 84±10% of maximal age-predicted heart rate.
Evidence for asymptomatic myocardial ischemia was
found in 29% of those without known coronary artery disease.
Exercise termination was more often due to generalized fatigue than
cardiopulmonary intolerance (23/31 versus 4/31;
P<.0001) or hemiparetic leg fatigue (1/31;
P<.0001). Floor walking across a wide range of velocities
(0.25 to 2.5 mph) demonstrated a strong linear relation with treadmill
velocities (n=24; r=.80; P<.0001); all patients
floor walking at 
0.5 mph had adequate neuromotor function to perform
the exercise test.
Conclusions These findings suggest that graded treadmill exercise testing, with proper safety precautions, can be used to assess cardiopulmonary function in paretic stroke patients. A simple floor-walking test predicts adequate neurological function to perform the exercise test. Exercise capacity is most limited by generalized fatigue and not by the paretic limb, supporting a rationale for endurance training in this population.
Key Words: cerebrovascular disorders • exercise • exercise test • hemiplegia
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