Research progress on exercise load and cardiorespiratory fitness after stroke_West China Medical Journal

Authors：

ZHANG Zeyan ^1,2 ,  DU Xiaoxia ^1,2

1. School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, P. R. China;
2. Department of Neurorehabilitation, Beijing Bo’Ai Hospital, China Rehabilitation Research Center, Beijing 100068, P. R. China;

Corresponding author：

DU Xiaoxia, Email: 364906784@qq.com

Keywords：

Stroke; aerobic exercise; exercise prescription; cardiorespiratory fitness

DOI：

10.7507/1002-0179.202403205

Video：

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Abstract Full text Figures/Tables Video References Cited by

Stroke has a high disability rate, with patients often experiencing varying degrees of motor function impairment. Some patients also have concurrent cardiovascular diseases, leading to varying degrees of cardiopulmonary dysfunction. Formulating exercise prescriptions tailored to stroke patients, selecting appropriate assessment methods, and determining suitable exercise intensity are significant clinical concerns. However, there is a lack of definitive conclusions on how to formulate precise exercise prescriptions based on the assessment of cardiopulmonary and motor functions. This paper reviews the determination of post-stroke exercise loads and current research on stroke and cardiopulmonary fitness, aiming to provide a basis for the precise formulation of exercise prescriptions for stroke patients.

Citation： ZHANG Zeyan, DU Xiaoxia. Research progress on exercise load and cardiorespiratory fitness after stroke. West China Medical Journal, 2024, 39(5): 807-812. doi: 10.7507/1002-0179.202403205 Copy

1.	《中国脑卒中防治报告 2021》编写组. 《中国卒中防治报告 2021》概要. 中国脑血管病杂志, 2023, 20(11): 783-793.
2.	Oyake K, Baba Y, Ito N, et al. Cardiorespiratory factors related to the increase in oxygen consumption during exercise in individuals with stroke. PLoS One, 2019, 14(10): e0217453.
3.	Boss HM, Deijle IA, Van Schaik SM, et al. Cardiorespiratory fitness after transient ischemic attack and minor ischemic stroke: baseline data of the moveit study. J Stroke Cerebrovasc Dis, 2017, 26(5): 1114-1120.
4.	钱贞, 阮秋香, 何俊, 等. 脑卒中患者心肺功能及其影响因素研究. 实用心脑肺血管病杂志, 2019, 27(11): 11-15, 20.
5.	Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 2013, 53(2): 255-267.
6.	Billinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(8): 2532-2553.
7.	Saunders DH, Greig CA, Mead GE. Physical activity and exercise after stroke: review of multiple meaningful benefits. Stroke, 2014, 45(12): 3742-3747.
8.	刘昆. 制动与运动、康复评价与康复训练的研究进展. 中国临床康复, 2002, 6(2): 174-176.
9.	Wei X, Sun S, Zhang M, et al. A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke. BMC Neurol, 2024, 24(1): 91.
10.	AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 2015, 386(9988): 46-55.
11.	Kramer SF, Cumming T, Johnson L, et al. Determining maximal tolerable aerobic training intensity in the acute phase after stroke: a novel dose ranging trial protocol. J Stroke Cerebrovasc Dis, 2020, 29(12): 105359.
12.	Luo L, Meng H, Wang Z, et al. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: a systematic review and meta-analysis. Ann Phys Rehabil Med, 2020, 63(1): 59-68.
13.	Tollár J, Nagy F, Csutorás B, et al. High frequency and intensity rehabilitation in 641 subacute ischemic stroke patients. Arch Phys Med Rehabil, 2021, 102(1): 9-18.
14.	Lamberti N, Straudi S, Malagoni AM, et al. Effects of low-intensity endurance and resistance training on mobility in chronic stroke survivors: a pilot randomized controlled study. Eur J Phys Rehabil Med, 2017, 53(2): 228-239.
15.	Horváth J, Debreceni Nagy A, Fülöp P, et al. Effectiveness of hospital-based low intensity and inspected aerobic training on functionality and cardiorespiratory fitness in unconditioned stroke patients: importance of submaximal aerobic fitness markers. Medicine (Baltimore), 2022, 101(42): e31035.
16.	杨倩, 刘邦忠. 脑卒中患者适宜运动剂量的研究进展. 中华物理医学与康复杂志, 2022, 44(9): 848-851.
17.	Kim BR, Han EY, Joo SJ, et al. Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients. Disabil Rehabil, 2014, 36(3): 227-231.
18.	Scheitz JF, Nolte CH, Doehner W, et al. Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol, 2018, 17(12): 1109-1120.
19.	Gambassi BB, Coelho-Junior HJ, Paixão Dos Santos C, et al. Dynamic resistance training improves cardiac autonomic modulation and oxidative stress parameters in chronic stroke survivors: a randomized controlled trial. Oxid Med Cell Longev, 2019, 2019: 5382843.
20.	Pang MY, Eng JJ, Dawson AS, et al. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil, 2006, 20(2): 97-111.
21.	苏醒, 王洁, 刘义锋, 等. 40 岁以上人群缺血性卒中风险现况调查及预测模型的构建. 河南医学研究, 2024, 33(2): 277-280.
22.	李键, 程迎, 胡丹丹, 等. 脑卒中心肺适能康复研究进展. 中国临床研究, 2023, 36(9): 1397-1401, 1406.
23.	刘遂心. 心肺运动试验: 有氧运动处方的制定. 临床心电学杂志, 2017, 26(4): 247-248.
24.	Mustafa E, Aytür YK. Assessment for cardiovascular fitness in patients with stroke: which cardiopulmonary exercise testing method is better?. Top Stroke Rehabil, 2022, 29(5): 347-355.
25.	钱贞, 卢同波, 何俊, 等. 精准化运动处方对卒中患者心肺适能及睡眠质量的影响研究. 中国全科医学, 2022, 25(20): 2468-2474.
26.	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
27.	Marzolini S, Oh P, McIlroy W, et al. The feasibility of cardiopulmonary exercise testing for prescribing exercise to people after stroke. Stroke, 2012, 43(4): 1075-1081.
28.	Brito SAF, Aguiar LT, Garcia LN, et al. Cardiopulmonary exercise testing and aerobic treadmill training after stroke: feasibility of a controlled trial. J Stroke Cerebrovasc Dis, 2020, 29(7): 104854.
29.	杨青青, 周明超, 王玉龙. 脑卒中患者心肺运动试验评估方法的研究进展. 中华物理医学与康复杂志, 2023, 45(6): 558-562.
30.	中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 心肺运动试验临床规范应用中国专家共识. 中华心血管病杂志, 2022, 50(10): 973-986.
31.	Stoller O, de Bruin ED, Schindelholz M, et al. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability. J Neuroeng Rehabil, 2014, 11: 145.
32.	钱贞, 陈伟. 心肺运动试验在卒中患者心肺功能评估中的研究进展. 临床与病理杂志, 2018, 38(3): 641-646.
33.	徐泉, 潘钰, 张啸飞, 等. 脑卒中偏瘫患者心肺运动功能评估临床研究. 中国康复医学杂志, 2016, 31(12): 1334-1338.
34.	Fulk GD, Echternach JL, Nof L, et al. Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiother Theory Pract, 2008, 24(3): 195-204.
35.	中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 六分钟步行试验临床规范应用中国专家共识. 中华心血管病杂志, 2022, 50(5): 432-442.
36.	Macchiavelli A, Giffone A, Ferrarello F, et al. Reliability of the six-minute walk test in individuals with stroke: systematic review and meta-analysis. Neurol Sci, 2021, 42(1): 81-87.
37.	滕宝梅, 郭媛. 心肺耐力评估方法及应用研究进展. 临床医学进展, 2023, 13(3): 3744-3751.
38.	Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J, 2023, 61(1): 2200879.
39.	Quintino LF, Aguiar LT, de Brito SAF, et al. Reliability and validity of the incremental shuttle walking test in individuals after stroke. Top Stroke Rehabil, 2021, 28(5): 331-339.
40.	Azman MZB, Huang KS, Koh WJ, et al. Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years. PLoS One, 2023, 18(9): e0291132.
41.	Dite W, Langford ZN, Cumming TB, et al. A phase 1 exercise dose escalation study for stroke survivors with impaired walking. Int J Stroke, 2015, 10(7): 1051-1056.
42.	Galloway M, Marsden DL, Callister R, et al. How little is enough? The feasibility of conducting a dose-escalation study for exercise training in people with stroke. J Stroke Cerebrovasc Dis, 2023, 32(8): 107190.
43.	Sociedade Brasileira de Cardiologia. Ⅲ guidelines of sociedade brasileira de cardiologia on the exercise test. Arq Bras Cardiol, 2010, 95(5 Suppl 1): 1-26.
44.	Peniche PDC, Aguiar LT, Ferreira Dos Reis MT, et al. An equation with clinical applicability and adequate validity to predict the maximum oxygen consumption of individuals post-stroke. Arch Phys Med Rehabil, 2023, 104(5): 769-775.
45.	Peters S, Klassen T, Schneeberg A, et al. Step number and aerobic minute exercise prescription and progression in stroke: a roadmap. Neurorehabil Neural Repair, 2022, 36(2): 97-102.
46.	Krawcyk RS, Vinther A, Petersen NC, et al. High-intensity training in patients with lacunar stroke: a one-year follow-up. J Stroke Cerebrovasc Dis, 2023, 32(4): 106973.
47.	寇璐璐, 刘敏, 王晓青, 等. 心肺康复训练对卒中合并冠心病患者运动功能及心肺适应性的影响. 疑难病杂志, 2023, 22(11): 1126-1131.
48.	Smith AC, Saunders DH, Mead G. Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke, 2012, 7(6): 499-510.

1. 《中国脑卒中防治报告 2021》编写组. 《中国卒中防治报告 2021》概要. 中国脑血管病杂志, 2023, 20(11): 783-793.
2. Oyake K, Baba Y, Ito N, et al. Cardiorespiratory factors related to the increase in oxygen consumption during exercise in individuals with stroke. PLoS One, 2019, 14(10): e0217453.
3. Boss HM, Deijle IA, Van Schaik SM, et al. Cardiorespiratory fitness after transient ischemic attack and minor ischemic stroke: baseline data of the moveit study. J Stroke Cerebrovasc Dis, 2017, 26(5): 1114-1120.
4. 钱贞, 阮秋香, 何俊, 等. 脑卒中患者心肺功能及其影响因素研究. 实用心脑肺血管病杂志, 2019, 27(11): 11-15, 20.
5. Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 2013, 53(2): 255-267.
6. Billinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2014, 45(8): 2532-2553.
7. Saunders DH, Greig CA, Mead GE. Physical activity and exercise after stroke: review of multiple meaningful benefits. Stroke, 2014, 45(12): 3742-3747.
8. 刘昆. 制动与运动、康复评价与康复训练的研究进展. 中国临床康复, 2002, 6(2): 174-176.
9. Wei X, Sun S, Zhang M, et al. A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke. BMC Neurol, 2024, 24(1): 91.
10. AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 2015, 386(9988): 46-55.
11. Kramer SF, Cumming T, Johnson L, et al. Determining maximal tolerable aerobic training intensity in the acute phase after stroke: a novel dose ranging trial protocol. J Stroke Cerebrovasc Dis, 2020, 29(12): 105359.
12. Luo L, Meng H, Wang Z, et al. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: a systematic review and meta-analysis. Ann Phys Rehabil Med, 2020, 63(1): 59-68.
13. Tollár J, Nagy F, Csutorás B, et al. High frequency and intensity rehabilitation in 641 subacute ischemic stroke patients. Arch Phys Med Rehabil, 2021, 102(1): 9-18.
14. Lamberti N, Straudi S, Malagoni AM, et al. Effects of low-intensity endurance and resistance training on mobility in chronic stroke survivors: a pilot randomized controlled study. Eur J Phys Rehabil Med, 2017, 53(2): 228-239.
15. Horváth J, Debreceni Nagy A, Fülöp P, et al. Effectiveness of hospital-based low intensity and inspected aerobic training on functionality and cardiorespiratory fitness in unconditioned stroke patients: importance of submaximal aerobic fitness markers. Medicine (Baltimore), 2022, 101(42): e31035.
16. 杨倩, 刘邦忠. 脑卒中患者适宜运动剂量的研究进展. 中华物理医学与康复杂志, 2022, 44(9): 848-851.
17. Kim BR, Han EY, Joo SJ, et al. Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients. Disabil Rehabil, 2014, 36(3): 227-231.
18. Scheitz JF, Nolte CH, Doehner W, et al. Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol, 2018, 17(12): 1109-1120.
19. Gambassi BB, Coelho-Junior HJ, Paixão Dos Santos C, et al. Dynamic resistance training improves cardiac autonomic modulation and oxidative stress parameters in chronic stroke survivors: a randomized controlled trial. Oxid Med Cell Longev, 2019, 2019: 5382843.
20. Pang MY, Eng JJ, Dawson AS, et al. The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clin Rehabil, 2006, 20(2): 97-111.
21. 苏醒, 王洁, 刘义锋, 等. 40 岁以上人群缺血性卒中风险现况调查及预测模型的构建. 河南医学研究, 2024, 33(2): 277-280.
22. 李键, 程迎, 胡丹丹, 等. 脑卒中心肺适能康复研究进展. 中国临床研究, 2023, 36(9): 1397-1401, 1406.
23. 刘遂心. 心肺运动试验: 有氧运动处方的制定. 临床心电学杂志, 2017, 26(4): 247-248.
24. Mustafa E, Aytür YK. Assessment for cardiovascular fitness in patients with stroke: which cardiopulmonary exercise testing method is better?. Top Stroke Rehabil, 2022, 29(5): 347-355.
25. 钱贞, 卢同波, 何俊, 等. 精准化运动处方对卒中患者心肺适能及睡眠质量的影响研究. 中国全科医学, 2022, 25(20): 2468-2474.
26. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
27. Marzolini S, Oh P, McIlroy W, et al. The feasibility of cardiopulmonary exercise testing for prescribing exercise to people after stroke. Stroke, 2012, 43(4): 1075-1081.
28. Brito SAF, Aguiar LT, Garcia LN, et al. Cardiopulmonary exercise testing and aerobic treadmill training after stroke: feasibility of a controlled trial. J Stroke Cerebrovasc Dis, 2020, 29(7): 104854.
29. 杨青青, 周明超, 王玉龙. 脑卒中患者心肺运动试验评估方法的研究进展. 中华物理医学与康复杂志, 2023, 45(6): 558-562.
30. 中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 心肺运动试验临床规范应用中国专家共识. 中华心血管病杂志, 2022, 50(10): 973-986.
31. Stoller O, de Bruin ED, Schindelholz M, et al. Cardiopulmonary exercise testing early after stroke using feedback-controlled robotics-assisted treadmill exercise: test-retest reliability and repeatability. J Neuroeng Rehabil, 2014, 11: 145.
32. 钱贞, 陈伟. 心肺运动试验在卒中患者心肺功能评估中的研究进展. 临床与病理杂志, 2018, 38(3): 641-646.
33. 徐泉, 潘钰, 张啸飞, 等. 脑卒中偏瘫患者心肺运动功能评估临床研究. 中国康复医学杂志, 2016, 31(12): 1334-1338.
34. Fulk GD, Echternach JL, Nof L, et al. Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke. Physiother Theory Pract, 2008, 24(3): 195-204.
35. 中华医学会心血管病学分会, 中国康复医学会心肺预防与康复专业委员会, 中华心血管病杂志编辑委员会. 六分钟步行试验临床规范应用中国专家共识. 中华心血管病杂志, 2022, 50(5): 432-442.
36. Macchiavelli A, Giffone A, Ferrarello F, et al. Reliability of the six-minute walk test in individuals with stroke: systematic review and meta-analysis. Neurol Sci, 2021, 42(1): 81-87.
37. 滕宝梅, 郭媛. 心肺耐力评估方法及应用研究进展. 临床医学进展, 2023, 13(3): 3744-3751.
38. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J, 2023, 61(1): 2200879.
39. Quintino LF, Aguiar LT, de Brito SAF, et al. Reliability and validity of the incremental shuttle walking test in individuals after stroke. Top Stroke Rehabil, 2021, 28(5): 331-339.
40. Azman MZB, Huang KS, Koh WJ, et al. Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years. PLoS One, 2023, 18(9): e0291132.
41. Dite W, Langford ZN, Cumming TB, et al. A phase 1 exercise dose escalation study for stroke survivors with impaired walking. Int J Stroke, 2015, 10(7): 1051-1056.
42. Galloway M, Marsden DL, Callister R, et al. How little is enough? The feasibility of conducting a dose-escalation study for exercise training in people with stroke. J Stroke Cerebrovasc Dis, 2023, 32(8): 107190.
43. Sociedade Brasileira de Cardiologia. Ⅲ guidelines of sociedade brasileira de cardiologia on the exercise test. Arq Bras Cardiol, 2010, 95(5 Suppl 1): 1-26.
44. Peniche PDC, Aguiar LT, Ferreira Dos Reis MT, et al. An equation with clinical applicability and adequate validity to predict the maximum oxygen consumption of individuals post-stroke. Arch Phys Med Rehabil, 2023, 104(5): 769-775.
45. Peters S, Klassen T, Schneeberg A, et al. Step number and aerobic minute exercise prescription and progression in stroke: a roadmap. Neurorehabil Neural Repair, 2022, 36(2): 97-102.
46. Krawcyk RS, Vinther A, Petersen NC, et al. High-intensity training in patients with lacunar stroke: a one-year follow-up. J Stroke Cerebrovasc Dis, 2023, 32(4): 106973.
47. 寇璐璐, 刘敏, 王晓青, 等. 心肺康复训练对卒中合并冠心病患者运动功能及心肺适应性的影响. 疑难病杂志, 2023, 22(11): 1126-1131.
48. Smith AC, Saunders DH, Mead G. Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke, 2012, 7(6): 499-510.

West China Medical Journal

Research progress on exercise load and cardiorespiratory fitness after stroke

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