Evidence map›Paper›PMID 32494824›Full record

ArticlePhysical therapy2020

Determining Safe Participation in Aerobic Exercise Early After Stroke Through a Graded Submaximal Exercise Test.

Elizabeth L Inness, Anthony Aqui, Evan Foster, Julia Fraser, Cynthia J Danells, Louis Biasin, Karen Brunton, Jo-Anne Howe, Vivien Poon, Ada Tang and 4 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Physical therapy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.5field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 8 citations in OpenAlex.

  1. Article
  2. Lower middle cerebral artery blood velocity during low-volume high-intensity interval exercise in chronic stroke.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2024
    Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 1 country.

Elizabeth L InnessToronto 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.
Anthony AquiToronto Rehabilitation Institute, University Health Network-KITE Research Institute.
Evan FosterToronto Rehabilitation Institute, University Health Network-KITE Research Institute.
Julia FraserDepartment of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
Cynthia J DanellsToronto Rehabilitation Institute, University Health Network-KITE Research Institute; and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
Louis BiasinToronto Rehabilitation Institute, University Health Network-Brain and Spinal Cord Rehab Program; and Department of Physical Therapy, University of Toronto.
Karen BruntonToronto Rehabilitation Institute, University Health Network-Education; and Department of Physical Therapy, University of Toronto.
Jo-Anne HoweToronto Rehabilitation Institute, University Health Network-Education.
Vivien PoonToronto Rehabilitation Institute, University Health Network-Brain and Spinal Cord Rehab Program; and Department of Physical Therapy, University of Toronto.
Ada TangSchool of Rehabilitation Science, Institute of Applied Health Science, McMaster University, Hamilton, Ontario, Canada.
Avril MansfieldToronto Rehabilitation Institute, University Health Network-KITE Research Institute; Department of Physical Therapy, University of Toronto; and Sunnybrook Research Institute-Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada.
Susan MarzoliniToronto Rehabilitation Institute, University Health Network-KITE Research Institute and Cardiovascular Prevention and Rehabilitation Program; and Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto.
Paul OhToronto Rehabilitation Institute, University Health Network-KITE Research Institute and Cardiovascular Prevention and Rehabilitation Program.
Mark BayleyToronto Rehabilitation Institute, University Health Network-KITE Research Institute; and Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto.
University Health Network · CAMcMaster University · CASunnybrook Health Science Centre · CAUniversity of Waterloo · CA

Funding

CIHR MSH-141983
6 · The paper itself

Abstract

objectiveThe 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.

methodsThis 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.

resultsThe 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.

conclusionA 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. IMPACT: 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. LAY SUMMARY: 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.

Indexed as

Stroke RehabilitationAdrenergic beta-AntagonistsAdultAgedAged, 80 and overElectrocardiographyExerciseExercise TestFemaleHeart RateHumansMaleMiddle AgedPatient SafetyPhysical ExertionRetrospective StudiesAdrenergic beta-Antagonists

Identifiers

PMID32494824
PMCPMC7462052
OpenAlexW3032681322

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.