title: Low-velocity graded treadmill stress testing in hemiparetic stroke patients.
abstract: OBJECTIVE
  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 > or = 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.
authors.affiliation: Geriatrics Service, Baltimore Department of Veterans Affairs Medical Center, Md, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Macko
authors.forename: L I
authors.initials: LI
authors.lastname: Katzel
authors.forename: A
authors.initials: A
authors.lastname: Yataco
authors.forename: L D
authors.initials: LD
authors.lastname: Tretter
authors.forename: C A
authors.initials: CA
authors.lastname: DeSouza
authors.forename: D R
authors.initials: DR
authors.lastname: Dengel
authors.forename: G V
authors.initials: GV
authors.lastname: Smith
authors.forename: K H
authors.initials: KH
authors.lastname: Silver
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D005684:Gait; D006429:Hemiplegia / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance