title: Systematic review of cardiopulmonary exercise testing post stroke: Are we adhering to practice recommendations?
abstract: OBJECTIVE
  To systematically review the use of cardiopulmonary exercise testing in people who have survived a stroke. The following questions are addressed: (i) What are the testing procedures used? (ii) What are the patient, safety and outcomes characteristics in the cardiopulmonary exercise testing procedures? (iii) Which criteria are used to determine maximum oxygen uptake (VO2peak/max) in the cardiopulmonary exercise testing procedures?
  
  
  METHODS
  Systematic review of studies of cardiopulmonary exercise testing in stroke survivors. PubMed, EMBASE, and CINAHL were searched from inception until January 2014. MeSH headings and keywords used were: oxygen capacity, oxygen consumption, oxygen uptake, peak VO2, max VO2, aerobic fitness, physical fitness, aerobic capacity, physical endurance and stroke. Search and selection were performed independently by 2 reviewers. Sixty studies were scrutinized, including 2,104 stroke survivors.
  
  
  RESULTS
  Protocols included treadmill (n = 21), bicycle (n = 33), stepper (n = 3) and arm (n = 1) ergometry. Five studies reported 11 adverse events (1%). Secondary outcomes were reported in few studies, which hampered interpretation of the patient's effort, and hence the value of the VO2peak.
  
  
  CONCLUSIONS
  Most studies did not adhere, or insufficiently adhered, to the existing cardiopulmonary exercise testing guidelines for exercise testing. Thus, the results of cardiopulmonary exercise testing protocols in stroke patients cannot be compared.
authors.affiliation: Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Center De Hoogstraat and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, NL-3583 TM Utrecht, The Netherlands. i.vandeport@revant.nl.
authors.forename: Ingrid G L
authors.initials: IG
authors.lastname: van de Port
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
authors.forename: Harriet
authors.initials: H
authors.lastname: Wittink
mesh_terms: D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010807:Physical Endurance; D020521:Stroke / Q000401:mortality / Q000628:therapy; D000071939:Stroke Rehabilitation; D017741:Survivors