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Cognition and Motor Impairment Correlates with Exercise Test Performance after Stroke.
MedLine Citation:
PMID:  23135375     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Exercise not only benefits physical and cardiovascular function in older adults with multiple chronic conditions, but may also improve cognitive function. Peak heart rate (HR), a physiological indicator for maximal effort, is the most common and practical means of establishing and monitoring exercise intensity. In particular, in the absence of graded maximal exercise tests (GXT) results, age-predicted maximal HR values are typically used. Using individuals with stroke as a model for examining older adults with co-existing cardiovascular and neuromotor conditions, the purpose of this paper was to examine the determinants associated with achieving age-predicted maximal HR on a GXT, with respect to neurological, cognitive and lower limb function. METHODS: Forty-seven participants with stroke (mean±SD age 67±7 years, 4±3 years post-stroke) performed GXTs. Peak values for gas exchange, HR and ratings of perceived exertion were noted. Logistic regression analysis was performed to examine determinants (neurological impairment, leg motor impairment, Montreal Cognitive Assessment (MoCA) score, walking ability) associated with the ability to achieve age-predicted maximal HR on the GXT. RESULTS: VO2peak was 16.5±6 ml•kg□min. Fourteen (30%) participants achieved ≥100% of age-predicted maximal HR. Logistic regression modeling revealed that the ability to achieve this threshold was associated with less leg motor impairment (P=0.02, OR 2.3) and higher cognitive scores (P=0.048, OR 1.3). CONCLUSIONS: These results suggest that non-cardiopulmonary factors such as leg motor impairment and cognitive function are important contributors to achieving maximal effort during exercise tests. This study has important implications for post-stroke exercise prescription whereby training intensities that are based on peak HR from GXTs may be underestimated among individuals with cognitive and physical impairments.
Authors:
Ada Tang; Janice J Eng; Teresa Sm Tsang; Andrei V Krassioukov
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-6
Journal Detail:
Title:  Medicine and science in sports and exercise     Volume:  -     ISSN:  1530-0315     ISO Abbreviation:  Med Sci Sports Exerc     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8005433     Medline TA:  Med Sci Sports Exerc     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the University of British Columbia, 1Department of Physical Therapy, 2Division of Cardiology, 3Division of Physical Medicine and Rehabilitation; Vancouver Coastal Health, 4GF Strong Rehabilitation Centre, 5Vancouver General Hospital, 6International Collaboration on Repair Discoveries, Vancouver Canada.
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