Rowing-Ramp Protocol as A Cardiopulmonary Exercise Test for Hemiparetic Stroke Survivors
Rowing-Ramp CPET Protocol
Vol. 14 No. 1 : 2019 (157-171)
Abstract
Cardiopulmonary capacity should be evaluated accurately to determine exercise intolerance and training intensity of stroke survivors before an exercise rehabilitation programme is prescribed. However, no cardiopulmonary exercise test (CPET) is suitable because of the stroke victims’ physical impairment. The aim of this study was to develop and validate a new rowing-ramp protocol as a CPET for stroke survivors. Eleven stroke patients (6 male; 5 female; age, 45 + 16.01 years, performed two incremental exercise tests on a Concept II rowing ergometer to determine the peak oxygen consumption (VO2 peak). Test-retest reliability for VO2 peak, measured 1-week apart, resulted in an intra-class correlation of 0.97 and 0.95, respectively. A linear regression equation was developed to predict the VO2 peak from final stage stroke power. Validity and reliability of the prediction equation were established. The regression equation for predicted VO2 peak was VO2 peak=11.429±+ 0.232 (Final Stage Stroke Power) + 12.63 (F=25.326, p<0.01; R=0.859, R2=0.738). Limits of agreement between predicted and measured VO2 peak were acceptable, with a mean bias of 0.37 ml/kg/min. The validity coefficient (R) was 0.83 (p<0.01) and 0.81 (p<0.01) in both trials. Test-Retest reliability coefficient for predicted VO2 peak 0.95 (p<0.01). The positive relationship between Final Stage Stroke Power and VO2 peak suggests that the Rowing-Ramp protocol could be used to measure VO2 peak of stroke survivors. Additional studies are needed to cross-validate the regression equation using larger sample size, different type and severity of stroke.
Keywords :
cardiopulmonary exercise test,
CPET protocol,
oxygen consumption,
rowing,
stroke hemiparetic,
Correspondance Address
D. Maryama Binti Ag. Daud. Physical Fitness Rehab Centre, Faculty Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, 88400 Sabah, Malaysia. Tel: +6010-9310913 Email: dmaryama@ums.edu.my
References
Albouaini, K., Egred, M., Alahmar, A., Wright, D.J. 2007. Cardiopulmonary exercise testing and its application. Postgrad Med J 93(10): 675-82.
Aziz, N.A., Raymond, A.A. 2008. Managing further rehabilitation in longer-term stroke patients in the community: a new approach. Med & Heath 3(1): 1-6.
Balady, G.J., Arena, R., Sietsema, K., Myers, J., Coke, L., Fletcher, G.F., Forman, D., Franklin, B., Guazzi, M., Gulati, M., Keteyian, S.J., Lavie, C.J., Macko, R., Mancini, D., Milani, R.V. 2010. Clinician’s guide to cardiopulmonary exercise testing in adults. a scientific statement from the american heart association. Circulation 122(2): 191-225.
Billinger, S.A., Boyne, P., Coughenour, E., Dunning, K., Mattlage, A. 2015. Does aerobic exercise and the fitt principle fit into stroke recovery? Curr Neurol Neurosci Rep 15(2): 519.
Corrà, U., Agostoni, P.G., Anker, S.D., Coats, A.J.S., Leiro, M.G.C., Boer, R.A.d., Harjola, V.P., Hill, L., Lainscak, M., Lund, L.H., Metra, M., Ponikowski, P., Riley, J., Petar, M., Seferovic, P.M., Piepoli, M.F. 2018. Role of cardiopulmonary exercise testing
in clinical stratification in heart failure.
A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure 20: 3-15.
Fujita, T., Sato A., Togashi, Y., Kasahara, R., Ohashi, T., Tsuchiya, K., Yamamoto, Y., Otsuki, K. 2015. Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis. J Phys Ther Sci 27(7): 2217-20.
Hamzat, T-K., Alabi, F.A. 2006. Effects of lesion laterality on cardiovascular responses of post stroke hemiparetic patients to a single bout of exercise. Hong Kong Physiotherapy Journal 24: 2-7.
Hastings, J.L., Krainski, F., Snell, P.G., Pacini, E.L., Jain, M., Bhella, P.S., Shibata, S. Fu, Q., Palmer, D., Levine, B.D. 2012. Effect of rowing ergometry and oral volume loading on cardiovascular structure and function during bed rest. J Appl Physiol 112(10): 1735-43.
Huntsman, H.D., DiPietro, L., Drury, D., Miller, T. 2010. Development of a valid rowing-specific VO2max field test: 3043. Med Sci Sports Exerc 42: 838.
Hyndman, D., Ashburn, A. 2003. People with stroke living in the community: Attention deficits, balance, ADL ability and falls. Disabil Rehabil 25(15): 817-22.
Kendall, K.L., Fukuda, D.H., Smith, A.E., Cramer, J.T., Stout, J.R. 2012. Predicting maximal aerobic capacity (VO2max) from the critical velocity test in female collegiate rowers. J Strength Cond Res 26(3): 733-8.
Klusiewicz, A., Borkowski, L., Sitkowski, D., Burkhard-Jagodzińska, K., Szczepańska, B., Ladyga, M. 2016. Indirect methods of assessing maximal oxygen uptake in rowers: practical implications for evaluating physical fitness in a training cycle. J Hum Kinet 50(1): 187-94.
Lakomy, H., Lakomy, J. 1993. Estimation of maximum oxygen uptake from submaximal exercise on a concept ii rowing ergometer. J Sports Sci 11: 227-32.
Martins, R.A., Coelho E Silva, M.J., Cumming, S.P., Sardinha, L.B. 2012. New equations to determine exercise intensity using different exercise modes. Biol Sport 29(2): 163-7.
Marzolini, S., Oh, P., Corbett, D., Dooks, D., Calouro, M., Macintosh, B.J., Goodman, R., Brooks, D. 2016. Prescribing aerobic exercise intensity without a cardiopulmonary exercise test post stroke: utility of the six-minute walk test. J Stroke Cerebrovasc Dis 25(9): 2222-31.
Metcalfe, A.J., Castle, P.C., Brewer, J. 2013. The use of an indoor rowing ergometer test for the prediction of maximal oxygen uptake. Journal of Athletic Enhancement 2: 6.
Myers, J., Froelicher, V.F. 1990. Optimizing the exercise test for pharmacological investigations. Circulation 82(5): 1839-46.
Myers, J., Bellin, D. 2000. Ramp Exercise protocols for clinical and cardiopulmonary exercise testing. Sports Med 30(1): 23-9.
Ratter, J., Radlinger, L., Lucas, C. 2014. Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review. J Physiother 60(3): 144-50.
Ratter, J., Radlinger, L., Lucas, C. 2003. A new proposal to guide velocity and inclination in the ramp protocol for the treadmill ergometer. Arq Bras Cardiol 81(1): 48-53.
Saengsuwan, J., Huber, C., Schreiber, J., Schuster-Amft, C., Nef, T., Hunt, K.J. 2015. Feasibility of cardiopulmonary exercise testing and training using a robotics-assisted tilt table in dependent-ambulatory stroke patients. J Neuroeng Rehabil 12: 88.
Shimoda, M., Kawakami, Y. 2005. Critical power determination with ergometry rowing: relation to rowing performance. International Journal of Sport and Health Science 3: 21-6.
Sobral, F.D.C. 2003. A new proposal to guide velocity and inclination in the ramp protocol for the treadmill ergometer. Arq Bras Cardiol 81: 48-53.
Soper, C., Hume, P.A. 2004. Towards an Ideal rowing technique for performance. Sports Med 34 (12): 825-48.
Stevens S., Snell C., Stevens J., Keller B., and VanNess JM. 2018. Cardiopulmonary exercise test methodology for assessing exertion intolerance in myalgic encephalomyelitis/chronic fatigue syndrome. Front. Pediatr 6: 242.
Stoller, O., de Bruin, E.D., Knols, R.H., Hunt, K.J. 2012. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol 12: 45.
Tang, L.H., Zwisler, A.D., Taylor, R.S., Doherty, P., Zangger, G., Berg, S.K., Langberg, H. 2016. Self-rating level of perceived exertion for guiding exercise intensity during a 12-week cardiac rehabilitation programme and the influence of heart rate reducing medication. J Sci Med Sport 19(8): 611-5.
Wallen, M.P., Dias K.A., Ramos J.S., Keating S.E., Woodward A.J., Skinner T.L., Macdonald G.A., Arena R., Coombes J.S. 2017. Impact of beta-blockers on cardiopulmonary exercise testing in patients with advanced liver disease. Aliment Pharmacol Ther 46(8): 741–7.
Whipp, B.J., Davis, J.A., Torres, F., Wasserman, K. 1981. A test to determine parameters of aerobic function during exercise. J Appl Physiol Respir Environ Exerc Physiol 50(1): 217-21.
Will, P.M., Walter, J.D. 1999. Exercise testing: improving performance with a ramped bruce protocol. Am Heart J 138(6): 1033-7.
Winget, C.M., DeRoshiai, C.W., Holley, D.C. 1985. Circadian rhythms and athletic performance. Med Sci Sports Exerc 17(5): 498-516.
Zuniga, J.M., Housh, T.J., Camic, C.L., Bergstrom, H.C., Traylor, D.A., Schmidt, R.J., Johnson, G.O. 2012. Metabolic parameters for ramp versus step incremental cycle ergometer tests. Appl Physiol Nutr Metab 37(6): 1110-7.
Zuniga, J.M., Housh, T.J., Camic, C.L., Bergstrom, H.C., Traylor, D.A., Schmidt, R.J., Johnson, G.O. 2013. Neuromuscular and metabolic comparisons between ramp and step incremental cycle ergometer tests. Muscle Nerve 47(4): 555-60.
