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BACKGROUND This study aimed to analyze the correlations among peak oxygen uptake (VO2) in cardiopulmonary exercise test (CPX), incremental shuttle walking test (ISWT), and 6-minute walking test (6MWT) distances in patients with myocardial infarction (MI). Additionally, we aimed to determine the relationship between the maximum heart rate (HRmax) and the rate of perceived exertion (RPE) among the tests and compare the changes in heart rate to verify the clinical benefit of the submaximal stress test. MATERIAL AND METHODS We analyzed the correlation by using the ISWT and 6MWT at 30-min intervals after 24 h of CPX in patients with MI. The differences in HRmax and RPE between the tests were also compared. Additionally, changes in heart rate were analyzed using descriptive statistics. RESULTS The ISWT distance was more strongly correlated with peak VO₂ (r=.823: 95% CI, 0.681-0.910) than was 6MWT (r=0.776: 95% CI, 0.683-0.870). HRmax in the CPX demonstrated a significant correlation with that in the ISWT and 6MWT (P0.05), with the ISWT (r=0.815: 95% CI, 0.451-0.996) having a stronger correlation than the 6MWT (r=0.664: 95% CI, 0.146-0.911). The value of RPE was significantly different (P0.05); however, there was no significant correlation. Changes in heart rate in the 6MWT plateaued after the initial increase, while the heart rate in the ISWT and CPX increased gradually. CONCLUSIONS We recommend the ISWT as a submaximal exercise test to evaluate exercise capacity in patients with MI.

Background: Shoulder subluxation occurs in 17–64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing.

Purpose: Neuromodulation therapy has been used as an adjunct treatment to promote motor recovery in stroke patients. The objectives of the present study were to determine the effect of repetitive transcranial magnetic stimulation (rTMS) on neurobehavioural recovery, evoked potential, and underlying biological mechanisms associated with neuronal cell death in rats after permanent middle cerebral artery occlusion. Methods: Our study included 10 control and 40 Sprague-Dawley (SD) rats; of them, 30 were successfully subjected to the induction of permanent middle cerebral artery occlusion (MCAO) stroke model (rTMS = 15, sham rTMS = 15). Ten-Hertz high-frequency rTMS was applied to the ipsilesional forepaw motor cortex for 2 weeks in the rTMS group. The somatosensory-evoked potential (SSEP) and motorevoked potential (MEP) were used to evaluate the electrophysiological changes. The behavioural function of the stroke rats was evaluated using the rotarod and Garcia tests. Stroke area was measured using a histological staining technique. Immunoblotting was used to explore the mechanisms of rTMS associated with neuronal apoptosis. Results: 10 control and 20 MCAO rats (NrTMS = 10; Nsham = 10) completed the experimental course. Regarding MEP amplitude, repeated-measured analysis of variance (RMANOVA) showed a significant TIME effect [F (2, 0.106) = 11.241, P < 0.001] and TIME × INTERVENTION interaction [F (2, 0.057) = 6.053, P = 0.005] on MEP amplitude, suggesting the beneficial effect of rTMS on motor cortical excitability. Regarding peak to peak SSEP amplitude, RMANOVA showed a significant TIME effect [F (2, 4.920) = 3.4551, P = 0.042]. In terms of latency to fall, RMANOVA identified a significant TIME effect [F (7, 16640.335) = 24.425, P < 0.001] and INTERVENTION × TIME interaction [F (7, 2348.295) = 3.447, P = 0.002]. In terms of distance to fall, RMANOVA revealed a TIME effect [F (7, 101.679) = 26.515, P < 0.001] and INTERVENTION × TIME interaction [F (7, 13.607) = 3.548, P < 0.002]. In terms of Garcia score, RMANOVA revealed a significant effect of TIME [F (7, 69.282) = 153.689, P < 0.05] and INTERVENTION × TIME interaction [F (7, 2.282) = 5.063, P < 0.05], suggesting a beneficial effect of rTMS over sham treatment. In the Kruskal-Wallis test of endoplasmic reticulum (ER) stress protein, rTMS also inhibited the protein levels of glucose-regulated protein 78 (GRP78), CATT/EBP homologous protein (CHOP), and p-eukaryotic initiation factor 2α (eIF2α). Conclusion: 10-Hertz rTMS leads to a rapid recovery in behavioural performance after permanent MCAO stroke model and maintains increased ipsilesional motor cortex activity 2 weeks after rTMS. The underlying beneficial effects of rTMS may be associated with ER stress protein in the neuronal cell death pathway.