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AbstractObjectivesMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATION1) to develop two maximum heart rate (HRmax) prediction equations for individuals after stroke; 2) to investigate its validity.The HRmax was obtained by a Cardiopulmonary Exercise Test (CPET). Participants also completed the Six-minute Walking Test (6MWT) and the Incremental Shuttle Walking Test (ISWT).60 individuals (54(12) years; 64(69) months after stroke) were included. Twenty individuals (58(10) years; 67(61) months after stroke) were included in the cross-validation group. For the first model, the following equation was generated (equation-1): HRmax= 87.655 + 0.726 (HRpeak in the 6MWT) − 0.386 (age in years), (R2=0.53; Standard Error of the Estimate (SEE)= 15.35; p < 0.0001). For the second model, the following equation was generated (equation-2): HRmax= 96.523 + 0.681 (HRpeak in the ISWT) − 0.039 (walking distance in meters in the ISWT) − 0.400 (age in years), (R2=0.53; SEE = 15.51; p < 0.0001). Significant and high magnitude agreement was found between the HRmax obtained by the CPET and the predicted HRmax by equation-1 (ICC= 0.85; 95% CI= 0.63 − 0.94) and equation-2 (ICC= 0.72; 95% CI= 0.29 − 0.89).Two HRmax prediction equations have been developed and showed adequate validity. Professionals will have the option of choosing one of the two equations to use.Two maximum heart rate prediction equations, with clinical applicability and adequate validity, were provided for individuals after strokeTo apply the equations, it is necessary to perform the Six-Minute Walking Test or the Incremental Shuttle Walking Test.Both equations are valid and suitable for use in this population for the prescription of aerobic exercise intensity in clinical practice.Two maximum heart rate prediction equations, with clinical applicability and adequate validity, were provided for individuals after strokeTo apply the equations, it is necessary to perform the Six-Minute Walking Test or the Incremental Shuttle Walking Test.Both equations are valid and suitable for use in this population for the prescription of aerobic exercise intensity in clinical practice. [ABSTRACT FROM AUTHOR]

To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9– (0.67 × age), proposed by Gellish; (3) 208– (0.7 × age), proposed by Tanaka; (4) 216.6– (0.84 × age), proposed by Astrand; (5) 164– (0.72 × age) and (6) 200– (0.92 × age) proposed by Brawner. No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1–5 (–0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05–0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1–4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. The equations developed for non-disabled individuals (1–4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously. Prediction equations for maximum heart rate (HRmax) are commonly used to prescribe aerobic exercise for individuals following a stroke. The equations developed for non-disabled individuals are not valid for use with individuals after stroke, leading to an overestimation of the HRmax. An age-predicted HRmax equation developed for individuals with coronary heart disease may provide outcomes that are more accurate for stroke survivors, but care should still be taken when using it. [ABSTRACT FROM AUTHOR]

• Equation to predict the oxygen consumption of individuals post-stroke is necessary. • An equation with clinical applicability and adequate validity was provided. • V̇ o 2max =22.239+0.020 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI. • Studies with larger sample must investigate the external validity of this equation. To develop an equation with clinical applicability and adequate validity to predict the maximum oxygen consumption (V̇ o 2max) of individuals post-stroke. A cross-sectional study. A university laboratory. Individuals post-stroke in the chronic phase (at least 6 months post-stroke). Step-1 (equation development): n=50, aged 55±12 years; Step-2 (validity investigation): n=20, aged 58±8 years (N=50 [step 1], N=20 [step 2]). Not applicable. Step-1 (equation development): multiple linear regression analysis was performed. Dependent variable: V̇ o 2max (mL/kg/min) in the cardiopulmonary exercise test. Independent variables: age (years), sex (1-women, 2-men), body mass index (BMI) (kg/m2), and distance (meters) in the Six-Minute Walk Test (6MWT) (6MWT-Equation) or in the Incremental Shuttle Walk Test (ISWT) (ISWT-Equation). Step-2 (validity investigation): agreement between the V̇ o 2max measured and predicted was evaluated with the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and the Bland-Altman method (α=5%). In step-1 (equation development), the 4 independent variables for each equation were retained (6MWT-Equation: R 2=0.68, P <.001; ISWT-Equation: R 2=0.58, P <.001). In step-2 (validity investigation), the 6MWT-Equation showed an ICC of 0.73 (95% CI=0.30, 0.89; P =.004) and a mean bias of 0.003 mL/kg/min; and the ISWT-Equation showed an imprecise ICC of 0.55 (95% CI=-0.12, 0.82; P =.045) and a mean bias of 0.971 mL/kg/min. 6MWT-Equation (V̇ o 2max =22.239+0.02 × distance in the 6MWT+4.039 × sex-0.157 × age-0.265 × BMI) showed adequate validity. An equation with clinical applicability and adequate validity in the investigated sample was developed to predict the V̇ o 2max of individuals post-stroke in the chronic phase (6MWT-Equation). Future studies with larger sample should investigate its external validity. [ABSTRACT FROM AUTHOR]

• The Human Activity Profile (HAP) is a clinically applicable way to provide VO 2peak. • The HAP questionnaire is used to provide a valid value of VO 2peak (in mL/kg−1/min−1). • The HAP demonstrated adequate validity to assess exercise capacity. • The HAP can be used to assess cardiorespiratory fitness when cardiopulmonary exercise testing cannot be performed. To investigate the concurrent validity of the Human Activity Profile (HAP) in individuals after stroke to provide the peak oxygen uptake (V̇ o 2peak) and the construct validity of the HAP to assess exercise capacity, and to provide equations based on the HAP outcomes to estimate the distance covered in the Incremental Shuttle Walking Test (ISWT). Cross-sectional study. University laboratory. Individuals (N=57) aged 54±11 years who have experienced stroke. Not applicable. Agreement between the V̇ o 2peak provided by the HAP (lifestyle energy consumption [LEC] outcome, in mL/kg−1/min−1) and the criterion standard measure of the V̇ o 2peak (mL/kg−1/min−1), obtained through the symptom-limited Cardiopulmonary Exercise Test (CPET). Correlation between the HAP outcomes (LEC, maximum activity score [MAS], and adjusted activity score [AAS]) and the construct measure: the distance covered (in meters) in the ISWT. An equation to estimate the distance covered in the ISWT was determined. High magnitude agreement was found between the V̇ o 2peak , in mL/kg−1/min−1, obtained by the symptom-limited CPET and the value of V̇ o 2peak , in mL/kg−1/min−1, provided by the HAP (LEC) (intraclass correlation coefficient, 0.75; P <.001). Low to moderate magnitude correlations were found between the distance covered in the ISWT and the HAP (LEC/MAS/AAS) (0.34≤ρ≤0.58). The equation to estimate the distance covered in the ISWT explained 31% of the variability of the ISWT (ISWT estimated , –361.91+(9.646xAAS)). The HAP questionnaire is a clinically applicable way to provide a valid value of V̇ o 2peak (in mL/kg−1/min−1) and to assess the exercise capacity of individuals after stroke. Furthermore, an equation to estimate the distance covered in the submaximal field exercise test (ISWT) based on the result of the AAS (in points) was provided. [ABSTRACT FROM AUTHOR]

To describe the perspectives, satisfaction, and self-efficacy towards aerobic exercise and to investigate the barriers to aerobic exercise identified by individuals with stroke in a developing country. A cross-sectional study was performed with 15 individuals (55 ± 12 years, 69 ± 77 months post-stroke), who received a 12-week vigorous intensity aerobic treadmill training (three 30-min sessions/week). To assess participants' perspectives, satisfaction, self-efficacy, and barriers to aerobic exercise, a standardized interview and the Short Self-Efficacy for Exercise scale were employed. Participants considered aerobic exercise important (100% (IQR 20%), out of 100), recognized that it improves recovery (93%) and heart health (100%) and were satisfied with the training (80%). Self-efficacy was high (4 (IQR 1), out of 5). The main barriers were lack of information (86.7%), fear of falling (80%), lack of equipment (73.3%) or support (66.7%-73.3%), cognitive (66.7%) and physical impairments (60%) and severe weather conditions (60%). Most of them preferred to exercise in groups (93%). Individuals with stroke in a developing country considered aerobic exercise important. However, they perceived barriers related to safety, individual ability, social support, and aerobic exercise. It is necessary to improve education of these individuals, family members, and health care professionals regarding aerobic exercises. Individuals after stroke in developing countries consider aerobic exercise important and recognized that it improves stroke recovery and health, although they perceived barriers related to safety, individual ability, social support, and aerobic exercise itself. It is important to improve education to stroke survivors, family members and healthcare professionals in developing countries about the possibilities, risks, and benefits of aerobic exercises. Rehabilitation professionals should provide aerobic exercise for individuals after stroke in groups. Rehabilitation professionals might use cycle ergometers or partial body weight support to overcome fear of falling and facilitate implementation of aerobic exercise after stroke. [ABSTRACT FROM AUTHOR]

(a) to investigate the test-retest and inter-rater reliabilities and the criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of muscle strength in community-dwelling older adults, (b) to calculate the standard error of measurement (SEM) and the smallest real difference (SRD); (c) to verify whether the number of trials affect the results. Bilateral strength of lower limbs (LL) and grip muscles were evaluated with the MST and with portable dynamometers in 50 older adults (69.92 ± 5.52 years). Intra-class Correlation Coefficients (ICC) was used to evaluate the inter-rater and test-retest reliabilities and Pearson Correlations was used to investigate the criterion-related validity of the MST. SEM and SRD were also calculated. Analysis of variance was used to investigate whether the number of trials affects the results. Significant correlations with high to very high magnitude were found for all muscle groups evaluated for test-retest and inter-rater reliabilities (0.80 ≤ ICC ≤ 0.99; p < 0.001) and validity (0.80 ≤ r ≤ 0.91; p < 0.001). Moreover, the values provided by different numbers of trials were similar. The SEM (3.66 ≤ SEM ≤ 20.46) and the SRD (10.15 ≤ SRD95% ≤ 56.70) were considered low for all outcome measures. The MST showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength of older adults. Older adults often develop sarcopenia and dynapenia that are associated with an increased number of falls and fractures and loss of independence. Portable dynamometer is the standard instrument to evaluate isometric muscle strength, however this instrument is expensive and it is not readily available in the underdeveloped or in developed countries. The Modified Sphygmomanometer Test is an alternative method for the clinical measurement of muscle strength, is portable, has a low-cost and provides an objective measurement. In this study the Modified Sphygmomanometer Test showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength in community-dwelling older adults and a single trial after test familiarization can be used to measure the muscle strength in this population. [ABSTRACT FROM AUTHOR]

There are limitations to perform the cardiopulmonary exercise test (CPET) and the six-minute walking test (6MWT) in clinical settings. The incremental shuttle walking test (ISWT) might be an alternative assessment of exercise capacity and an estimation of cardiopulmonary fitness after stroke. To investigate the test–retest and inter-rater reliabilities, the standard error of measurement (SEM) and the minimal detectable change (MDC) of the ISWT, its construct validity to assess exercise capacity and its concurrent validity to estimate cardiopulmonary fitness after stroke. Prospective diagnostic accuracy study. Fifty-one individuals (54 ± 11 years) at the chronic phase (65 ± 73 months after stroke) were included. The distance walked, in meters, during the 12-stage-ISWT and the 6MWT and the peak oxygen uptake (VO2peak, ml.kg−1.min−1) in the CPET (gold standard) were assessed. Significant and high to very high magnitude test–retest and inter-rater reliabilities (0.88≤ICC≤0.93) of the ISWT was found. The SEM for both reliabilities was small (−23.35 m≤ SEM≤41.47 m). The MDC for test–retest and inter-rater reliabilities were 114.63 m and 64.53 m, respectively. For construct validity, a significant and high magnitude correlation between the ISWT and the 6MWT was found (ICC = 0.82). For the concurrent validity, a significant, but low magnitude correlation was found between the ISWT and the VO2peak (rho = 0.42). The ISWT demonstrated adequate reliabilities and construct validity for exercise capacity assessment. However, the concurrent validity of the ISWT as an estimation of cardiopulmonary fitness still requires further research. [ABSTRACT FROM AUTHOR]

Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known. To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VO2peak) of individuals after stroke, who participated in aerobic training. A cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VO2peak increase >1.3 ml.kg−1.min−1 from before to immediately after the training) or non-gain group (VO2peak change ≤1.3 ml.kg−1.min−1). Cardiorespiratory fitness (VO2peak), obtained by the cardiopulmonary exercise test was assessed one and 6 months after the end of the training (short- and long-term detraining, respectively), or collected retrospectively from patient chart (before and after the training). There was found a significant interaction effect (time*group) for VO2peak (F= 6.108;p < 0,001). Higher values in the VO2peak observed in the gain group with the aerobic training (F = 25.86; p<.001) were significantly reduced with short-term detraining, reaching values similar to that observed before the training and to that of the non-gain group (F = 14.81;p=.001). Both groups had similar VO2peak values within long-term detraining (F = 2.70;p=.12), with no significant differences from the values observed before the training and after short-term detraining (0.11 ≤ p≤ 1.00). Detraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE: To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS: A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. Control group: global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS: No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION: TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention. [ABSTRACT FROM AUTHOR]

Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature. Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales. Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity. Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited. Individuals with stroke show low physical activity, which may compromise function and health. The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended. Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke. [ABSTRACT FROM AUTHOR]

• The methodological quality of the studies ranged from "poor" to "good". • Most results of the quality of the measurement properties were considered doubtful. • The Frenchay activities index and the Human activity profile showed the highest clinical utility scores. • The content validity needs to be better investigated. • Further studies with good methodological quality are required. Individuals with stroke demonstrate low levels of physical activity. Self-report measures of physical activity are frequently used and the choice of the best one to use for each purpose and context should take into account the measurement properties of these instruments. To summarize the measurement properties and clinical utility of self-report measures of physical activity of post-stroke subjects and to evaluate both the methodological quality of the studies and the quality of the measurement properties. Searches were made in MEDLINE, EMBASE, PEDro, LILACS, and SCIELO. Two reviewers independently screened studies that investigated measurement properties or clinical utility of self-report measures of physical activity in post-stroke subjects. The studies' methodological quality, quality of the measurement properties, and clinical utility were evaluated. From the 11,826 identified studies, 19 were included. Six self-report tools were evaluated: The Activity card sort, Coded activity diary, Frenchay activities index (FAI), Human activity profile (HAP), Multimedia activity recall for children and adults, and the Nottingham leisure questionnaire. The methodological quality of the studies ranged from "poor" to "good". Most of the results regarding the quality of the measurement properties were doubtful. None of the self-report tools had their content validity investigated. The FAI and HAP showed the highest clinical utility scores. Content validity needs to be better investigated to determine if the instruments actually measure the physical activity domain. Further studies with good methodological quality are required to assist clinicians and researchers in selecting the best instrument to measure physical activity levels. [ABSTRACT FROM AUTHOR]

Background: The mean of 3 trials is commonly employed to report measures of muscle strength after a stroke. However, consistent and reliable results have been found for single trial dynamometric measures of grip, pinch, and trunk strength in individuals with stroke. Nevertheless, no studies were found that investigated whether only a single trial could be used for the assessment of the strength of both the upper and lower limb muscles.Objective: To determine the best scoring method (one vs the means of 2 or 3 trials) to measure the strength of the upper and lower limb muscles in individuals with sub-acute and chronic stroke.Design: Cross-sectional observational study.Setting: Research laboratory, participants' homes, and community-based settings.Participants: Fifty-five individuals at the sub-acute (mean age: 61 ± 13 years; 3.7 ± 0.7 months poststroke) and 59 at the chronic poststroke phases (mean age: 57 ± 130 years; 90 ± 71 months poststroke).Main Outcome Measurements: Bilateral maximum isometric strength measures of the shoulder, elbow, and wrist flexors/extensors; shoulder abductors; hip, knee, and ankle flexors/extensors; and hip abductors were obtained with a hand-held dynamometer.Methods: After familiarization, 3 trials of maximal isometric strength were obtained for all evaluated muscle groups. One-way analysis of variance was used to compare the results obtained with the first vs the means of 2 and 3 trials for all the assessed muscle groups.Results: The values provided by the different scoring methods were similar for all evaluated muscle groups in individuals with sub-acute (.68 ≤ P ≤ .99) and chronic (.69 ≤ P ≤ .99) stroke.Conclusions: A single trial, after familiarization, may be used for measuring the strength of the upper and lower limb muscles with hand-held dynamometers in individuals with sub-acute and chronic stroke. This increases the clinical applicability of hand-held dynamometers for strength measurement, as it reduces the assessment burden placed on the participants and therapists.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]