The safety and feasibility of early cardiorespiratory fitness testing after stroke

Background
Cardiorespiratory fitness testing is recommended as part of a pre-exercise evaluation to aid the programming of safe, tailored cardiorespiratory fitness training after stroke. But there is limited evidence for its safety and feasibility in people with stroke with varying impairment levels in the early subacute phase of stroke recovery.

Objective
To assess the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase after stroke.

Design
A sub-study of a larger single service, multi-site, prospective cohort feasibility study (Cardiac Rehabilitation in Stroke Survivors to Improve Survivorship [CRiSSIS]).

Setting
Private subacute inpatient rehabilitation facilities.

Participants
Consecutive admissions of people with ischemic stroke admitted to subacute rehabilitation facilities.

Intervention
Not applicable.

Main Outcome(s)
Safety was determined by the occurrence of adverse or serious adverse events. Feasibility was determined by assessing the (1) number of participants recruited and (2) number of participants able to complete the fitness test.

Results
Between April 2018 and December 2019, a total of 165 people with stroke were screened to participate; 109 were eligible and 65 were recruited. Of the 62 who completed testing, 41 participants were able to complete a submaximal fitness test at a median of 12 days post-stroke. One minor adverse event was recorded. Of the 21 participants unable to complete the fitness test; 4 declined to complete the test, 9 were unable to commence the test, and 8 were unable to complete the first stage of the protocol due to stroke-related impairments. Participants with mild stroke, greater motor and cognitive function, and fewer depressive symptoms were more likely to be able to complete the cardiorespiratory fitness test.

Conclusion
Cardiorespiratory fitness testing was safe for most people with mild-to-moderately severe ischemic stroke and transient ischemic attack in the early subacute phase, but only two-thirds of the participants could complete the test.