Author/Editor		Erjavec, Tatjana; Žen Jurančič, Marijana; Vipavec, Branka; Hočevar Posavec, Bojana
Title		Obremenitveno testiranje in telesna zmogljivost bolnikov v subakutnem obdobju po možganski kapi
Translated title		Exercise stress testing and aerobic capacity in patients after stroke in the subacute stage
Type		članek
Vol. and No.		Letnik 14, št. 1
Publication year		2015
Volume		str. 11-18
ISSN		1580-9315 - Rehabilitacija
Language		slv
Abstract		Izhodišča: Obremenitveno testiranje tudi pri bolnikih po možganski kapi predstavlja zlati standard za opredelitev aerobne zmogljivosti in predpisa aerobne vadbe. Zaradi okvare po možganski kapi je potrebna prilagoditev načina obremenitve in uporabljenega protokola. V študiji smo želeli ugotoviti, kakšne so možnosti obremenitvenega testiranja v subakutnem obdobju po možganski kapi, opredeliti najprimernejši protokol obremenitve, določiti aerobno zmogljivost in morebitne razlike pri bolnikih z ishemično možgansko kapjo ali možgansko krvavitvijo. Metode: V študijo smo vključili 30 bolnikov v subakutnem obdobju po možganski kapi, ki so bili prvič sprejeti v programe rehabilitacije na Univerzitetnem rehabilitacijskem inštitutu RS % Soča v obdobju od 1. 1. 2014 do 30. 6. 2014. Po protokolu smo predvidevali submaksimalno obremenitev na polsedečem kolesu z neposredno meritvijo porabe kisika. Na podlagi kliničnega pregleda smo uporabljali štiri zvezne protokole z različno intenziteto obremenitve. Primerjali smo raven dosežene obremenitve in čas trajanja obremenitve pri posameznem protokolu. Izmerili smo največjo porabo kisika (VO2,), največji porast srčne frekvence, respiratorni količnik (RQ), opredelili vzroke za prekinitev testa ter zbrali podatke o bolnikovi subjektivni oceni napora na zadnji stopnji dosežene obremenitve. Rezultate smo primerjali med bolniki z ishemično in hemoragično možgansko kapjo. Rezultati: Povprečna najvišja poraba kisika je bila 14,8 ml/kg/ min (SO 3,7), najvišji srčni utrip je bil v povprečju 71,4% (SO 10,7) maksimalno predvidenega glede na starost. Med bolniki z ishemično ali hemoragično možgansko kapjo ni bilo pomembnih razlik. Le štirje bolniki so dosegli submaksimalno obremenitev. Pri 23 bolnikih smo test zaključili zaradi splošne utrujenosti ali težav z okvarjeno nogo. Najpogostejši zaplet pri obremenitvenem testiranju je bil hipertenzivni odgovor na napor (pri 3 bolnikih). Drugih pomembnih srčno-žilnih zapletov ni bilo. Če upoštevamo dosežene obremenitve in časovno omejitev testa, se zdi najbolj primerna obremenitve z naraščanjem intenzitete 10 W/min. Zaključek: Obremenitveno testiranje s pomočjo sobnega kolesa je pri bolnikih v subakutnem obdobju po možganski kapi mogoče le pri manjšem številu bolnikov. Med štirimi uporabljenimi protokoli je bil najbolj ustrezen zvezni protokol z naraščanjem intenzitete obremenitve 10 W/ min. Aerobna zmogljivost je bila nizka, utrudljivost hitra, zato je tudi submaksimalni test težko izvedljiv. S pomočjo največje dosežene srčne frekvence pri obremenitvi lahko objektivno predpišemo program aerobne vadbe. Predpis vadbe glede na maksimalno predvideno srčno frekvenco glede na starost pri teh bolnikih ni primeren.Background: Exercise stress testing represents the gold standard for the determination of aerobic capacity and prescription the aerobic training not only in the healthy population but also in patients after stroke. Due to their functional limitations, it is necessary to use specific protocols and instruments for testing. In this study we explored the possibility to perform exercise testing in the subacute period after stroke in order to identify the most appropriate protocol for determining aerobic capacity and detect possible differences between patients after ischemic or haemorrhagic stroke. Methods: Thirty patients in the subacute stage after stroke admitted to primary rehabilitation programs in our institute were included in the study. A sub-maximal stress test on a recumbent bike with direct measurement of oxygen consumption was performed in all the patients. Based on clinical examination of patients, four different protocols with varying intensity of load were used. We compared the heighest reach level and the duration of the stress testing between the protocols. Peak oxygen consumption, increase of heart rate on maximal load level and respiratory exchange ratio (RER) were measured, the reasons for test termination were recorded, and the subjective rating of perceived exertion was assessed using the Borg scale on the highest load level reached. The results were compared between patients after ischemic or haemorrhagic stroke. Results: The average peak oxygen consumption was 14,8 ml/kg/min (SD 3.7) and the average peak heart rate was 71.4% (SD 10.7) of the maximal predicted according to the patient%s age. There were no notable differences among the patients with ischemic or haemorrhagic stroke. The planned submaximal exercise test was completed only by four patients. In 23 patients, the test was interrupted because of fatigue or paretic leg problems. The most common complication of stress testing was a hypertensive reaction to effort. Other cardiovascular complications were not observed. Taking into consideration the reached load level and time limitations, the low-intensity protocol (10 W/min) seems to be the most suitable for patients after stroke in the subacute stage. Conclusions: Exercise testing with recumbent cycling is possible only in a minority of patients in the subacute period after stroke. Among the four used protocols the most appropriate was the one with intensity load increasing by 10W/min. Aerobic capacity of the patients was low and the patients rapidly experienced fatigue, so even the planned sub-maximal test was difficult to perform. Aerobic training prescription based on age-predicted maximum heart rate is not feasible in patients after stroke in the subacute stage.
Descriptors		Stroke Exercise test
Keywords		exercise stress testing aerobic capacity SHAP možganska kap obremenitveno testiranje aerobna zmogljivost