The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke: a cross-sectional analysis

Jacqueline C. Outermans, Ingrid van de Port, Gert Kwakkel, Johanna M. Visser-Meily, Harriet Wittink

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Reports on the association between aerobic capacity and walking capacity in people after stroke show disparate results. AIM: The aim of this study was to determine: 1) if the predictive validity of peak oxygen uptake (VO2peak) for walking capacity post stroke is different from that of maximal oxygen uptake (VO2max), and 2) if postural control, hemiplegic lower extremity muscle strength, age and gender distort the association between aerobic capacity and walking capacity. DESIGN: Cross-sectional study. SETTING: General community in Utrecht, The Netherlands. POPULATION: Community-dwelling people more than three months after stroke. METHODS: Measurement of aerobic capacity were performed with cardiopulmonary exercise testing (CPET) and differentiated between the achievement of VO2peak or VO2max. Measurement of walking capacity with the 6-Minute Walk Test (6MWT), postural control with the Performance-Oriented Mobility Assessment (POMA) and hemiplegic lower extremity muscle strength with the Motricity Index (MI-LE). RESULTS: Fifty-one out of 62 eligible participants, aged 64.7±12.5 years were included. Analysis of covariance (ANCOVA) showed a non-significant difference between the predictive validities of VO2max (N.=22, β=0.56; 95% CI: 0.12-0.97) and VO2peak (N.=29, β=0.72; 95% CI: 0.38-0.92). Multiple regression analysis of the pooled sample showed a significant decrease in the β value of VO2peak (21.6%) for the 6MWT when adding the POMA as a covariate in the association model. VO2peak remained significantly related to 6MWT after correcting for the POMA (β=0.56, 95% CI: 0.39-0.75). CONCLUSIONS: The results suggest similar predictive validity of aerobic capacity for walking capacity in participants achieving VO2max compared to those only achieving VO2peak. Postural control confounds the association between aerobic capacity and walking capacity. Aerobic capacity remains a valid predictor of walking capacity. CLINICAL REHABILITATION IMPACT: Aerobic capacity is an important factor associated with walking capacity after stroke. However, to understand this relationship, postural control needs to be measured. Both aerobic capacity and postural control may need to be addressed during interventions aiming to improve walking capacity after stroke.
Original languageEnglish
Pages (from-to)837-844
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume54
Issue number6
Early online date12 Mar 2018
DOIs
Publication statusPublished - Dec 2018

Cite this

@article{37b9905baa104a4083f4ef1e2c06390b,
title = "The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke: a cross-sectional analysis",
abstract = "BACKGROUND: Reports on the association between aerobic capacity and walking capacity in people after stroke show disparate results. AIM: The aim of this study was to determine: 1) if the predictive validity of peak oxygen uptake (VO2peak) for walking capacity post stroke is different from that of maximal oxygen uptake (VO2max), and 2) if postural control, hemiplegic lower extremity muscle strength, age and gender distort the association between aerobic capacity and walking capacity. DESIGN: Cross-sectional study. SETTING: General community in Utrecht, The Netherlands. POPULATION: Community-dwelling people more than three months after stroke. METHODS: Measurement of aerobic capacity were performed with cardiopulmonary exercise testing (CPET) and differentiated between the achievement of VO2peak or VO2max. Measurement of walking capacity with the 6-Minute Walk Test (6MWT), postural control with the Performance-Oriented Mobility Assessment (POMA) and hemiplegic lower extremity muscle strength with the Motricity Index (MI-LE). RESULTS: Fifty-one out of 62 eligible participants, aged 64.7±12.5 years were included. Analysis of covariance (ANCOVA) showed a non-significant difference between the predictive validities of VO2max (N.=22, β=0.56; 95{\%} CI: 0.12-0.97) and VO2peak (N.=29, β=0.72; 95{\%} CI: 0.38-0.92). Multiple regression analysis of the pooled sample showed a significant decrease in the β value of VO2peak (21.6{\%}) for the 6MWT when adding the POMA as a covariate in the association model. VO2peak remained significantly related to 6MWT after correcting for the POMA (β=0.56, 95{\%} CI: 0.39-0.75). CONCLUSIONS: The results suggest similar predictive validity of aerobic capacity for walking capacity in participants achieving VO2max compared to those only achieving VO2peak. Postural control confounds the association between aerobic capacity and walking capacity. Aerobic capacity remains a valid predictor of walking capacity. CLINICAL REHABILITATION IMPACT: Aerobic capacity is an important factor associated with walking capacity after stroke. However, to understand this relationship, postural control needs to be measured. Both aerobic capacity and postural control may need to be addressed during interventions aiming to improve walking capacity after stroke.",
keywords = "Stroke, Walking, Exercise tolerance, Exercise test, Postural balance",
author = "Outermans, {Jacqueline C.} and Port, {Ingrid van de} and Gert Kwakkel and Visser-Meily, {Johanna M.} and Harriet Wittink",
year = "2018",
month = "12",
doi = "10.23736/S1973-9087.18.04987-0",
language = "English",
volume = "54",
pages = "837--844",
journal = "European Journal of Physical and Rehabilitation Medicine",
issn = "1973-9087",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "6",

}

The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke : a cross-sectional analysis. / Outermans, Jacqueline C.; Port, Ingrid van de; Kwakkel, Gert; Visser-Meily, Johanna M.; Wittink, Harriet.

In: European Journal of Physical and Rehabilitation Medicine, Vol. 54, No. 6, 12.2018, p. 837-844.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke

T2 - a cross-sectional analysis

AU - Outermans, Jacqueline C.

AU - Port, Ingrid van de

AU - Kwakkel, Gert

AU - Visser-Meily, Johanna M.

AU - Wittink, Harriet

PY - 2018/12

Y1 - 2018/12

N2 - BACKGROUND: Reports on the association between aerobic capacity and walking capacity in people after stroke show disparate results. AIM: The aim of this study was to determine: 1) if the predictive validity of peak oxygen uptake (VO2peak) for walking capacity post stroke is different from that of maximal oxygen uptake (VO2max), and 2) if postural control, hemiplegic lower extremity muscle strength, age and gender distort the association between aerobic capacity and walking capacity. DESIGN: Cross-sectional study. SETTING: General community in Utrecht, The Netherlands. POPULATION: Community-dwelling people more than three months after stroke. METHODS: Measurement of aerobic capacity were performed with cardiopulmonary exercise testing (CPET) and differentiated between the achievement of VO2peak or VO2max. Measurement of walking capacity with the 6-Minute Walk Test (6MWT), postural control with the Performance-Oriented Mobility Assessment (POMA) and hemiplegic lower extremity muscle strength with the Motricity Index (MI-LE). RESULTS: Fifty-one out of 62 eligible participants, aged 64.7±12.5 years were included. Analysis of covariance (ANCOVA) showed a non-significant difference between the predictive validities of VO2max (N.=22, β=0.56; 95% CI: 0.12-0.97) and VO2peak (N.=29, β=0.72; 95% CI: 0.38-0.92). Multiple regression analysis of the pooled sample showed a significant decrease in the β value of VO2peak (21.6%) for the 6MWT when adding the POMA as a covariate in the association model. VO2peak remained significantly related to 6MWT after correcting for the POMA (β=0.56, 95% CI: 0.39-0.75). CONCLUSIONS: The results suggest similar predictive validity of aerobic capacity for walking capacity in participants achieving VO2max compared to those only achieving VO2peak. Postural control confounds the association between aerobic capacity and walking capacity. Aerobic capacity remains a valid predictor of walking capacity. CLINICAL REHABILITATION IMPACT: Aerobic capacity is an important factor associated with walking capacity after stroke. However, to understand this relationship, postural control needs to be measured. Both aerobic capacity and postural control may need to be addressed during interventions aiming to improve walking capacity after stroke.

AB - BACKGROUND: Reports on the association between aerobic capacity and walking capacity in people after stroke show disparate results. AIM: The aim of this study was to determine: 1) if the predictive validity of peak oxygen uptake (VO2peak) for walking capacity post stroke is different from that of maximal oxygen uptake (VO2max), and 2) if postural control, hemiplegic lower extremity muscle strength, age and gender distort the association between aerobic capacity and walking capacity. DESIGN: Cross-sectional study. SETTING: General community in Utrecht, The Netherlands. POPULATION: Community-dwelling people more than three months after stroke. METHODS: Measurement of aerobic capacity were performed with cardiopulmonary exercise testing (CPET) and differentiated between the achievement of VO2peak or VO2max. Measurement of walking capacity with the 6-Minute Walk Test (6MWT), postural control with the Performance-Oriented Mobility Assessment (POMA) and hemiplegic lower extremity muscle strength with the Motricity Index (MI-LE). RESULTS: Fifty-one out of 62 eligible participants, aged 64.7±12.5 years were included. Analysis of covariance (ANCOVA) showed a non-significant difference between the predictive validities of VO2max (N.=22, β=0.56; 95% CI: 0.12-0.97) and VO2peak (N.=29, β=0.72; 95% CI: 0.38-0.92). Multiple regression analysis of the pooled sample showed a significant decrease in the β value of VO2peak (21.6%) for the 6MWT when adding the POMA as a covariate in the association model. VO2peak remained significantly related to 6MWT after correcting for the POMA (β=0.56, 95% CI: 0.39-0.75). CONCLUSIONS: The results suggest similar predictive validity of aerobic capacity for walking capacity in participants achieving VO2max compared to those only achieving VO2peak. Postural control confounds the association between aerobic capacity and walking capacity. Aerobic capacity remains a valid predictor of walking capacity. CLINICAL REHABILITATION IMPACT: Aerobic capacity is an important factor associated with walking capacity after stroke. However, to understand this relationship, postural control needs to be measured. Both aerobic capacity and postural control may need to be addressed during interventions aiming to improve walking capacity after stroke.

KW - Stroke

KW - Walking

KW - Exercise tolerance

KW - Exercise test

KW - Postural balance

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059796913&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/29532648

U2 - 10.23736/S1973-9087.18.04987-0

DO - 10.23736/S1973-9087.18.04987-0

M3 - Article

VL - 54

SP - 837

EP - 844

JO - European Journal of Physical and Rehabilitation Medicine

JF - European Journal of Physical and Rehabilitation Medicine

SN - 1973-9087

IS - 6

ER -