InveStigating and Stimulating long Term walking Activity IN stroke

Sedentary stroke survivors show detrimental walking ability and walking ability
over time, causing increased health risk in this population and decreased
quality of life. It is not clear which underlying mechanisms explain this
decrease in walking ability. To develop tailor made interventions to address
this problem it is necessary to further investigate this. It is hypothesised
that VOpeak, energy cost of locomotion, fatigue, experienced exertion,
depression and falls efficacy have a role in walking ability and walking
activity.

To explore the underlying mechanisms explaining walking ability and walking
activity.

To explore the underlying mechanisms explaining walking ability and walking
activity.

The participants are requested to participate in 5 measurements during a 2
year period. All participants start with an assessment during which subject
characteristics age, body mass index (BMI), gender, hemiplegic side, blood
pressure (BP), resting heart rate (HR) and resting VO2 are determined These
assessments are followed by the assessment of walking capacity, using the 6
Minute Walk Test (6MWT) during which HR and gas exchange are monitored and
which is video-recorded. During the first measurement, the participants wear an
activitymonitor. Immediately afterwards perceived exertion during the 6MWT is
assessed. Gait asymmetry, using a gait observation is assessed at a later point
in time with help of the video recording. Following this assessment after a
period of rest the VO2peak is assessed with the treadmill protocol as described
by Macko (1997). All testing and safety procedures are according to the
recommendations of the ACSM. The tests are conducted by the same physical
therapist experienced in exercise testing and gait evaluation. A second
assessor is present in case of adverse events. All assessors are AED-trained. A
physician is always stand-by in the immediate surroundings to act in case of
emergency. The testing location at the Faculty of Healthcare of the HU is
within 2 minutes of the University Medical Centre Utrecht, where full medical
care can be obtained. Testing is terminated if it is the patient's request, if
gait instability or cardiovascular decompensation is observed, according to
guidelines of the American College of Sports Medicine. All risks accompanying
exercise testing are reduced to an absolute minimum by honouring the safety
procedures recommended by the ACSM.
Besides the exercise tests, the participants fill out 4 questionnaires to
determine fatigue, depression, falls efficacy and walking activity. Also,
functional strength of the lower extremities as well as balance are assessed.
Before the first measurement the participants come for a familiarisation visit.
During this visit a preparticipation health screening using the AHA/ACSM
Health/Fitness Preparticipation Screening Questionairre (Balady, 1998) and risk
stratification is performed according to guidelines of the American College of
Sports Medicine (ACSM, 2009). Also, the participants conducted a 6MWT while
wearing the gas analyser and the activitymonitor and performed a short test on
the treadmill.
The study will provide with new insights in walking capacity and walking
activity in stroke, thus providing possibilities to develop more efficient
interventions to prevent loss of function and health risk. The individual
patients will receive a testreport which they may share with their care-givers
to integrate in ongoing treatment if applicable.