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Instrument Reviewers

Initially reviewed by Evan Cohen, PT, MA, PhD, NCS and the MS Edge Taskforce of the Neurology Section of the APTA.

Professional Association Recommendation

• Most appropriate for outpatient setting
• Widest use in EDSS range of 0 ¨C 5.5. May be useful with higher EDSS scores through sub-maximal testing with an appropriate ergometry device
• From Kluding¡¯s review of VO2max in the Stroke EDGE Summary: ¡°Maximal tests are not recommended for clinical practice because of limited feasibility: tests require extensive knowledge of exercise physiology, ECG interpretation, ability to respond to cardiac complications, expensive equipment, and physician supervision. However, referral to cardiac rehab settings for these tests is appropriate before initiating a moderate/vigorous aerobic training program.¡±
• The terms VO2max and VO2peak are often used interchangeably, however, they are distinct. True VO2max is measured less often than VO2peak. Researchers and readers of the literature must be careful to correctly apply and interpret these terms

Considerations

• VO2max and VO2peak testing are physically demanding. MS-related fatigue may limit the individual¡¯s ability to participate in the testing
• As PWMS have varied clinical presentations, the mode of exercise testing (upper vs. lower extremity ergometry, upright vs. recumbent seating, etc0 must be matched to the person¡¯s abilities
• Careful consideration must be given to any co-morbidities that might place the individual at risk. Particular attention must be pain to abnormalities in exercise response due to autonomic involvement. The ACSM recommends a medical examination and the introduction of graded exercise before maximal testing is conducted
• Although VO2max and VO2peak are commonly used measures of aerobic fitness in PWMS, two studies raise significant limitation for their use. Agiovlastis, Motl and Fernhall found that the formulas by the ACSM and by vander Walt and Wyndham underestimated VO2max in a sample of PWMS and in healthy controls. The discrepancy between actual and predicted oxygen consumption values increased with higher workloads. Another study found that VO2max was overestimated based on some sub-maximal (VO2peak) testing models. The was explained by the reduced heart rate response to the increasing workload in the sample of PWMS. The confounding effect of the abnormal HR response was minimized by the use of VO2max prediction equation which excluded HR from the model, but which requires a maximal exercise test protocol. Clinicians and researchers who use VO2max and peak testing in PWMS must carefully consider the predictive models upon which their calculations are based.

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Bibliography

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Dobrovolny, C. L., Ivey, F. M., et al. (2003). "Reliability of treadmill exercise testing in older patients with chronic hemiparetic stroke." Arch Phys Med Rehabil 84(9): 1308-1312.

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Ponichtera-Mulcare, J., Mathews, T., et al. (1995). "From the Field-Maximal aerobic exercise of individuals with multiple sclerosis: Using three modes of ergonometry." Clinical Kinesiology 49: 4-4.

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Ryan, A. S., Dobrovolny, C. L., et al. (2000). "Cardiovascular fitness after stroke: role of muscle mass and gait deficit severity." Journal of Stroke and Cerebrovascular Diseases 9(4): 185-191.

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Tang, A., Sibley, K. M., et al. (2006). "Maximal exercise test results in subacute stroke." Arch Phys Med Rehabil 87(8): 1100-1105.

Tseng, B. Y. and Kluding, P. (2009). "The relationship between fatigue, aerobic fitness, and motor control in people with chronic stroke: a pilot study." Journal of Geriatric Physical Therapy 32(3): 97-102.

Van der Walt, W. and Wyndham, C. (1973). "An equation for prediction of energy expenditure of walking and running." Journal of Applied Physiology 34(5): 559-563.