Bria L. Bartsch1, Alicen A. Whitaker2, Shem Oloyede1, Saniya Waghmare1, & Sandra A. Billinger1

1University of Kansas Medical Center, Kansas City, Kansas; 2Medical College of Wisconsin, Milwaukee, Wisconsin

Purpose: The recumbent stepper is ideal for stroke as it minimizes upright balance demand and offers adaptations for hemiparesis. We examined the feasibility of an acute bout of high intensity interval exercise (HIIE), performed on a recumbent stepper, in people with chronic stroke. We defined feasibility as 1) completion of exercise, 2) attainment of ≥77% heart rate max (HRmax) during high intensity intervals, and 3) no study-related cardiac or serious adverse events (SAEs).

Methods: Participants between 6 months to 5 years post stroke and 40-85 years of age completed two study visits. Visit 1: A submaximal exercise test was performed to predict peak power output (PPO). Visit 2: Participants completed a 10-minute, recumbent stepper HIIE bout at 95-100 steps per minute with continuous heart rate (HR) and blood pressure (BP) monitoring. One-minute high intensity intervals (60-80% PPO) were interspersed with 1-minute active recovery intervals (10% PPO). HR and BP data were sampled at 500Hz and interpolated to 10Hz for standardization. Data were divided by R-to-R cardiac intervals, and BP was calculated for each cardiac cycle. Peak HR was extracted for each high intensity interval, and minimum HR for each active recovery interval. Data are reported as mean (standard deviation). Results: Participants (n=28) were 61% male, 61(12) years of age, 32(17) months post stroke, and 79% White and 21% African American. For HIIE, all participants completed the exercise bout, and no study-related cardiac or SAEs occurred. Average percent HRmax across all high intensity intervals reached 77(11)%, and average systolic and diastolic BP were 164(23) and 69(12) mmHg, respectively. During active recovery, average percent HRmax was 68(11)%, systolic BP was 158(24) mmHg, and diastolic BP, 66(12) mmHg. We report no serious adverse events such as orthostatic hypotension during the active recovery period. Conclusion: In chronic stroke, HIIE using the recumbent stepper was feasible with no serious adverse events. Our work provides critical data regarding HR and BP response during each cardiac cycle during HIIE and recovery, which has not been previously published and provides a strong foundation for conducting future interventional studies using HIIE on a recumbent stepper.

ACKNOWLEDGEMENTS: B.L.B was supported by T32HD057850 and KUMC School of Health Professions Ph.D. Student Research Award. A.A.W. was supported by T32HL134643, T32HD057850, and American Heart Association (898190). S.O. was supported by T32AG078114 S.A.B. was supported in part by P30 AG072973.

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