{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:05:33Z","timestamp":1790791533886,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,6,3]],"date-time":"2020-06-03T00:00:00Z","timestamp":1591142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Ontario Heart & Stroke Foundation","award":["P-19-TA-1192"],"award-info":[{"award-number":["P-19-TA-1192"]}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MSH-141983"],"award-info":[{"award-number":["MSH-141983"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The benefits of aerobic exercise early after stroke are well known, but concerns about cardiovascular risk are a barrier to clinical implementation. Symptom-limited exercise testing with electrocardiography (ECG) is recommended but not always feasible. The purpose of this study was to determine the frequency of and corresponding exercise intensities at which ECG abnormalities occurred during submaximal exercise testing that would limit safe exercise prescription beyond those intensities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study was a retrospective analysis of ECGs from 195 patients who completed submaximal exercise testing during stroke rehabilitation. A graded submaximal exercise test was conducted with a 5- or 12-lead ECG and was terminated on the basis of predetermined endpoint criteria (heart rate, perceived exertion, signs, or symptoms). ECGs were retrospectively reviewed for exercise-induced abnormalities and their associated heart rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The peak heart rate achieved was 65.4% (SD\u00a0=\u00a010.5%) of the predicted maximum heart rate or 29.1% (SD\u00a0=\u00a015.5%) of the heart rate reserve (adjusted for beta-blocker medications). The test was terminated more often because of perceived exertion (93\/195) than because of heart rate limits (60\/195). Four patients (2.1%) exhibited exercise-induced horizontal or downsloping ST segment depression of \u22651\u00a0mm. Except for 1 patient, the heart rate at test termination was comparable with the heart rate associated with the onset of the ECG abnormality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A graded submaximal exercise test without ECG but with symptom monitoring and conservative heart rate and perceived exertion endpoints may facilitate safe exercise intensities early after stroke. Symptom-limited exercise testing with ECG is still recommended when progressing to higher intensity exercise.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>Concerns about cardiovascular risk are a barrier to physical therapists implementing aerobic exercise in stroke rehabilitation. This study showed that, in the absence of access to exercise testing with ECG, submaximal testing with conservative heart rate and perceived exertion endpoints and symptom monitoring can support physical therapists in the safe prescription of aerobic exercise early after stroke.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lay Summary<\/jats:title>\n                  <jats:p>It is recommended that people with stroke participate in aerobic exercise as early as possible during their rehabilitation. A submaximal exercise test with monitoring of heart rate, perceived exertion, blood pressure, and symptoms can support physical therapists in safely prescribing that exercise.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzaa103","type":"journal-article","created":{"date-parts":[[2020,6,1]],"date-time":"2020-06-01T19:15:02Z","timestamp":1591038902000},"page":"1434-1443","source":"Crossref","is-referenced-by-count":10,"title":["Determining Safe Participation in Aerobic Exercise Early After Stroke Through a Graded Submaximal Exercise Test"],"prefix":"10.1093","volume":"100","author":[{"given":"Elizabeth L","family":"Inness","sequence":"first","affiliation":[{"name":"Toronto Rehabilitation Institute, University Health Network\u2013KITE Research Institute , Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, 550 University Ave, Toronto, Ontario M5G 2A2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Aqui","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Foster","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Fraser","sequence":"additional","affiliation":[{"name":"Department of Kinesiology , University of Waterloo, Waterloo, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia J","family":"Danells","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute; and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Biasin","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013Brain and Spinal Cord Rehab Program; and Department of Physical Therapy, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Brunton","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013Education; and Department of Physical Therapy, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo-Anne","family":"Howe","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivien","family":"Poon","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013Brain and Spinal Cord Rehab Program; and Department of Physical Therapy, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6641-4017","authenticated-orcid":false,"given":"Ada","family":"Tang","sequence":"additional","affiliation":[{"name":"School of Rehabilitation Science , Institute of Applied Health Science, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0396-5815","authenticated-orcid":false,"given":"Avril","family":"Mansfield","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute; Department of Physical Therapy, University of Toronto; and Sunnybrook Research Institute\u2013Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3186-400X","authenticated-orcid":false,"given":"Susan","family":"Marzolini","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute and Cardiovascular Prevention and Rehabilitation Program; and Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Oh","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute and Cardiovascular Prevention and Rehabilitation Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bayley","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute , University Health Network\u2013KITE Research Institute; and Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,6,3]]},"reference":[{"key":"2023011804294598500_ref1","doi-asserted-by":"crossref","first-page":"2532","DOI":"10.1161\/STR.0000000000000022","article-title":"Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"45","author":"Billinger","year":"2014","journal-title":"Stroke."},{"key":"2023011804294598500_ref2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.3138\/physio.60.2.171","article-title":"Profile of patients at admission into an inpatient stroke rehabilitation programme: cardiorespiratory fitness and functional characteristics","volume":"60","author":"Brooks","year":"2008","journal-title":"Physiother Can."},{"key":"2023011804294598500_ref3","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1016\/j.apmr.2006.04.016","article-title":"Maximal exercise test results in subacute stroke","volume":"87","author":"Tang","year":"2006","journal-title":"Arch Phys Med Rehabil."},{"key":"2023011804294598500_ref4","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1016\/S0003-9993(03)00376-9","article-title":"Cardiorespiratory fitness and walking ability in subacute stroke patients","volume":"84","author":"Kelly","year":"2003","journal-title":"Arch Phys Med Rehabil."},{"key":"2023011804294598500_ref5","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/WCO.0000000000000383","article-title":"Four birds with one stone? 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