Aerobic Capacity and Aerobic Load of Activities of Daily Living After Stroke

  • I. J. Blokland
  • T. IJmker
  • H. Houdijk
Reference work entry


People after stroke often have a lower aerobic capacity than their healthy peers. On top of that, the aerobic load of daily activities such as walking is frequently (much) higher in this group. Often, these issues are investigated separately, but the actual impact on daily functioning can only be perceived when they are combined. A lower capacity and higher load will result in a high relative aerobic load of daily activities, i.e., people need to act at a high level of their maximal capacity. A high relative aerobic load may be a central cause of limitations in daily activities and participation as people either fatigue easily during tasks with a high load, have to slow their pace, or avoid these tasks all together. In this chapter, we review the current knowledge on aerobic capacity and aerobic load of daily activities in people after stroke. Moreover, we estimate the relative load experienced by stroke survivors performing these activities in an attempt to better understand the role of aerobic capacity and load in activity limitations in people after stroke.


Stroke Aerobic capacity Aerobic load Energy expenditure Energy cost Activities of daily living Walking Relative load Maximal aerobic capacity \( \dot{\mathrm{V}}{\mathrm{O}}_2 \) max Oxygen cost Oxygen consumption Metabolic energy 


  1. Ainsworth BE, Haskell WL, Herrmann SD et al (2011) 2011 compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 43:1575–1581CrossRefGoogle Scholar
  2. Alzahrani MA, Dean CM, Ada L (2009) Ability to negotiate stairs predicts free-living physical activity in community-dwelling people with stroke: an observational study. Aust J Physiother 55:277–281. Scholar
  3. Baert I, Daly D, Dejaeger E et al (2012a) Evolution of cardiorespiratory fitness after stroke: a 1-year follow-up study. Influence of prestroke patients’ characteristics and stroke-related factors. Arch Phys Med Rehabil 93:669–676. Scholar
  4. Baert I, Feys H, Daly D et al (2012b) Are patients 1 year post-stroke active enough to improve their physical health? Disabil Rehabil 34:574–580. Scholar
  5. Béjot Y, Bailly H, Durier J, Giroud M (2016) Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 45:e391–e398. Scholar
  6. Billinger SA, Coughenour E, MacKay-Lyons MJ, Ivey FM (2012) Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat 2012:959120. Scholar
  7. Bohannon RW, Andrews AW, Smith MB (1988) Rehabilitation goals of patients with hemiplegia. Int J Rehabil Res 11:181–184. Scholar
  8. Bosch PR, Holzapfel S, Traustadottir T (2015) Feasibility of measuring ventilatory threshold in adults with stroke-induced hemiparesis: implications for exercise prescription. Arch Phys Med Rehabil 96:1779–1784. Scholar
  9. Cress ME, Meyer M (2003) Maximal voluntary and functional performance needed for independence in adults aged 65 to 97 years. Phys Ther 83:37–48Google Scholar
  10. Danielsson A, Sunnerhagen KS (2000) Oxygen consumption during treadmill walking with and without body weight support in patients with hemiparesis after stroke and in healthy subjects. Arch Phys Med Rehabil 81:953–957. Scholar
  11. Delussu AS, Morone G, Iosa M et al (2014) Physiological responses and energy cost of walking on the gait trainer with and without body weight support in subacute stroke patients. J Neuroeng Rehabil 11:54. Scholar
  12. Detrembleur C, Dierick F, Stoquart G et al (2003) Energy cost, mechanical work, and efficiency of hemiparetic walking. Gait Posture 18:47–55. Scholar
  13. Eng JJ, Dawson AS, Chu KS (2004) Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil 85:113–118. Scholar
  14. Fujitani J, Ishikawa T, Akai M, Kakurai S (1999) Influence of daily activity on changes in physical fitness for people with post-stroke hemiplegia. Am J Phys Med Rehabil 78:540–544CrossRefGoogle Scholar
  15. Garber CE, Blissmer B, Deschenes MR et al (2011) Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43:1334–1359. Scholar
  16. Garby L, Astrup A (1987) The relationship between the respiratory quotient and the energy equivalent of oxygen during simultaneous glucose and lipid oxidation and lipogenesis. Acta Physiol Scand 129:443–444. Scholar
  17. Gäverth J, Parker R, MacKay-Lyons M (2015) Exercise stress testing after stroke or transient ischemic attack: a scoping review. Arch Phys Med Rehabil 96:1349–1359. Scholar
  18. Glaister BC, Bernatz GC, Klute GK, Orendurff MS (2007) Video task analysis of turning during activities of daily living. Gait Posture 25:289–294. Scholar
  19. Glymour MM, Berkman LF, Ertel KA et al (2007) Lesion characteristics, NIH stroke scale, and functional recovery after stroke. Am J Phys Med Rehabil 86:725–733. Scholar
  20. Guazzi M, Arena R, Halle M et al (2016) 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J 126:454–463. 180Google Scholar
  21. Harries N, Loeppky JA, Shaheen S et al (2015) A stair-climbing test for measuring mechanical efficiency of ambulation in adults with chronic stroke. Disabil Rehabil 37:1004–1008. Scholar
  22. Houdijk H, ter Hoeve N, Nooijen C et al (2010) Energy expenditure of stroke patients during postural control tasks. Gait Posture 32:321–326.
  23. IJmker T (2015) Balance control in human walking: an energetic perspective. Ipskamp Drukkers, AmsterdamGoogle Scholar
  24. IJmker T, Houdijk H, Lamoth CJ et al (2013) Effect of balance support on the energy cost of walking after stroke. Arch Phys Med Rehabil 94:2255–2261. Scholar
  25. IJmker T, Lamoth CJ, Houdijk H et al (2014) Postural threat during walking: effects on energy cost and accompanying gait changes. J Neuroeng Rehabil 11:71. Scholar
  26. Jones AM, Carter H (2000) The effect of endurance training on parameters of aerobic fitness. Sports Med 29:373–386CrossRefGoogle Scholar
  27. Jones AM, Poole DC (2005) Oxygen uptake dynamics: from muscle to mouth – an introduction to the symposium. Med Sci Sports Exerc 37:1542–1550. Scholar
  28. Jung T, Ozaki Y, Lai B, Vrongistinos K (2014) Comparison of energy expenditure between aquatic and overground treadmill walking in people post-stroke. Physiother Res Int 19:55–64.
  29. Kafri M, Myslinski MJ, Gade VK, Deutsch JE (2014) High metabolic cost and low energy expenditure for typical motor activities among individuals in the chronic phase after stroke. J Neurol Phys Ther 38:226–232. Scholar
  30. Koopman ADM, Eken MM, Van Bezeij T et al (2013) Does clinical rehabilitationimpose suficient cardiorespiratory strain to improve aerobic fitness. J Rehabil Med 45:92–98. Scholar
  31. Kramer S, Johnson L, Bernhardt J, Cumming T (2015) Energy expenditure and cost during walking after stroke: a systematic review. Arch Phys Med Rehabil 97:619–632.e1. Scholar
  32. Lee CD, Folsom AR, Blair SN (2003) Physical activity and stroke risk: a meta-analysis. Stroke 34:2475–2481. Scholar
  33. Lord SE, McPherson K, McNaughton HK et al (2004) Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil 85:234–239. Scholar
  34. MacKay-Lyons MJ, Makrides L (2002a) Exercise capacity early after stroke. Arch Phys Med Rehabil 83:1697–1702. Scholar
  35. MacKay-Lyons MJ, Makrides L (2002b) Cardiovascular stress during a contemporary stroke rehabilitation program: is the intensity adequate to induce a training effect? Arch Phys Med Rehabil 83:1378–1383. Scholar
  36. MacKay-Lyons MJ, Makrides L (2004) Longitudinal changes in exercise capacity after stroke. Arch Phys Med Rehabil 85:1608–1612. Scholar
  37. Macko RF, Ivey FM, Forrester LW et al (2005) Treadmill exercise rehabilitation improves ambulatory function and cardiovascular fitness in patients with chronic stroke: a randomized, controlled trial. Stroke 36:2206–2211. Scholar
  38. McArdle W, Katch K, Katch V (2009) Exercise physiology: nutrition, energy, and human performance. Lippincott, Willams & Wilkins, BaltimoreGoogle Scholar
  39. Mezzani A, Agostoni P, Cohen-Solal A et al (2009) Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the exercise physiology section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 16:249–267. Scholar
  40. Michael KM, Allen JK, Macko RF (2005) Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness. Arch Phys Med Rehabil 86:1552–1556. Scholar
  41. Milani RV, Lavie CJ, Mehra MR, Ventura HO (2006) Understanding the basics of cardiopulmonary exercise testing. Mayo Clin Proc 81:1603–1611. Scholar
  42. Mozaffarian D, Benjamin EJ, Go AS et al (2016) Heart disease and stroke statistics-2016 update a report from the American Heart Association. Circulation 133(4):e38–e48CrossRefGoogle Scholar
  43. Novak AC, Brouwer B (2012) Strength and aerobic requirements during stair ambulation in persons with chronic stroke and healthy adults. Arch Phys Med Rehabil 93:683–689. Scholar
  44. Orendurff MS, Schoen JA, Bernatz GC et al (2008) How humans walk: bout duration, steps per bout, and rest duration. J Rehabil Res Dev 45:1077–1089CrossRefGoogle Scholar
  45. Pinkstaff S, Peberdy MA, Kontos MC et al (2010) Quantifying exertion level during exercise stress testing using percentage of age-predicted maximal heart rate, rate pressure product, and perceived exertion. Mayo Clin Proc 85:1095–1100. Scholar
  46. Platts MM, Rafferty D, Paul L (2006) Metabolic cost of overground gait in younger stroke patients and healthy controls. Med Sci Sports Exerc 38:1041–1046. Scholar
  47. Polese JC, Scianni AA, Teixeira-Salmela LF (2015) Predictors of energy cost during stair ascent and descent in individuals with chronic stroke. J Phys Ther Sci 27:3739–3743. Scholar
  48. Ralston HJ (1958) Energy-speed relation and optimal speed during level walking. Int Zeitschrift für Angew Physiol Einschl Arbeitsphysiologie 17:277–283. Scholar
  49. Reisman DS, Rudolph KS, Farquhar WB (2009) Influence of speed on walking economy poststroke. Neurorehabil Neural Repair 23:529–534. Scholar
  50. Saunders DH, Sanderson M, Brazzelli M et al (2016) Physical fitness training for stroke patients. Cochrane Database Syst Rev 3:CD003316. www.cochranelibrary.comGoogle Scholar
  51. Slawinski J, Pradon D, Bensmail D et al (2014) Energy cost of obstacle crossing in stroke patients. Am J Phys Med Rehabil 93:1–7. Scholar
  52. Smith AC, Saunders DH, Mead G (2012) Cardiorespiratory fitness after stroke: a systematic review. Int J Stroke 7:499–510. Scholar
  53. Tang A, Sibley KM, Thomas SG et al (2006) Maximal exercise test results in subacute stroke. Arch Phys Med Rehabil 87:1100–1105. Scholar
  54. Thompson PD, Arena R, Riebe D, Pescatello LS (2013) ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep 12:215–217. Scholar
  55. Tiozzo E, Youbi M, Dave K et al (2015) Aerobic, resistance, and cognitive exercise training poststroke. Stroke 46:2012–2016. Scholar
  56. Tseng BY, Kluding P (2009) The relationship between fatigue, aerobic fitness, and motor control, in people with chronic stroke. A pilot study. J Geriatr Phys Ther 32:97–102. Scholar
  57. van de Port IGL, Kwakkel G, Van Wijk I, Lindeman E (2006) Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study. Stroke 37:167–171. Scholar
  58. van de Port IGL, Kwakkel G, Wittink H (2015) Systematic review of cardiopulmonary exercise testing post stroke: are we adhering to practice recommendations? J Rehabil Med 47:881–900. Scholar
  59. Verschuren O, De Haan F, Mead G et al (2016) Characterizing energy expenditure during sedentary behavior after stroke. Arch Phys Med Rehabil 97:232–237. Scholar
  60. Wasserman K, Hansen JE, Sue DY, Stringer WW, Sietsema KE, Sun X-G, Whipp BJ (2012) Principles of exercise testing and interpretation: including pathophysiology and clinical applications (5th ed.). Wolters Kluwer/Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  61. Waters RL, Mulroy S (1999) The energy expenditure of normal and pathologic gait. Gait Posture 9:207–231. Scholar
  62. Wezenberg D, Van Der Woude LH, Faber WX et al (2013) Relation between aerobic capacity and walking ability in older adults with a lower-limb amputation. Arch Phys Med Rehabil 94:1714–1720. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Behavioral and Movement SciencesVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
  2. 2.Heliomare Rehabilitation, Research and DevelopmentWijk aan ZeeThe Netherlands

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.duPont Hospital for ChildrenWilmingtonUSA

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