Fitness Testing for Stroke Recovery

Timing considerations for post-stroke testing:

• NOT During Acute Phase: First days to weeks after stroke are for medical stabilization and acute rehabilitation. Testing is not appropriate during this period
• Early Recovery (Weeks 2 to 12): Focus on physical therapy and occupational therapy. Some patients may be ready for baseline testing toward end of this period with physician clearance
• Chronic Phase (3+ Months Post-Stroke): Most appropriate time for testing. Medical status typically stabilized, basic mobility restored, cardiovascular risk managed
• Physician Determines Readiness: Your neurologist or physiatrist will assess cardiovascular stability, neurological status, mobility level, and readiness for exercise testing

Exercise testing provides valuable information for stroke recovery:

• Assess Cardiovascular Deconditioning: Stroke survivors often have 25 to 50% reduction in cardiovascular fitness due to hospitalization, reduced mobility, and pre-existing cardiovascular disease. Quantify current capacity
• Establish Safe Exercise Parameters: Know exactly what heart rate and intensity are appropriate for home exercise programs
• Guide Rehabilitation Progression: Results inform physical therapy and exercise prescription for optimal recovery
• Track Recovery Progress: Retest every 3 to 6 months to objectively measure cardiovascular fitness improvements
• Secondary Prevention: Exercise at appropriate intensity reduces recurrent stroke risk. Testing provides the data to exercise effectively
• Functional Capacity: VO₂ max correlates with ability to perform daily activities independently

Required before testing:

• Written Physician Clearance: Specific approval for VO₂ max testing from neurologist, physiatrist, or stroke specialist
• Cardiovascular Stability: Blood pressure controlled (typically below 180/110). No unstable angina or recent cardiac events
• Neurological Status: Stable neurological condition with no recent progression of symptoms
• Mobility Level: Able to walk or cycle with or without assistive devices. Sufficient balance and coordination for safe testing
• Cognitive Ability: Can understand and follow test instructions
• Complete Medication List: Especially blood thinners, blood pressure medications, antiseizure medications

Testing May NOT Be Appropriate If: Less than 3 months post-stroke (typically), uncontrolled blood pressure, recent TIA or stroke progression, severe balance impairment, uncontrolled seizures, severe cognitive impairment, severe aphasia preventing communication.

We adapt testing for stroke survivors:

• Equipment Selection: Choose based on affected side and mobility. Stationary bike often easiest for those with hemiparesis (one-sided weakness). Treadmill with handrail support if walking ability adequate
• Assistive Devices: Canes, AFO braces, or other mobility aids can be used during testing
• Extended Warm-Up: 10 to 15 minutes to prepare cardiovascular system and assess tolerance
• Gradual Progression: Smaller workload increases than standard protocols. Allow time to adapt to increasing demands
• Balance Support: Handrails, support bars, or staff assistance as needed for safety
• Communication Adaptations: If aphasia present, use visual cues and gestures. Allow extra time for responses
• Fatigue Monitoring: Stroke survivors often have significant post-stroke fatigue. Watch for signs of excessive fatigue
• Extended Recovery: Allow 15 to 30 minutes post-test recovery and monitoring before leaving
• Total Time: Plan for 75 to 90 minutes total appointment

Based on American Heart Association and American Stroke Association guidelines:

• Aerobic Exercise:
  • • Target: 20 to 60 minutes, 3 to 7 days per week
  • • Intensity: Moderate (Zone 2, typically 50 to 70% max heart rate)
  • • Can break into 10 minute bouts if needed
  • • Walking most common and functional for stroke survivors
• Resistance Training: 2 to 3 days per week. Critical for regaining strength, especially on affected side. Work with physical therapist initially
• Balance Training: Daily balance exercises reduce fall risk. Essential component of stroke rehabilitation
• Task-Specific Training: Practice functional movements needed for daily living

VO₂ max testing provides YOUR specific heart rate zones for safe aerobic exercise progression.

Exercise is crucial for preventing recurrent stroke:

• Risk Reduction: Regular exercise reduces recurrent stroke risk by 20 to 30%
• Blood Pressure Management: Exercise lowers blood pressure 5 to 10 mmHg
• Weight Management: Obesity increases stroke risk. RMR testing ($75) helps with weight loss
• Diabetes Control: Exercise improves insulin sensitivity and blood glucose control
• Cholesterol Improvement: Raises HDL (good) cholesterol, lowers triglycerides

What if I have weakness on one side? Stationary bike is often best option. Both legs work together, reducing coordination demands. We can accommodate hemiparesis.

What if my balance is impaired? We provide support and can use bike instead of treadmill. Safety is our priority.

Will testing be too hard? You control the test. We stop when you indicate you have reached your comfortable maximum. We are measuring YOUR current capacity.

What if I get too fatigued? Post-stroke fatigue is common. We allow rest breaks and can stop anytime. Plan rest after testing.

Monitor multiple markers with your healthcare team:

• VO₂ Max: Retest every 3 to 6 months to track cardiovascular fitness recovery
• Walking Speed: 10-meter walk test common in stroke rehab
• 6-Minute Walk Test: Functional endurance measure
• Balance Measures: Berg Balance Scale or similar
• Functional Independence: FIM or Barthel Index scores
• Cardiovascular Risk Factors: Blood pressure, lipids, A1C monitoring

VO₂ Max Test: $250

This is a cash-pay service. We do not bill insurance. However, some patients submit receipts for reimbursement under out-of-network benefits or use HSA/FSA funds. Check with your insurance provider.

Share your testing results with:

• Neurologist: Manages overall stroke care and secondary prevention
• Physiatrist (Physical Medicine and Rehabilitation): Specializes in stroke rehabilitation
• Physical Therapist: Uses VO₂ max data to progress exercise programs safely
• Occupational Therapist: Incorporates fitness data into functional training
• Primary Care Physician: Manages cardiovascular risk factors
• Cardiologist: If cardiac issues contributed to stroke or are present

Fit Evaluations
311 Soquel Ave
Santa Cruz, CA 95062

Behind Hindquarter restaurant (second entrance off Dakota St.)

Phone: 831-400-9227
Email: info@fitevals.com

Call to discuss your stroke recovery status and obtain medical clearance before booking.