Harriet Wittink, Olaf Verschuren, Caroline Terwee, Janke de Groot, Gert Kwakkel, Ingrid van de Port
Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS, Utrecht, The Netherlands. E-mail: harriet.wittink@hu.nl
DOI: 10.2340/16501977-2260

Objective: To systematically review and critically appraise the literature on measurement properties of cardiopulmonary exercise test protocols for measuring aerobic capacity, VO2max, in persons after stroke.
Data sources: PubMed, Embase and Cinahl were searched from inception up to 15 June 2016. A total of 9 studies were identified reporting on 9 different cardiopulmonary exercise test protocols.
Study selection: VO2max measured with cardiopulmonary exercise test and open spirometry was the construct of interest. The target population was adult persons after stroke. We included all studies that evaluated reliability, measurement error, criterion validity, content validity, hypothesis testing and/or responsiveness of cardiopulmonary exercise test protocols.
Data extraction: Two researchers independently screened the literature, assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and extracted data on measurement properties of cardiopulmonary exercise test protocols.
Data synthesis: Most studies reported on only one measurement property. Best-evidence synthesis was derived taking into account the methodological quality of the studies, the results and the consistency of the results.
Conclusion: No judgement could be made on which protocol is “best” for measuring VO2max in persons after stroke due to lack of high-quality studies on the measurement properties of the cardiopulmonary exercise test.

Maximal exercise tests are used to measure fitness in people after stroke. The results of these tests are used to determine training intensity or to evaluate the results of treatment. People after stroke often have difficulty performing these tests because of balance difficulties, lack of strength or spasticity. Researchers have tried measuring fitness in different ways, but it is unclear which way best measures fitness. In this study we conclude there is a need for improvement in how we measure and report on fitness. As a result, we were unable to make recommendations on which way to best test fitness in people after stroke.

Appendix S1