Moncion K; School of Physical & Occupational Therapy, McGill University, Quebec, CANADA
Rodrigues L; DE Las Heras B; Wiley E; Sikorska K; Cristini J;
Allison EY; Eng JJ; Tang A; Roig M

Medicine & Science in Sports & Exercise. 58(5):1073-1084, 2026 May 01.

BACKGROUND: Accurate assessment of cardiorespiratory fitness is a critical
component of cardiopulmonary exercise testing (CPET) and prescription for
people with stroke. However, post-stroke disability and neuromuscular
impairments are common and may disproportionately affect females
throughout the continuum of recovery. There is a need to evaluate
alternative whole-body CPET protocols and to characterize the sex-specific
CPET responses throughout the continuum of stroke recovery.

PURPOSE: To characterize the sex-specific CPET responses on a whole-body
recumbent stepper CPET using American College of Sports Medicine (ACSM)
criteria in people with subacute (7-90 d) and chronic (>=6-60 months)
stroke.

METHODS: Participants underwent a whole-body recumbent stepper
symptom-limited CPET. Each CPET was assessed for ventilatory threshold
(VT), peak oxygen uptake ( ) and ACSM maximal oxygen uptake criteria,
including respiratory exchange ratio >=1.10; plateau, heart rate (HR)
within 10 beats of HRmax, and ratings of perceived exertion (RPE) >=17/20
or >=7/10. Sex differences by stroke chronicity were evaluated via t
tests, rank-sum tests, chi 2 , or Fisher exact tests.

RESULTS: In total, 145 participants underwent a symptom-limited CPET. In
subacute stroke ( n = 69), no sex differences were found for VT or ( P >
0.05), but females were more likely to achieve a plateau ( P = 0.002). In
chronic stroke ( n = 76), no sex differences were observed for VT or
criteria ( P > 0.05), but females had lower ( P = 0.002). Irrespective of
sex, achieving the RPE ( n = 41 subacute [61%], n = 38 chronic [54%]) or
respiratory exchange ratio criteria ( n = 28 subacute [41%], n = 39 [51%])
was the most commonly met ACSM criteria.

CONCLUSIONS: This whole-body CPET protocol is appropriate for eliciting
peak and maximal efforts in people post-strok