With respect to the exercise response, our previous work demonstrated that there was no significant difference in the right versus left MCAv response to exercise in healthy adults.
9 Herein, the left MCA was the primary vessel of interest for the older adults. For the participants with stroke, both MCA signals were acquired in one visit. In the seated position on the stepper, individuals were set up with the following equipment: 1) transcranial Doppler ultrasound (TCD) (Multigon Industries Inc. Yonkers, NY). An adjustable headband and 2-MHz TCD probes with ultrasonic gel were placed on the temporal window (temple region of the head) for acquisition of MCA blood flow velocity cm*sec
−1.
16 (link) The MCA was accurately identified using practice standards for probe positioning and orientation, MCA depth selection and velocity flow direction.
16 (link) The TCD sonographer, who was blinded to the side of stroke, entered the room only after the participant was set up; 2) A 5- lead electrocardiogram (ECG;
Cardiocard, Nasiff Associates, Central Square, NY) recorded HR; 3) A nasal cannula and capnography (
BCI Capnocheck Sleep 9004 Smiths Medical, Dublin, OH) was used to assess end tidal carbon dioxide (P
ETCO
2); and 4) we recorded beat to beat mean arterial pressure (MAP;
Finometer, Finapres Medical Systems, Amsterdam, The Netherlands) from the left middle finger. Data acquisition of raw data occurred through an analog-to-digital unit (
NI-USB-6212, National Instruments) and custom written software operating in MATLAB (v2014a, The Mathworks Inc. Natick, MA); (see
Video,
Supplemental Digital Content 1, which demonstrates the experimental procedure set up).
Moderate intensity exercise was defined as 45% to 55% of the participant’s heart rate reserve. We determined the HR range by using either: 1) age-predicted (220- age) HR maximum (HR
max) or 2) for participants using beta-blocker medication, we used 164-0.72 × age
17 (link) to calculate HR
max. We determined the HR range for the moderate intensity bout using the Karvonen formula,
9 ,10 HR range = [% exercise intensity (age-predicted HR max-resting HR)] + resting HR.
12 After the setup, the BL recording lasted 90 seconds followed by 6 minutes of moderate intensity exercise at the targeted HR range. The participants were instructed to maintain a step rate of approximately 90 steps per minute throughout the entire exercise bout and resistance was adjusted to obtain the targeted workloads and HR range.
9 Work rate increased during the first 30 seconds of exercise until the target work rate was reached. At the end of exercise, recording stopped and the participant engaged in an active cool down for 2 minutes and then rested until HR returned to baseline. Participants then repeated the 90 seconds BL assessment and 6 minutes of moderate intensity exercise. Our previous work revealed improved signal-to-noise ratio when the data acquired from multiple bouts of exercise are averaged.
9 Variables were sampled at 500 Hz and then interpolated to 2.0 Hz. Three-second averages were calculated and then smoothed using a 9-second sliding window average.
10 We used commercial statistical software(R version 3.2.4, R Core team, Vienna, Austria
18 with the ‘nls’ function package) to model the response. Data with R-to-R intervals greater than 5 Hz or changes in peak blood flow velocity greater than 10 cm/s in a single cardiac cycle were considered artifact and censored. Acquisitions with more than 15% of data points censored were discarded.
Kempf K.S., Whitaker A.A., Lui Y., Witte E., Perdomo S.J., Ward J.L., Eickmeyer S., Ledbetter L., Abraham M, & Billinger S.A. (2016). The Effect of Stroke on Middle Cerebral Artery Blood Flow Velocity Dynamics During Exercise. Journal of Neurologic Physical Therapy, 43(4), 212-219.