The Right Tool for the Task: Body-Weight Supported Treadmill or Total Body Recumbent Stepper for Mobility-Adapted Cardiopulmonary Exercise Testing in Multiple Sclerosis Patients with Disability
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Objective
Cardiopulmonary Exercise Testing (CPET) is challenging among persons with mobility disability. We sought the optimal adapted device to achieve a maximal CPET.
Design
Randomized crossover trial, within-subjects, repeated measures design
Setting
Primary Care and Referral Center
Participants
Clinic-referred persons with multiple sclerosis (PwMS) (n=10) with three-month stability, no exercise obstruction, MoCa>24, ability to walk with or without assistance, and sex- and age-matched (±3 years) Controls (n=7) recruited by convenience sampling
Interventions
CPET on body weight-supported treadmill (BWST) and total body recumbent stepper (TBRS)
Main Outcome Measures
Standard aerobic metrics (V̇O 2max , % normative values for V̇O 2max [%V̇O 2max ], heart rate maximum [HR max ], age-predicted HR max , and Respiratory Exchange Ratio)
Results
PwMS achieved similar V̇O 2max (mL·min -1 ·kg -1 ) on the TBRS and BWST (26.53±8.7 vs. 24.24±7.8) while Controls obtained higher values on BWST than TBRS (40.27±7.6 vs. 34.32±7.1, p <0.001). PwMS more consistently achieved criteria for maximum CPET using TBRS. During the preliminary investigation of the MS subgroup with a higher mobility disability, CPET using BWST exaggerated already low CPET metrics.
Conclusions
Although Controls achieved higher CPET values on BWST, V̇O 2max between devices were similar among PwMS. Only when using BWST, PwMS V̇O 2max and %V̇O 2max were lower than Controls, likely because of leg fatigue and weakness. Using TBRS permits persons with mobility disability to achieve more criteria for a maximum CPET. Our results suggest that CPET using BWST, being reliant on the lower body, likely disadvantages PwMS, especially those with mobility disability.
