Impaired Cardiorespiratory Fitness and Its Predictors in Pakistani Stroke Survivors: Implications for Rehabilitation in Low-Resource Settings

Abstract Cardiorespiratory fitness (CRF), moderate-to-vigorous physical activity (MVPA), and post-stroke fatigue (PSF) are critical factors in stroke recovery. This cross-sectional study evaluated these parameters in 150 patients three months post-ischemic stroke in Pakistan's Swat Valley, a low-resource setting. Cardiopulmonary exercise testing (CPET), ACTi Graph accelerometers, and the Fatigue Severity Scale (FSS-7) were used to assess CRF, MVPA, and PSF, respectively. The mean VO₂ peak was 26.8 ± 6.5 mL/kg/min (72% predicted), with 42% exhibiting suboptimal CRF (<70% expected). Dyspnea (48%) and leg fatigue (30%) were the primary reasons for CPET termination. Regression analysis revealed that each minute/day of MVPA increased VO₂ peak by 0.5% (β=0.05, p<0.01), while each FSS-7 point reduced it by 3.8% (β=-0.38, p<0.001). These findings underscore the need for tailored exercise and pulmonary rehabilitation to enhance CRF and mitigate PSF in LMIC settings. Future longitudinal studies are needed to establish causality and inform context-specific interventions to improve stroke recovery outcomes.