Evaluating and understanding performance testing in COPD patients

Correlation Comparison and Personalized Utility of Field Walking Tests in Assessing the Exercise Capacity of Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Background: Incremental shuttle walking tests (ISWT) are regarded as valuable alternatives to 6-min walking tests (6MWT) and cardiopulmonary exercise tests (CPET) owing to the maximal and externally paced loading. This study investigated the validity and reliability of ISWT by analyzing the correlation of the distances of two field tests with peak oxygen consumption (VO2) of CPET in patients with COPD. Methods: In this randomized controlled trial, patients with COPD were enrolled from two hospitals. Three assessments were performed for all patients. The ISWT and 6MWT were repeated twice in Hospital 1 to assess reliability. Results: A total of 29 patients were enrolled. The distances of ISWT (0.782, p < 0.001) and 6MWT (0.512, p = 0.005) correlated with peak VO2. The intraclass correlation coefficients of both ISWT (0.988, p < 0.001) and 6MWT (0.959, p < 0.001) was high. Patients with higher peak VO2 walked a longer distance in ISWT than 6MWT (r = 0.590, p < 0.001). Conclusions: The ISWT more highly correlates with peak VO2 than the 6MWT and has excellent reliability in patients with COPD. According to peak VO2, the walking distances of each field test varied, suggesting that the application should be personalized for the exercise capacity.

Stronger correlation of peak oxygen uptake with distance of incremental shuttle walk test than 6-min walk test in patients with COPD: a systematic review and meta-analysis

Background

The 6-min walk test (6MWT) and incremental shuttle walk test (ISWT) are valid and reliable measures to assess exercise capacity of patients with chronic obstructive pulmonary disease (COPD). However, the comparison of correlation between peak oxygen uptake (peak VO₂) and 6MWT or ISWT distance has not been investigated. We aimed to investigate the correlation between peak VO₂ and 6MWT and ISWT distances in COPD patients through a meta-analysis.

Methods

We systematically searched MEDLINE, Scopus, Embase, and the Cochrane Library up to June, 2020 for studies comparing the correlation of peak VO₂ with either 6MWT or ISWT in COPD patients. Meta-analysis was performed with R software using a fixed-effect model. We compared the correlation coefficient and measured the heterogeneity using I² statistics.

Results

We identified 12 studies involving 746 patients. Meta-analysis showed a significant correlation between peak VO₂ and 6MWT and ISWT distances (6MWT: r = 0.65, 95% CI 0.61–0.70; ISWT: r = 0.81, 95% CI 0.74–0.85; p < 0.0001). The heterogeneity was lower in ISWT than in 6MWT (6MWT: I² = 56%, p = 0.02; ISWT: I² = 0%, p = 0.71). Subgroup analysis showed a higher correlation coefficient in the low exercise capacity group than in the high exercise capacity group in both field tests.

Conclusions

6MWT and ISWT significantly correlated with peak VO₂. Our findings suggest that ISWT has a stronger correlation with peak VO₂ than 6MWT. The exercise capacity in COPD patients may affect the strength of the relationship between peak VO₂ and walking distance in both field tests, suggesting the importance of using various exercise tests.

Trial registration CRD 42020200139 at crd.york.ac.uk/prospero/

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01897-0.

Association between 6 min pegboard and ring test and arm performance in GOLD stage II-III patients

BACKGROUND

The 6 min pegboard and ring test (6PBRT) is a valid and reproducible test of unsupported arm exercise endurance. The aim of this study was to determine the associations between the 6PBRT, activities of daily living (ADL) and hemoglobin levels in chronic obstructive pulmonary disease (COPD).

METHODS

This study included 40 stable patients with COPD. All participants underwent the 6PBRT, peripheral venous blood sampling, arm ergometer test and the Glittre-ADL and ADL simulation tests for the ADLs performance.

RESULTS

An average 172.51 ± 25.94 rings were moved in 6 min. The number of rings in 6PBRT was significantly positively correlated with the number of cycles in ADL simulation test (r = 0.553, p < 0.001), peak oxygen consumption in arm ergometer (r = 0.381, p = 0.024) and serum hemoglobin level (r = 0.411, p = 0.011).

CONCLUSION

The number of rings moved in the 6PBRT is associated with ADL simulation test performance that reflects upper extremity ADLs. Therefore, the 6PBRT can be used for estimating limitation in upper extremity ADLs as a simple and quick evaluation in patients with GOLD stage II-III COPD.

The therapeutic role of motor imagery during the chronic phase after total knee arthroplasty: a pilot randomized controlled trial

BACKGROUND

There is now ample evidence that motor imagery contributes to enhance motor learning and promote motor recovery in patients with motor disorders. Whether motor imagery practice is likely to facilitate mobility in patients suffering from knee osteoarthritis, at 6-months after total knee arthroplasty, remains unknown.

AIM

This trial was designed to evaluate the therapeutic effectiveness of implementing motor imagery into the classical course of physical therapy at 6-months after total knee arthroplasty.

DESIGN

Randomized controlled trial.

POPULATION

Twenty-four patients with unilateral total knee arthroplasty were assigned to a motor imagery or control group in a test-retest procedure, following a rehabilitation program as outpatients.

METHODS

During both the pre- and post-test, a set of strength and functional mobility measures were assessed: quadriceps strength, peak knee flexion during the swing phase, performance at the timed up and go test, stair climbing test, and 6-minute walk test, and finally Oxford knee score. In addition to a common physical therapy program, the motor imagery group practiced additional motor imagery exercises, while participants of the control group were subjected to a period of neutral activities for an equivalent amount of time.

RESULTS

Data provided evidence that motor imagery enhanced the quadriceps muscle strength of the operated knee (F (1, 22)=10.36, P=0.003), improved the peak knee flexion during the swing phase (F (1, 22)=31.52, P<0.001), and increased the speed to climb and descend stairs (F (1, 22)=14.28, P=0.001).

CONCLUSIONS

This study demonstrated the effectiveness of motor imagery exercises in gait performance and functional recovery in a small sample of individuals who underwent total knee arthroplasty. However, before drawing final conclusions sample size calculation should be conducted in the future.

CLINICAL REHABILITATION IMPACT

While waiting for further research, our findings encourage incorporating motor imagery exercises into classical physical therapy protocols at 6-months after total knee arthroplasty.

Systematic review of the association between exercise tests and patient-reported outcomes in patients with chronic obstructive pulmonary disease

Introduction

Chronic obstructive pulmonary disease (COPD) is an increasingly common cause of death worldwide. Its cardinal symptoms include breathlessness and severely reduced exercise capacity. Several patient-reported outcome (PRO) measures are used to assess health-related quality of life (HRQoL), functional performance, and breathlessness in patients with COPD. Exercise testing is employed to measure functional performance objectively, which is generally believed to impact on overall HRQoL. However, the extent to which commonly used laboratory- and field-based exercise test results correlate with PROs has not been systematically assessed.

Materials and methods

A search of Embase, MedLine, and the Cochrane Library identified primary publications in English that reported data on the correlations (Pearson’s r or Spearman’s ρ) between the outcomes of exercise tests and HRQoL and breathlessness PROs. Studies reporting on the following tests were included: 6-minute walk test (6MWT), 12MWT, incremental and endurance shuttle walk tests, incremental and endurance cycle ergometer tests, and treadmill tests.

Results

Of 3,205 articles screened, 28 were deemed eligible for inclusion. The most commonly reported HRQoL PRO measure was the St George’s Respiratory Questionnaire (13 studies), and the most commonly reported breathlessness PRO measure was the Baseline Dyspnea Index (six studies). The St George’s Respiratory Questionnaire appears to correlate very weakly to moderately with the 6MWT, and breathlessness PROs appear to be moderately to strongly associated with 6MWT outcomes. Across all studies, the 6MWT was the most commonly reported exercise test. Very few publications reporting associations between other exercise tests and PRO measures were found.

Conclusion

This review found evidence to support the association of 6MWT outcomes with HRQoL and breathlessness PROs. There were limited data showing correlations with the outcomes of other exercise tests. Further work is required to examine the associations between these PROs and exercise test outcomes.

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.

Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others.

Systematic Review of the Association Between Laboratory- and Field-Based Exercise Tests and Lung Function in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Typical symptoms of chronic obstructive pulmonary disease (COPD) include breathlessness and reduced exercise capacity. Several laboratory- and field-based exercise tests are used to assess the exercise capacity of patients with COPD. It is unclear whether these exercise tests reflect the spirometric measures recommended for diagnosis of COPD. We therefore aimed to systematically assess the correlation between these exercise tests and common measures of lung function. Methods: A search of Embase™, MEDLINE^® and The Cochrane Library identified primary publications in English that reported data on the correlations (Pearson's r or Spearman's rho) between the outcomes of exercise tests and the physiological measures of interest: forced expiratory volume in 1 second (FEV₁), forced vital capacity, inspiratory capacity and arterial oxygen saturation. We included studies reporting on the following exercise tests: 6- and 12-minute walk tests (6MWT and 12 MWT), incremental and endurance shuttle walk tests, incremental and endurance cycle ergometer tests, and treadmill tests. Results: Of 1781 articles screened, 45 were ultimately deemed eligible for inclusion in this review. The most commonly reported lung function variable was FEV₁ (reported by 39 studies); the most commonly reported exercise test was the 6-minute walk test (reported by 24 studies). FEV₁ appears to correlate moderately-to-strongly with 6MWT and 12MWT; and moderately-to-very strongly with incremental cycle ergometer tests (ICET); evidence for other exercise tests was limited. Conclusion: There is evidence that 6MWT, 12MWT and ICET correlate with FEV₁ to some degree; - evidence for associations of other exercise tests with measures of lung function in patients with COPD is limited. Clinicians must consider this when deciding to use these tests. Further comparisons of these tests must be made in order to assess which physiological and hemodynamic characteristics they reflect in patients with COPD.

Comparison of laboratory- and field-based exercise tests for COPD: a systematic review

Exercise tests are often used to evaluate the functional status of patients with COPD. However, to the best of our knowledge, a comprehensive systematic comparison of these tests has not been performed. We systematically reviewed studies reporting the repeatability and/or reproducibility of these tests, and studies comparing their sensitivity to therapeutic intervention. A systematic review identified primary manuscripts in English reporting relevant data on the following exercise tests: 6-minute walk test (6MWT) and 12-minute walk test, incremental and endurance shuttle walk tests (ISWT and ESWT, respectively), incremental and endurance cycle ergometer tests, and incremental and endurance treadmill tests. We identified 71 relevant studies. Good repeatability (for the 6MWT and ESWT) and reproducibility (for the 6MWT, 12-minute walk test, ISWT, ESWT, and incremental cycle ergometer test) were reported by most studies assessing these tests, providing patients were familiarized with them beforehand. The 6MWT, ISWT, and particularly the ESWT were reported to be sensitive to therapeutic intervention. Protocol variations (eg, track layout or supplemental oxygen use) affected performance significantly in several studies. This review shows that while the validity of several tests has been established, for others further study is required. Future work will assess the link between these tests, physiological mechanisms, and patient-reported measures.

An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease

This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic respiratory disease.

Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013.

The 6-min walking distance (6MWD) is a reliable measure (intra-class correlation coefficients ranged from 0.82 to 0.99 in seven studies). There is a learning effect, with greater distance walked on the second test (pooled mean improvement of 26 m in 13 studies). Reliability was similar for ISWT and ESWT, with a learning effect also evident for ISWT (pooled mean improvement of 20 m in six studies). The 6MWD correlates more strongly with peak work capacity (r=0.59–0.93) and physical activity (r=0.40–0.85) than with respiratory function (r=0.10–0.59). Methodological factors affecting 6MWD include track length, encouragement, supplemental oxygen and walking aids. Supplemental oxygen also affects ISWT and ESWT performance. Responsiveness was moderate to high for all tests, with greater responsiveness to interventions that included exercise training.

The findings of this review demonstrate that the 6MWT, ISWT and ESWT are robust tests of functional exercise capacity in adults with chronic respiratory disease.

Patient-reported physical activity questionnaires: a systematic review of content and format

Background

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.

Methods

Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers.

Results

104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories.

Conclusions

A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.

Utility of the late life function and disability instrument as an outcome measure in patients participating in outpatient cardiac rehabilitation: a preliminary study

PURPOSE

The purpose of this study was to examine the concurrent validity of the Late Life Function and Disability Instrument (LLFDI) in patients with coronary heart disease (CHD) and to evaluate the accuracy of information obtained through self-report questionnaire versus interview formats.

METHODS

The study included 29 patients older than 60 years attending an outpatient cardiac rehabilitation program. Participants completed the LLFDI, three additional self-report criterion measures, and six performance-based tests; they completed the LLFDI a second time via interview. We used descriptive statistics, correlations, and t-tests to analyze the data.

RESULTS

All LLFDI components were correlated (rs=0.36-0.83) with the self-report criterion measures. The Function Component of the LLFDI was moderately correlated with the 6-Minute Walk Test (r=0.62), timed up-and-go (r=-0.58), walking speed (r=-0.57), and timed sit-to-stand (r=-0.56) scores. The LLFDI demonstrated a ceiling effect (10%) only in the Disability Limitation component. All LLFDI component scores obtained via self-report questionnaire were correlated with scores obtained via interview; except in a single subcategory, there was no difference between LLFDI scores obtained through self-report questionnaire and those obtained through interview.

CONCLUSIONS

RESULTS indicate that the LLFDI has appropriate validity for older patients (>60 years) with CHD and can be completed independently by patients rather than administered by clinicians.

How should we measure arm exercise capacity in patients with COPD? A systematic review

BACKGROUND

There are no recommendations on how to measure arm exercise capacity in individuals with COPD. The objectives of this study were (1) to synthesize the literature on measures of arm exercise capacity in individuals with COPD, (2) to describe the psychometric properties and the target construct of each measure, and (3) to make recommendations for clinical practice and research.

METHODS

Studies conducted in patients with COPD that included a measure of arm exercise capacity were identified after searches of five electronic databases (PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library) and reference lists of pertinent articles. One reviewer performed data extraction, and two assessed the quality of the studies that described measurement properties, using the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist.

RESULTS

Of 654 reports, 41 met the study criteria. Five types of arm exercise tests were identified: arm ergometry, ring shifts, dowel lifts, proprioceptive neuromuscular facilitation, and activities of daily living. Four studies assessed the measurement properties of the unsupported upper-limb exercise test (UULEX), the 6-min pegboard and ring test (6PBRT), a test involving weight shifts, and the grocery-shelving task (GST). Validity studies were of fair to good quality, whereas reliability studies were of poor quality.

CONCLUSIONS

Arm ergometry may be the best method for measuring peak supported arm exercise capacity and endurance. The UULEX, 6PBRT, and GST may better reflect activities of daily living and should be the tests of choice to measure peak unsupported arm exercise capacity (UULEX) and arm function (6PBRT and GST).

Functional assessment of chronic obstructive pulmonary disease

PURPOSE

To describe available methods for assessing functional capacity in persons with chronic obstructive pulmonary disease (COPD).

DATA SOURCES

An extensive literature review is used to provide pertinent information.

CONCLUSIONS

COPD disease affects millions of Americans and is physically and psychologically distressing. The hallmark of chronic obstructive pulmonary disease is irreversible airflow limitation and dyspnea. Dyspnea is a major contributor to decreased exercise capacity and functional status in this population. Understanding the methods to complete a functional assessment is important for all practitioners caring for this population.

IMPLICATIONS FOR PRACTICE

This paper provides an overview of current methods used to assess functional status, including pulmonary function testing, exercise testing, and anthropomorphic and self-report measurements. In addition, there is discussion of the indications and contraindications for exercise testing in chronic obstructive pulmonary disease and the clinical significance of performing a global composite of functional ability.

Predicting exercise capacity through submaximal fitness tests in persons with multiple sclerosis

OBJECTIVE

To estimate, for persons with multiple sclerosis (MS), the extent to which peak oxygen consumption (Vo(2)peak) can be predicted by the results on submaximal tests.

DESIGN

Cross-sectional study.

SETTING

Three MS clinics in the Greater Montreal region, Canada.

PARTICIPANTS

A center-stratified random sample of 135 women and 48 men was drawn (N=183). A subgroup of 59 subjects with MS, who were able to perform the step test, was selected from this sample to complete the maximal exercise test.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Vo(2)peak.

RESULTS

In this sample (mean age +/- SD, 39 +/- 9 y; median Expanded Disability Status Scale=1.5), the mean Vo(2)peak +/- SD was 27.6 +/- 7.3 mL.kg(-1).min(-1). This value is considerably low when compared with healthy persons, ranking below the 25th percentile for both men and women. In a multivariate regression analysis, the step test and grip strength were identified as the only significant predictors of Vo(2)peak. When combined with body weight, grip strength and the step test explained 74% of the variance in Vo(2)peak.

CONCLUSIONS

Patients with MS with a mild degree of disability exhibit marked reductions in exercise capacity. Also, in persons with MS, submaximal tests are good predictors of exercise capacity. These measures may be used in clinical settings to help assess and monitor maximum oxygen consumption and in research to evaluate the effect of exercise-related interventions. Furthermore, they will allow people with MS to self-monitor their exercise capacity and be more actively engaged in taking charge of their fitness level.

A lifestyle activity intervention in patients with chronic obstructive pulmonary disease

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients have lower levels of physical activity compared to age-matched controls, and they limit physical activities requiring normal exertion. Our purpose was to compare the effectiveness of a traditional exercise therapy (TET) program with a behavioral lifestyle activity program (LAP) in promoting physical activity.

METHODS

Moderate physical activity (kcal/week) was assessed in 176 COPD patients using the Community Health Activities Model for Seniors questionnaire. Patients were randomized to either a three month TET program that meet thrice weekly or a LAP. The LAP was designed to teach behavioral skills that encouraged the daily accumulation of self-selected physical activities of at least moderate intensity. Interventionist contact was similar (36 h) between the two groups. Patients were assessed at baseline and 3, 6 and 12 months.

RESULTS

Compared to baseline values, self-reported moderate physical activity increased three months post-randomization with no significant difference (p = 0.99) found between the TET (2501 +/- 197 kcal/week) and the LAP (2498 +/- 211 kcal/week). At 6 and 12 months post-randomization, there were no significant differences (p = 0.37 and 0.69, respectively) in self-reported levels of moderate physical activity between the TET (2210 +/- 187 and 2213 +/- 218 kcal/week, respectively) and the LAP (2456 +/- 198 and 2342 +/- 232 kcal/week, respectively).

CONCLUSION

Although there was no difference between treatment groups, the TET and the LAP were both effective at in increasing moderate levels of physical activity at 3 months and maintaining moderate physical activity levels 12 months post-randomization. This clinical trial is registered with ClinicalTrials.gov. Its identifier is NCT00328484.

Paced-walk and step tests to assess exertional dyspnea in COPD

This study reports on the development and test-retest reproducibility of a modified shuttle walking and step testing protocols to assess exertional dyspnea in patients with COPD. Patients with COPD randomly performed four externally paced 3-min bouts of shuttle walking at 1.5, 2.5, 4.0 and 6.0 km x h(- 1) or stepping at constant rate of 18, 22, 26 and 32 steps x min(- 1). Walking and stepping procedures were repeated once, on a separate occasion. Ventilation, heart rate, gas exchange parameters and dyspnea Borg scores were obtained at the end of each exercise bout. Most patients completed walking or stepping at the slow and middle speed cadences but only 33% completed walking at 6.0 km x h(- 1) and 40% completed stepping at 32 steps x min(- 1). Walking and stepping at progressively faster pace caused a progressive increase in ventilation and dyspnea. Test-retest Pearson correlation coefficients for ventilation, heart rate, gas exchange parameters and dyspnea scores over the four exercise bouts, all exceeded 0.80. Intra-class correlation coefficients were at least as strong as Pearson coefficients. Bland & Altman representation showed that for repeated Borg scores, 92 and 96% of points lied within 2 SD of the mean difference between test-retest values for walking and stepping. The majority of moderate and severe COPD patients completed the 3-min shuttle waking testing at 1.5 to 4.0 km x h(- 1) and the 3-min of step testing at rates between 18 and 26 steps x min(- 1). Both field tests were highly reproducible in patients with COPD.

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients

BACKGROUND

Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health.

METHODS

This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV1%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used.

RESULTS

Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV1%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV1%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%-51%).

CONCLUSION

Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.

Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee

AIM

This paper reports a study of the effects of aquatic exercise on physical fitness (flexibility, strength and aerobic fitness), self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee.

BACKGROUND

Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement. Exercise is important for preventing and/or managing the functional limitations associated with joint disease. Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis; however, few studies have examined the effects on people with osteoarthritis, and these have yielded inconsistent results.

METHODS

A two-group randomized controlled trial with a convenience sample was used. Participants were recruited from community sources and randomly assigned to a 12-week aquatic programme or a non-exercise control condition. Data for 38 participants were collected at baseline, week 6, and week 12 during 2003 and 2004. Instruments were a standard plastic goniometer, a handheld dynamometer, the 6-minute walk test, the multidimensional Health Assessment Questionnaire, and a visual analogue scale for pain.

RESULTS

Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility, strength and aerobic fitness, but had no effect on self-reported physical functioning and pain. The exercise adherence rate was 81.7%, and no exercise-related adverse effect was observed or reported.

CONCLUSIONS

Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee. Although the programme may not offer pain relief or self-reported improvements in physical functioning, results suggest that aquatic exercise does not worsen the joint condition or result in injury. Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients.

Development of an Unsupported Arm Exercise Test in Patients With Chronic Obstructive Pulmonary Disease

BACKGROUND

Unsupported arm exercise tests have been used to evaluate the effects of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD), but the reliability and validity of these tests are not established.

OBJECTIVE

We evaluated the test-retest reliability and validity of a 6-minute pegboard and ring test (PBRT) in 27 outpatients with COPD and 30 age-matched controls.

METHODS

We evaluated a 6-minute PBRT, subject demographics, pulmonary function and disease-specific quality of life questionnaire, and the Pulmonary Functional Status Dyspnea Questionnaire-Modified version in 27 patients with COPD.

RESULTS

Highly significant correlation coefficients (r = .91, P < .001) were found between test and retest of PBRT scores. Statistically significant correlation coefficients were found between PBRT scores and pulmonary function tests such as FEV1% pred and FVC% pred, and activity domain and subdomain of Pulmonary Functional Status Dyspnea Questionnaire-Modified (P <or= .045). In addition, PBRT scores of healthy subjects were significantly higher than those of COPD subjects (P < .001), and were inversely related to age (P = .031). The FEV1% predicted and gender together accounted for 50% of the variance in the PBRT scores of patients with COPD.

CONCLUSION

PBRT is a reliable and valid method to assess unsupported arm exercise endurance in patients with COPD.

The Reconditioning Exercise and Chronic Obstructive Pulmonary Disease Trial II (REACT II): rationale and study design for a clinical trial of physical activity among individuals with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality in the United States. In addition, persons with COPD are at risk for lower levels of physical activity, leading to further morbidity and mortality. Several studies have demonstrated that long-term exercise therapy confers benefits upon physical functioning among patients with COPD, and some studies indicate that embedding cognitive-behavioral interventions into group-mediated exercise programs is useful in promoting compliance to activity recommendations. However, compliance to long-term activity is low among COPD patients, and the effectiveness of behavioral interventions to enhance long-term activity among these patients has not been extensively explored. Thus, the primary objective of the Reconditioning Exercise and COPD Trial II (REACT II) trial is to determine whether a group-mediated cognitive-behavioral intervention will result in increased physical activity after 12 months, compared to a standard exercise therapy experience among older adults with COPD. The cognitive-behavioral intervention is designed to promote independent physical activity by encouraging participants to self-regulate physical activity with minimal dependence upon staff. The primary study outcome is kcal expended per week in moderate physical activity, and the study is designed to provide 90% power to detect a 400 kcal/week difference in moderate energy expenditure between the two intervention groups. Other outcomes to be compared between the two interventions include physical function, self-reported physical disability, health-related quality of life, exercise capacity, body composition and inflammatory mediators.

Exercise barrier and task self-efficacy in breast cancer patients during treatment

Understanding exercise self-efficacy in breast cancer patients during treatment is important for enhancing physical activity adherence. Therefore, the primary study purpose was to determine, among breast cancer patients during treatment, the psychometric properties of scales to measure exercise barrier and task self-efficacy. The study also aimed to determine the following: (1) level of self-efficacy, (2) associations between barrier and task self-efficacy, and (3) associations between self-efficacy and patient age, race, and treatment type. Eighty-six female breast cancer patients recruited from a medical oncologist's office completed the scales once, and 46 repeated the scales 2 weeks later. The majority were Caucasian (95%), with 26% receiving chemotherapy, 64% hormonal therapy alone, and 5% radiation/other. The mean age was 59+/-14 years. The Cronbach's alpha for the nine-item barrier self-efficacy scale was 0.96, with a test-retest correlation of 0.89 (p<0.001). The Cronbach's alpha for the four-item task self-efficacy scale was 0.89, with a test-retest correlation of 0.83 (p<0.001). The mean barrier self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to exercise when nauseated. The mean task self-efficacy was slightly to moderately confident, with the lowest confidence reported in the ability to jog for 10 min without stopping. Although no significant associations were found between self-efficacy and participant's race or treatment type, lower task self-efficacy was associated with older age (r=-0.36, p=0.001). Both self-efficacy scales demonstrated good internal consistency and test-retest reliability. Self-efficacy may be a useful target for physical activity interventions among breast cancer patients during treatment.

Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease

PURPOSE

To compare measures of balance, coordination, and mobility between patients with chronic obstructive pulmonary disease (COPD) and healthy control subjects, and to determine whether differences in these measures are associated with measures of disease severity.

METHODS

The subjects were divided into three groups: 15 patients with COPD who required the use of supplemental oxygen (WO), 15 patients with COPD who did not require the use of supplemental oxygen (NO), and 21 healthy control subjects (CO). The subjects performed spirometry and several measures of balance, coordination, and mobility including the Community Balance and Mobility Scale, the timed up and go test, the fast-gait speed test, posturography, and both a finger-to-nose test and a toe-tapping coordination test. Significance was set at an alpha less than 0.05.

RESULTS

When control was used for age, significant differences were found between the WO group and the CO group for the finger-to-nose test, and for both the sway index and peak sway index for the eyes open, moving-platform test. Differences were found among all three groups for the Community Balance and Mobility Scale overall score. The scores for the WO group were significantly worse than for the NO group on the timed up and go and the fast-gait speed tests. Moderate correlation was found among all of the measures, demonstrating significant differences in forced-expiratory volume in 1 second (FEV1), peak expiratory flow, and forced-expiratory volume. When controls were used for both age and FEV1, between-group differences disappeared.

CONCLUSIONS

Patients with COPD exhibit deficiencies in functional balance, coordination, and mobility tasks associated with disease severity or differences in activity levels, but not in the requirement for supplemental oxygen.

Reliability of the 400-m usual-pace walk test as an assessment of mobility limitation in older adults

OBJECTIVES

To assess the test-retest reliability of the 400-m usual-pace walk test (400-MWT), and to determine whether the 4-m walk test predicts inability to walk 400 m.

DESIGN

Observational.

SETTING

Community, 20-m tract course.

PARTICIPANTS

Sixty study participants (aged>or=65) were enrolled from the community and met the following eligibility criteria: self-reported difficulty in two or more of four functional domains (mobility and exercise tolerance, upper extremity function, basic self-care, higher functional tasks of independent living) and a score of 18 or higher on the Mini-Mental State Examination.

METHODS

The 400-MWT and 4-m walk test were each repeated within 7 days.

RESULTS

The mean age+/-standard deviation of the study population was 84.3+/-6.3; 88.3% were women. Nineteen participants (31.7%) failed both 400-MWTs, and 41 successfully completed both tests (kappa=1). Mean walking speed for the 4-m test was 0.87+/-0.18 m/s for those who completed the 400-MWT and 0.53+/-0.17 m/s for those who failed (P<.001). The Spearman correlation coefficient between 4-m and 400-m walking speeds was 0.93. The estimated area under the receiver operating characteristic curve between 4-m walking speed and the ability to perform the 400-MWT was 0.91. The 4-m gait speed averaged less than 0.6 m/s in 80% of subjects who failed the 400-MWT.

CONCLUSION

The test-retest reliability for inability to complete the 400-MWT is high. Four-m walking speed is highly predictive of ability to perform the 400-MWT. These findings may prove useful to future clinical trials and observational studies that involve assessment of mobility limitations in older adults.

Perceived difficulty, importance, and satisfaction with physical function in COPD patients

BACKGROUND

Research suggests that patients' satisfaction with their physical functioning (SPF) is a critical component of HRQL. This study was designed to examine the extent to which perceptions of physical function and the value placed on physical function are related to satisfaction ratings. The sample consisted of older adults suffering from a progressively debilitating disease, chronic obstructive pulmonary disease (COPD).

METHODS

During baseline assessments, COPD patients participating in a randomized controlled physical activity trial completed measures of SPF, perceived difficulty, and perceived importance.

RESULTS

An ANCOVA controlling for age and gender indicated that perceived difficulty, perceived importance, and their interaction accounted for 43% of the variance in SPF. Additionally, participants were most satisfied with important tasks that they performed with little difficulty. Participants were least satisfied with important tasks that they perceived as highly difficult.

CONCLUSION

The results of the present study indicate that not being able to perform valued tasks produces discontent that is reflected in lower rating of satisfaction with physical functioning. Clearly, the significance of loss in function to individual patients is related to the importance of the functional activities that may be compromised. These data have implications for the scope of patient assessment in clinical care and for the conceptual basis of future research in the area of physical functioning.

Walking performance and cardiovascular response: associations with age and morbidity--the Health, Aging and Body Composition Study

BACKGROUND

The long-distance corridor walk is a timed 400-meter walk test used to assess walking endurance in well-functioning men and women aged 70-79 in the Health, Aging and Body Composition Study.

METHODS

We examined walking time along with heart rate and blood pressure response in relationship to prevalent chronic conditions, weight, physical activity, and markers of subclinical disease. Of 3075 participants, 2324 (76%) completed the test with heart rate and blood pressure responses in the range expected for a moderate level of exertion.

RESULTS

Slower walking time was influenced by both clinical and subclinical disease, and also was strongly related to both low and high body weight and low self-reported physical activity. Heart rate and blood pressure responses were higher with several clinical and subclinical diseases, but heart rate response and recovery were more strongly related to walking time than to disease. Higher body mass index and lower physical activity were associated with greater heart rate response and recovery.

CONCLUSIONS

The independent contribution of both clinical and subclinical disease to walking time supports the use of walking tests as a summary measure of disease in older adults. The independent association of walking time with physical activity suggests that it is sensitive to levels of fitness as well. Together these findings show that walking performance is a valid indicator of physiologic reserve in older adults.

A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease

PURPOSE

To compare the effects of short-term (3 months) and long-term (18 months) involvement in an exercise program on self-reported disability and physical function in patients with chronic obstructive pulmonary disease (COPD).

METHODS

A total of 140 patients with COPD were studied in a randomized, single-blinded clinical trial. Self-reported disability and physical function were assessed using a 21-item questionnaire, a 6-minute walk, timed stair climb, and an overhead task.

RESULTS

At the completion of the trial, participants in the long-term intervention reported 12% less disability than those in the short-term intervention (adjusted mean with 95% confidence interval, 1.53 (1.43-1.63) versus 1.71 (1.61 to 1.81) units, respectively; P=.016), walked 6% farther during 6-minutes (1,815.0 [1,750.4-1,879.6] vs 1,711.5 [1,640.7-1,782.3] feet, respectively), climbed steps 11% faster (11.6 [11.0-12.2] vs 12.9 [12.3-13.5] seconds, respectively), and completed an overhead task 8% faster (46.8 [44.4-49.2] vs 50.4 [47.8-53.0] seconds, respectively) than those in the short-term intervention.

CONCLUSION

An 18 month exercise program results in greater improvements in self-reported disability and physical function in patients with COPD when compared with a 3-month exercise program. As such, long-term exercise should be recommended for all patients with COPD.

Estudo de correlação entre provas funcionais respiratórias e o teste de caminhada de seis minutos em pacientes portadores de doença pulmonar obstrutiva crônica

Introdução: A espirometria e a gasometria são largamente utilizadas na estimativa da limitação ventilatória e do prognóstico de pacientes portadores de doença pulmonar obstrutiva crônica. Entretanto, testes físicos funcionais, como o teste de caminhada de seis minutos (Tc6), têm surgido como complemento na avaliação dinâmica de portadores de doença pulmonar obstrutiva crônica. Objetivo: Determinar as correlações entre as provas funcionais respiratórias e o teste de caminhada de seis minutos em portadores de DPOC. Pacientes e métodos: 45 pacientes foram submetidos à coleta de história clínica e a exame físico completo realizado pela equipe médica do Serviço de Pneumologia do Hospital Universitário de Brasília. Em seguida, foi realizada a avaliação das variáveis espirométricas, gasométricas, das pressões respiratórias e o teste de caminhada de seis minutos (Tc6). Resultados: Observaram-se correlações positivas estatisticamente significativas (p < 0,05) das variáveis VEF1, PaO2, SpO2 e Pe máx em relação ao teste de caminhada de seis minutos. Conclusões: O teste de caminhada de seis minutos correlacionou-se de forma significativa (p < 0,05) e positiva e pode ser utilizado como instrumento alternativo na avaliação funcional do paciente portador de DPOC.