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Leonardi NT, Kawakami DMO, Hurst JR, Cruz J, Mendes RG. Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties. Eur Respir Rev 2023; 32:230013. [PMID: 37437913 DOI: 10.1183/16000617.0013-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Hospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD. METHODS A systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS 13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties. CONCLUSION Measurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management.
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Affiliation(s)
- Naiara Tais Leonardi
- Department of Physical Therapy, Federal University of Sao Carlos, São Paulo, Brazil
| | | | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Joana Cruz
- School of Health Sciences of the Polytechnic of Leiria, Leiria, Portugal
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Azman MZB, Huang KS, Koh WJ, Leong SS, Ong B, Soon JL, Tan SW, Chan MY, Yang M, Yeung MT. Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years. PLoS One 2023; 18:e0291132. [PMID: 37669286 PMCID: PMC10479918 DOI: 10.1371/journal.pone.0291132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The validated Incremental Shuttle Walk Test (ISWT) is widely used for evaluating maximal exercise capacity, with the distance-walked (IWSD) as the primary outcome. However, there are no normative reference values (NRV) and reference equations to predict ISWD for the Singaporean population. OBJECTIVES This study aims to establish the NRV and reference equations for ISWD in healthy Singaporeans aged 21 to 80 and investigate the determining variables during ISWT. METHODS This cross-sectional study recruited community-dwelling healthy subjects aged 21-80 from the community via convenience sampling. Each subject completed two trials of the ISWT according to the standard protocol. Variables measured during the trials included ISWD, pre-and post-test heart rate (HR), oxygen saturation, blood pressure (BP), modified Borg's dyspnoea score and Borg's rate of perceived exertion (RPE). RESULTS 199 healthy Singaporean (females = 114, males = 85) participated in the study. The overall median ISWD was 660.0 metres (m) [interquartile range (IQR):440.0-850.0]. The age-stratified mean ISWD ranged from 430.0 m (IQR:350.0-450.0) (aged 60-80) to 480.0 m (IQR:438.0-650.0) (aged 40-59) to 780.0 m (IQR:670.0-960.0) (aged 21-39). Gender, age, weight, height and HR change (highest post-test HR minus pre-test HR) were the most significant variables (p < 0.001). IWSD (m) = 651.4(Height, m) +89.7(Gender, male = 1; female = 0) -6.31(Age, years) -3.61(Weight, kilograms) +2.54(HR change, beats per minute); R2 = 0.741. Previously published ISWT reference equations cannot accurately predict the ISWD in the Singaporean population. CONCLUSIONS This study investigated the ISWD NRV and established reference equations for healthy Singaporeans aged 21-80. The information would be beneficial in setting performance benchmarks to guide physical assessment, intervention and rehabilitation.
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Affiliation(s)
- Muhammad Zulhaziq Bin Azman
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Katherin S. Huang
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Wei Jun Koh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Sarah S. Leong
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Benjamin Ong
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Sengkang General Hospital, Singapore, Singapore
| | - Johanna L. Soon
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sherman W. Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Melissa Y. Chan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Mingxing Yang
- Department of Physiotherapy, Singhealth Polyclinics, Singapore, Singapore
| | - Meredith T. Yeung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
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Silva GAG, Santos JSFD, Dantas DDS, Fernandes ATDNSF, Lima ÍNDF. Physiological responses of incremental and endurance shuttle walk tests in patients with chronic obstructive pulmonary disease (COPD): narrative review. European Journal of Physiotherapy 2020. [DOI: 10.1080/21679169.2020.1754463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gabriely Azevêdo Gonçalo Silva
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
| | - Juliana Simonelly Felix dos Santos
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
| | - Diego de Souza Dantas
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
| | | | - Íllia Nadinne Dantas Florentino Lima
- Postgraduate Program in Rehabilitation Sciences, Faculdade de Ciências da Saúde do Trairi- FACISA, Universidade Federal do Rio Grande do Norte – UFRN, Santa Cruz, Brazil
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Leone M, Duvergé S, Kalinova É, Bui HT, Comtois AS. Comparison of bioenergetics of walking during a multistage incremental shuttle walk test and a 6-min walk test in active older adults. Aging Clin Exp Res 2017; 29:239-246. [PMID: 26971801 DOI: 10.1007/s40520-016-0555-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Abstract
The goal of the present research was to compare the bioenergetics variability of walking, during the 6-min walk test (6-MWT) and a multistage incremental shuttle walk test (MISWT) in an active older population. Twenty-two healthy physically active older adults with a group mean age of 70.4 ± 5.8 years completed the 6-MWT and the MISWT. Heart rate (HR), walking speed and walking [Formula: see text]O2 were measured throughout each test with a portable metabolic cart. Strong correlations were found for the [Formula: see text]O2 peak and the walking speed (r = 0.91 and r = 0.89 respectively for 6-MWT and MISWT). Differences in [Formula: see text]O2 peak values were analysed with a paired Student's t test. Repeated measures ANOVA were conducted to detect differences between tests. The Bland and Altman plot indicates that the average difference between both tests was 2.5 ml kg-1 min-1. MISWT [Formula: see text]O2 peak means were significantly greater than the 6-MWT [Formula: see text]O2 peak mean values (21.6 ± 5.3 vs. 18.9 ± 4.5 ml kg-1 min-1) which indicate bioenergetics differences between the two walking tests. Thus, the MISWT and 6-MWT elicited different walking [Formula: see text]O2 peak and HR suggesting that the MISWT field test challenge the participants to a higher level of cardiovascular and respiratory stress. The walking [Formula: see text]O2 peak recorded for the MISWT was significantly greater than the 6-MWT. Consequently, both tests seem to measure different facets of the aerobic capacity. MISWT seems to be a better indicator of maximal aerobic power whereas the 6-MWT provides more relevant information regarding aerobic endurance in aging population.
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Affiliation(s)
- Mario Leone
- Département des Sciences de la Santé (division Kinésiologie), Université du Québec à Chicoutimi, 555, Boulevard de l'Université, Saguenay, QC, G7H 2B1, Canada.
- Centre de Recherche Universitaire Interdisciplinaire sur la Qualité et les Saines Habitudes de Vie, Université du Québec à Chicoutimi, Chicoutimi, Canada.
| | - Sébastien Duvergé
- Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Canada
| | - Émilia Kalinova
- Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Canada
- Centre de Recherche Universitaire Interdisciplinaire sur la Qualité et les Saines Habitudes de Vie, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Hung Tien Bui
- Département des Sciences Appliquées (Ingénierie), Université du Québec à Chicoutimi, Chicoutimi, Canada
- Centre de Recherche Universitaire Interdisciplinaire sur la Qualité et les Saines Habitudes de Vie, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Alain S Comtois
- Département de Kinanthropologie, Université du Québec à Montréal, Montréal, Canada
- Centre de Recherche Universitaire Interdisciplinaire sur la Qualité et les Saines Habitudes de Vie, Université du Québec à Chicoutimi, Chicoutimi, Canada
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Ushiki A, Nozawa S, Yasuo M, Urushihata K, Yamamoto H, Hanaoka M, Fujimoto K. Associations between the distance covered in the incremental shuttle walk test and lung function and health status in patients with chronic obstructive pulmonary disease. Respir Investig 2016; 55:33-38. [PMID: 28012491 DOI: 10.1016/j.resinv.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/27/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Field walk tests such as the incremental shuttle walk test (ISWT) are simple tests for assessing the degree of disability in individuals with chronic obstructive pulmonary disease (COPD). In the present study, the correlations between exercise performance in the ISWT, lung function, and health status were examined in patients with COPD of varying severities. METHODS A retrospective examination of 277 COPD patients was performed using the ISWT and lung function tests along with assessment of health status using St. George׳s Respiratory Questionnaire (SGRQ). In addition, we assessed the correlations between the walking distance, lung function parameters, and SGRQ scores. RESULTS ISWT distances were poorly correlated with lung function parameters and SGRQ scores in mild COPD patients. In contrast, ISWT distances were significantly correlated with pulmonary function parameters, such as vital capacity (%predicted) and forced expiratory volume in one second, and SGRQ scores in moderate and severe COPD patients. CONCLUSIONS The ISWT is more independent of health status and pulmonary function in patients with mild COPD compared to moderate or severe cases. Therefore, the exercise capacity of patients with mild COPD should be estimated by the ISWT.
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Affiliation(s)
- Atsuhito Ushiki
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Shuhei Nozawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Kazuhisa Urushihata
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621 Japan.
| | - Keisaku Fujimoto
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
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Saglam M, Vardar-Yagli N, Savci S, Inal-Ince D, Aribas Z, Bosnak-Guclu M, Arikan H, Calik-Kutukcu E, Gunes-Yalcin E. Six minute walk test versus incremental shuttle walk test in cystic fibrosis. Pediatr Int 2016; 58:887-93. [PMID: 26756566 DOI: 10.1111/ped.12919] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/21/2015] [Accepted: 01/08/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although both self-paced and externally paced field tests are widely used in cystic fibrosis (CF), it is still unclear whether they induce clinically relevant and similar cardiorespiratory responses. The aim of this study was therefore to compare the incremental shuttle walk test (ISWT) and 6 min walk test (6MWT), and to determine the factors influencing exercise capacity in CF. METHODS Fifty clinically stable CF patients were included in the study. Pulmonary function, peripheral and respiratory muscle strength were assessed, anthropometric measurements were recorded, and 6MWT and ISWT carried out. RESULTS The CF patients covered significantly more distance in the ISWT than 6MWT (P < 0.001). Heart rate response and dyspnea score at the end of the tests and during the recovery phase were significantly higher in the ISWT compared with the 6MWT (P < 0.05). The 6MWT and ISWT had similar moderate-strong correlations with age, height, weight, pulmonary function, respiratory and peripheral muscle strength (P < 0.05). Forty-nine percent of the variance in 6MWT distance was explained by age and forced expiratory volume in 1 s (FEV1 ; R(2) = 0.49, F(2-48) = 22.033, P < 0.001). The variables contributing to ISWT distance were FEV1 , inspiratory muscle strength, and body mass index (R(2) = 0.596, F(3-44) = 20.176, P < 0.001). CONCLUSIONS The ISWT is a better reflection of exercise tolerance in CF than 6MWT. ISWT is a preferable alternative assessment of exercise tolerance in terms of cardiorespiratory response.
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Affiliation(s)
- Melda Saglam
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara, Turkey.
| | - Naciye Vardar-Yagli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara, Turkey
| | - Sema Savci
- School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Deniz Inal-Ince
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara, Turkey
| | - Zeynep Aribas
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Meral Bosnak-Guclu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hulya Arikan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ankara, Turkey
| | - Ebru Gunes-Yalcin
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Johnson-Warrington V, Mitchell KE, Singh SJ. Is a Practice Incremental Shuttle Walk Test Needed for Patients with Chronic Obstructive Pulmonary Disease Admitted to Hospital for an Acute Exacerbation? Respiration 2015; 90:206-10. [DOI: 10.1159/000435960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 06/01/2015] [Indexed: 11/19/2022] Open
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Bell M, Fotheringham I, Punekar YS, Riley JH, Cockle S, Singh SJ. Systematic Review of the Association Between Laboratory- and Field-Based Exercise Tests and Lung Function in Patients with Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis 2015; 2:321-342. [PMID: 28848854 DOI: 10.15326/jcopdf.2.4.2014.0157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- Martin Bell
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, United Kingdom
| | - Iain Fotheringham
- Value Demonstration Practice, Oxford PharmaGenesis Ltd, Oxford, United Kingdom
| | | | - John H Riley
- Global Clinical Development and Respiratory R and D, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Sarah Cockle
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford, United Kingdon
| | - Sally J Singh
- Global Clinical Development and Respiratory R and D, GlaxoSmithKline, Uxbridge, United Kingdom
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Pires-Neto RC, Pereira AL, Parente C, Sant'anna GND, Esposito DD, Kimura A, Fu C, Tanaka C. Characterization of the use of a cycle ergometer to assist in the physical therapy treatment of critically ill patients. Rev Bras Ter Intensiva 2015; 25:39-43. [PMID: 23887758 PMCID: PMC4031855 DOI: 10.1590/s0103-507x2013000100008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/18/2013] [Indexed: 12/03/2022] Open
Abstract
Objective The objective of this study was to use a cycle ergometer to assess
cardiorespiratory changes during active exercise and to verify patients'
satisfaction with this type of activity. Methods A single intervention involving active lower limb exercise was performed with a
cycle ergometer (without load) for 5 minutes. The following variables were
measured before, during and immediately after exercise: heart rate, blood
pressure, respiratory rate, peripheral oxygen saturation and the Borg dyspnea
scale score. Following the exercise, the patients answered a questionnaire to
evaluate their satisfaction with this type of activity. Results A total of 38 patients (65% male) with a mean age of 48 ± 16 years old
participated in the study. Enrolled patients presented a sequential organ failure
assessment (SOFA) score of 2 (0 - 5 scale). During the exercise, 16% of the
patients used ventilation support and 55% of them were breathing at room air. A
comparison of the initial and final values of the variables indicated increases in
the heart rate (92±17 beats/min vs. 95±18 beats/min; p<0.05), the respiratory
rate (19 ± 8 breaths/min vs. 23±8 breaths/min; p<0.05) and the Borg dyspnea
scale score (1.3±1.8 vs. 2.8±2.2; p<0.05). In addition, 85% of the patients
reported enjoying the activity. Only 25% of the patients reported some discomfort,
and 100% of the patients wanted to repeat this type of activity in future
treatments. Conclusion During the cycle ergometer exercises, minor cardiorespiratory changes were
observed in the patients. The evaluated patients reported high satisfaction with
this type of activity.
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Affiliation(s)
- Ruy Camargo Pires-Neto
- Physical Therapy Service, Central Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, Brazil.
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Fotheringham I, Meakin G, Punekar YS, Riley JH, Cockle SM, Singh SJ. Comparison of laboratory- and field-based exercise tests for COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2015; 10:625-43. [PMID: 25834421 PMCID: PMC4372024 DOI: 10.2147/copd.s70518] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Iain Fotheringham
- Value Demonstration Practice, Oxford PharmaGenesis, Oxford, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Georgina Meakin
- Value Demonstration Practice, Oxford PharmaGenesis, Oxford, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Yogesh Suresh Punekar
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - John H Riley
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sarah M Cockle
- GlaxoSmithKline, Uxbridge, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Oliver N, Onofre T, Carlos R, Barbosa J, Godoy E, Pereira E, Guerra RO, Bruno S. Ventilatory and Metabolic Response in the Incremental Shuttle and 6-Min Walking Tests Measured by Telemetry in Obese Patients Prior to Bariatric Surgery. Obes Surg 2015; 25:1658-65. [DOI: 10.1007/s11695-014-1548-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Parreira VF, Janaudis-Ferreira T, Evans RA, Mathur S, Goldstein RS, Brooks D. Measurement properties of the incremental shuttle walk test. a systematic review. Chest 2014; 145:1357-1369. [PMID: 24384555 DOI: 10.1378/chest.13-2071] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The incremental shuttle walk test (ISWT) was developed > 20 years ago and has been used to assess peak exercise capacity in a variety of chronic diseases. The aim of this systematic review is to describe the measurement properties of the ISWT in a clinical population.Methods: Of 800 articles identified by electronic and hand searches, 35 were included. Twenty-one articles included data on the validity of the ISWT, 18 on the reliability, four on the responsiveness,and four on the interpretability.Results: Most of the studies were conducted in patients with COPD (n = 13) or cardiac disease(n = 8). For criterion validity, comparisons between distance covered during the ISWT and peak oxygen consumption reported correlations ranging from 0.67 to 0.95 ( P <.01). Intraclass correlation coefficients for test-retest reliability ranged from 0.76 to 0.99. The ISWT was shown to be responsive to pulmonary rehabilitation and bronchodilator administration. The minimal clinically important difference (MCID) in patients with COPD was 48 m. Predictive equations for the distance in the ISWT are available for healthy individuals.Conclusions: The ISWT can be considered a valid and reliable test to assess maximal exercise capacity in individuals with chronic respiratory diseases. The ISWT has been shown to be responsive to pulmonary rehabilitation and bronchodilator use in individuals with COPD, cystic fibrosis,and asthma. Further studies examining responsiveness and the MCID of the ISWT in patients with conditions other than lung diseases are required for the interpretation of interventions in other populations.
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Affiliation(s)
- Verônica F Parreira
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; CAPES Brazil, West Park Healthcare Centre (Respiratory Medicine), Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tania Janaudis-Ferreira
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England
| | - Rachel A Evans
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sunita Mathur
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England
| | - Roger S Goldstein
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dina Brooks
- Sunnybrook Health Sciences Centre, St. John's Rehabilitation Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Infection, Immunity and Inflammation, School of Medicine, University of Leicester, Leicester, England.
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Abstract
STUDY DESIGN Longitudinal cross-sectional study. BACKGROUND In the early stages after total knee arthroplasty (TKA), quadriceps strength of the operated limb decreases and is substantially less than that of the nonoperated limb. This asymmetry in strength is related to asymmetrical movement patterns that increase reliance on the nonoperated limb. Over time, quadriceps strength in the operated limb increases but remains less than that in age-matched controls without knee pathology, whereas the quadriceps strength in the nonoperated limb gradually decreases. The purpose of this study was to investigate the changes in quadriceps strength and function of both limbs up to 3 years after TKA and to evaluate change in interlimb kinematic and kinetic parameters over time compared to that in age-matched individuals without knee pathology. METHODS Fourteen individuals after TKA and 14 healthy individuals matched for age, weight, height, and sex participated in the study. Outcome measures included kinematics, kinetics, quadriceps strength, and functional performance. RESULTS In participants who underwent TKA, quadriceps strength was significantly different between limbs at 3 months and 1 year after TKA, but not at 3 years after TKA. In this group, there was also a significant improvement in self-reported function between 3 months and 1 year after TKA, but a significant decrease between years 1 and 3 for the physical component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey. In the TKA group, there were few interlimb differences in joint kinematics and kinetics 3 years after TKA, which may be attributed to a combination of worsening in the nonoperated limb, as well as improvement in the operated limb. Differences between participants without knee pathology and those 3 years after TKA still existed for kinematic, kinetic, and spatiotemporal variables. CONCLUSION As interlimb differences in quadriceps strength decrease after TKA, there are concomitant symmetrical improvements in temporospatial and kinetic gait parameters. The symmetry 3 years after TKA in quadriceps strength is primarily the result of progressive weakness in the nonoperated limb.
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Mazzocchi CS, Costa CCD, Canterle DB, Moussalle LD, Colombo C, Teixeira PJZ. Comparação das variáveis fisiológicas no teste de caminhada de seis minutos e no teste da escada em portadores de doença pulmonar obstrutiva crônica. REV BRAS MED ESPORTE 2012. [DOI: 10.1590/s1517-86922012000500002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: A intolerância ao exercício prejudica a realização das atividades de vida diária em portadores de doença pulmonar obstrutiva crônica (DPOC) e a avaliação dessa limitação é fundamental. Objetivo: Comparar o teste de caminhada dos seis minutos (TC6') com o teste da escada (TE) em portadores de DPOC. MÉTODOS: Prospectivo composto por 21 pacientes portadores de DPOC avaliados para um programa de reabilitação pulmonar que realizaram o TC6' e o TE. As variáveis fisiológicas frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2), além da escala de Borg modificada, foram aferidas antes e após cada teste. A distância percorrida era medida ao término de ambos os testes. RESULTADOS: Comparando os momentos (inicial versus final) das variáveis fisiológicas de ambos os testes, foi observado no TC6' (FC 81,1 ± 2,6 versus 98,4 ± 4,4; SpO2 94,9 ± 2,2 versus 90,4 ± 5,0; PSE Borg 0,5 ± 0,8 versus 3,6 ± 2,5) e no TE (FC 86,9 ± 18,8 versus 119,3 ± 14,5; SpO2 94,7 ± 2,5 versus 90,1 ± 4,5; PSE Borg 0,2 ± 0,4 versus 7,0 ± 2,3), sendo que todas as variações foram estatisticamente significativas (p < 0,001) em ambos os testes. Quando avaliada a alteração das variáveis em ambos os testes, verificou-se que a SpO2 obteve redução semelhante (p = 0,912), a FC aumentou significativamente mais no TE (p = 0,006), bem como a PSE Borg (p < 0,001). Em relação à distância percorrida, o TC6' permitiu que os participantes percorressem uma distância significativamente maior do que o TE (404m versus 153m; p < 0,001) CONCLUSÃO: Ambos os testes promoveram alterações fisiológicas significativas. Apesar de o TE representar uma distância significativamente menor, a sobrecarga, bem como a percepção de trabalho, foi significativamente maior.
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HILL KYLIE, DOLMAGE THOMASE, WOON LYNDA, COUTTS DEBBIE, GOLDSTEIN ROGER, BROOKS DINA. Comparing peak and submaximal cardiorespiratory responses during field walking tests with incremental cycle ergometry in COPD. Respirology 2012; 17:278-84. [DOI: 10.1111/j.1440-1843.2011.02089.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elazzazi A, Chapman N, Murphy E, White R. Measurement of Distance Walked and Physiologic Responses to a 6-Minute Walk Test on Level Ground and on a Treadmill. J Geriatr Phys Ther 2012; 35:2-7. [DOI: 10.1519/jpt.0b013e31821c91b1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Marcus RL, Yoshida Y, Meier W, Peters C, Lastayo PC. An Eccentrically Biased Rehabilitation Program Early after TKA Surgery. Arthritis 2011; 2011:353149. [PMID: 22046514 DOI: 10.1155/2011/353149] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 01/10/2011] [Accepted: 02/17/2011] [Indexed: 01/01/2023]
Abstract
Rehabilitation services are less-studied aspects of the management following total knee arthroplasty (TKA) despite long-term suboptimal physical functioning and chronic deficits in muscle function. This paper describes the preliminary findings of a six-week (12 session) eccentrically-biased rehabilitation program targeted at deficits in physical function and muscle function, initiated one month following surgery. A quasiexperimental, one group, pretest-posttest study with thirteen individuals (6 female, 7 male; mean age 57 ± 7 years) examined the effectiveness of an eccentrically-biased rehabilitation program. The program resulted in improvements in the primary physical function endpoints (SF-36 physical component summary and the six-minute walk test) with increases of 59% and 47%, respectively. Muscle function endpoints (knee extension strength and power) also increased 107% and 93%, respectively. Eccentrically-biased exercise used as an addition to rehabilitation may help amplify and accelerate physical function following TKA surgery.
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Jürgensen SP, Antunes LCDO, Tanni SE, Banov MC, Lucheta PA, Bucceroni AF, Godoy I, Dourado VZ. The Incremental Shuttle Walk Test in Older Brazilian Adults. Respiration 2011; 81:223-8. [DOI: 10.1159/000319037] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 04/19/2010] [Indexed: 01/06/2023] Open
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Cunha-Filho ITD, Pereira DAG, Carvalho AMBD, Campedeli L, Soares M, Freitas JDS. Confiabilidade de testes de caminhada em pacientes claudicantes: estudo piloto. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000200004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTO: Uma vez que a obstrução arterial periférica pode se apresentar de maneira difusa, com clínica diversa e com resultados de intervenção variados, é fundamental que a avaliação dos pacientes com doença arterial obstrutiva periférica seja feita com instrumentos que possam apresentar dados objetivos e reprodutíveis. OBJETIVO: Investigar e contrastar a confiabilidade do teste de caminhada de 6 minutos (T6M) com teste de deslocamento bidirecional progressivo (TDBP) em indivíduos claudicantes portadores de doença arterial obstrutiva periférica. MÉTODOS: Quatorze pacientes em estágio II de Fontaine participaram deste estudo piloto. Onze pacientes realizaram ambos os testes e três realizaram apenas T6M. Após familiarização, os pacientes foram avaliados em duas ocasiões distintas com intervalo máximo de 1 semana entre si. O coeficiente de correlação de intraclasse (ICC2,1) foi utilizado para avaliação da reprodutibilidade teste-reteste. RESULTADOS: A média da distância máxima de caminhada no teste e no reteste no T6M foi de 397,04±120,74 e 408,6±153,64 metros (p = 0,58), respectivamente, com ICC = 0,87 (p = 0,00005); já no TDBP, a média foi de 345±145,75 metros e, no reteste, de 345,91±127,97 (p = 0,92), com ICC = 0,99 (p = 0,00005). O tempo médio para surgimento da dor inicial, em segundos, com o T6M, foi de 172,25±88,23 (teste) e 148,58±70,36 (reteste) (p = 0,13), com ICC = 0,81 (p = 0,0004). No TDBP, o tempo médio foi de 282±141,90 (teste) e 267,14±150,58 (reteste) (p = 0,55), com ICC = 0,91 (p = 0,0008). CONCLUSÃO: Ambos os testes de caminhada são confiáveis e úteis para avaliação clínico-funcional desses pacientes. O TDBP, entretanto, gerou índices de confiabilidade mais elevados, podendo ser melhor opção para avaliação da performance desses indivíduos.
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Abstract
Exercise testing is useful to assess the degree of disability, prognosis for survival, presence of exercise-induced hypoxemia, and response to treatment in individuals with chronic obstructive pulmonary disease. Simple walking tests have been developed and are increasingly used in assessment of chronic obstructive pulmonary disease patients for clinical and research purposes. This article reviews how these tests are performed and to what degree they are reliable, and how these tests are used in assessment of individuals with chronic obstructive pulmonary disease.
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Affiliation(s)
- Cynthia D Brown
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Lewko A, Marshall J, Garrod R. Ambulatory oxygen therapy assessment: a comparative study of incremental shuttle and 6-minute walking tests. Physiotherapy 2007; 93:261-6. [DOI: 10.1016/j.physio.2007.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosa FW, Camelier A, Mayer A, Jardim JR. Evaluating physical capacity in patients with chronic obstructive pulmonary disease: comparing the shuttle walk test with the encouraged 6-minute walk test. J Bras Pneumol 2007; 32:106-13. [PMID: 17273579 DOI: 10.1590/s1806-37132006000200005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 08/06/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. METHODS A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. RESULTS The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 +/- 11.4%) than on the shuttle walk test (76.4 +/- 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 +/- 89.3 meters on the shuttle walk test and 515.5 +/- 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). CONCLUSION The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.
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da Cunha-Filho IT, Pereira DAG, de Carvalho AMB, Campedeli L, Soares M, de Sousa Freitas J. The Reliability of Walking Tests in People with Claudication. Am J Phys Med Rehabil 2007; 86:574-82. [PMID: 17581292 DOI: 10.1097/phm.0b013e31806de721] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To contrast the reliability of the 6-min walking test (6MW) with that of the shuttle walking test (SWT) in patients with intermittent claudication attributable to peripheral obstructive arterial disease (POAD), and to examine the relationships of the walking tests, medical outcomes, and hemodynamic variables. DESIGN Twenty-three patients were randomly assigned to perform both walking tests on two different occasions. Total distance walked (DW), time of pain onset (PO), and time of limiting claudicating symptom (TLS) were analyzed. RESULTS The reliability coefficients (ICC) generated with the 6MW for DW, PO, and TLS were 0.84, 0.81, and 0.63, respectively, and the coefficients of variation (CV) across trials were 18, 31.8, and 20.3%, respectively. With the SWT, the ICCs were 0.95, 0.72, and 0.90 for each variable, respectively, whereas the CV was 10.9% for DW, 26.8% for PO, and 9.1% for TLS. There was a significant correlation between DW and double product with the SWT (r=0.51, P=0.01), but there was no correlation with the 6MW. CONCLUSION Both the 6MW and the SWT are reliable walking tests for claudicant patients. However, the reliability coefficients obtained with the SWT are higher, the measurements are less variable, and there were better associations between this walking test and hemodynamic variables.
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Abstract
BACKGROUND Pulmonary rehabilitation is effective in improving exercise endurance and quality of life in chronic obstructive pulmonary disease (COPD). However, the efficacy of pulmonary rehabilitation in restrictive lung disease has not been extensively studied. METHODS Forty-six patients with restrictive lung disease (35 interstitial lung diseases, 11 skeletal abnormalities) were admitted to a pulmonary rehabilitation program; 26 completed the 8-week program and 15 were followed to a 1-year reassessment. Fifteen noncompliant patients were excluded and 1 patient with interstitial lung disease died at 8 weeks. Pulmonary function tests, exercise endurance, quality of life (Chronic Respiratory Disease Questionnaire, St. George's Respiratory Questionnaire, Hospital Anxiety and Depression scale and dyspnea) were measured at baseline, 8 weeks, and 1 year. RESULTS Exercise endurance (treadmill) improved at 8 weeks (mean improvement, 10.2 +/- 7.4 minutes) and at 1 year (mean improvement, 8.7 +/- 12.2 minutes). Shuttle test improved at 8 weeks (mean improvement, 27.2 +/- 75.9 m) but not at 1 year. Patients using long-term oxygen therapy (LTOT) had a better improvement in the treadmill test (P < .01) at 8 weeks compared with those not using LTOT. Thirty-three percent of patients failed to complete the program. There was significant improvement in dyspnea and quality of life in Chronic Respiratory Disease Questionnaire, St. George's Respiratory Questionnaire, and Hospital Anxiety and Depression scale for depression at 8 weeks compared with baseline; there was a sustained significant reduction in hospital admission days noted at 1-year postrehabilitation (P < .05). CONCLUSIONS Pulmonary rehabilitation is effective in improving exercise endurance and the quality of life and in reducing hospital admissions in this small group of patients with significant restrictive lung disease. The relatively large dropout number suggests that a standard chronic obstructive pulmonary disease program may not be ideal for patients with restrictive lung disease.
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Affiliation(s)
- Nizar A Naji
- St. Michael's Hospital and St. Vincent's University Hospitals, Dublin 4, Ireland
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Verkindre C, Bart F, Aguilaniu B, Fortin F, Guérin JC, Le Merre C, Iacono P, Huchon G. The Effect of Tiotropium on Hyperinflation and Exercise Capacity in Chronic Obstructive Pulmonary Disease. Respiration 2006; 73:420-7. [PMID: 16484769 DOI: 10.1159/000089655] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 07/20/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, which results in the progressive development of dyspnea and exercise limitation. OBJECTIVE AND METHODS To compare the effect of tiotropium with placebo on forced vital capacity (FVC) in patients with moderate-to-severe COPD and lung hyperinflation, using exercise endurance, dyspnea and health-related quality of life (HRQoL) as secondary endpoints. One hundred patients were randomized to receive either tiotropium 18 mug once daily or placebo for 12 weeks. RESULTS Trough (predose) FVC was significantly improved with tiotropium compared to placebo on day 42 (0.27 +/- 0.08 liters) and 84 (0.20 +/- 0.08 liters; p < 0.05 for both). Trough inspiratory capacity (IC) was also significantly improved with tiotropium compared to placebo on day 42 (0.16 +/- 0.07 liters) and 84 (0.15 +/- 0.07 liters; p < 0.05 for both). Tiotropium increased the mean distance walked during the shuttle walking test by 33 +/- 12 (day 42) and 36 +/- 14 m (day 84) compared to placebo (p < 0.05 for both). On day 84, 59% of the patients in the tiotropium group and 35% of the patients in the placebo group had significant and clinically meaningful improvements in the St. George's Respiratory Questionnaire total score (p < 0.05). Numerical decreases in the focal score in the Transition Dyspnea Index in patients receiving tiotropium versus placebo suggest that tiotropium also improved dyspnea during activities of daily living. CONCLUSION Tiotropium 18 mug once daily reduced hyperinflation with consequent improvements in walking distance and HRQoL in patients with COPD and lung hyperinflation.
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Affiliation(s)
- C Verkindre
- Centre Hospitalier Germon et Gauthier, Béthune, France
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Ozalevli S, Ozden A, Itil O, Akkoclu A. Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease. Respir Med 2006; 101:286-93. [PMID: 16806873 DOI: 10.1016/j.rmed.2006.05.007] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 03/16/2006] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To discuss the utility of Sit-to-Stand Test (STST) compared to the 6min walking test (6MWT) for the evaluation of functional status in patients with chronic obstructive pulmonary disease (COPD). MATERIAL-METHOD SUBJECTS Fifty-three patients with stable COPD (mean forced expiratory volume in 1s (FEV(1)) 46+/-9% predicted, mean age 71+/-12 year) and 15 healthy individuals (mean FEV(1) 101+/-13% predicted and mean age 63+/-8) were included. INTERVENTIONS Functional performance was evaluated by STST and 6MWT. During the tests, severity of dyspnea (by Modified Borg Scale), heart rate, pulsed oxygen saturation (SpO(2), by Modified Borg Scale) (by pulse oxymeter), blood pressure were measured. The pulmonary function (by spirometry), quadriceps femoris muscle strength (by manual muscle test) and quality of life (by Nottingham Health Profile Survey) were evaluated. RESULTS The STST and 6MWT results were lower in COPD group than the healthy group (P<0.05). During the 6MWT the rise in the heart rate, systolic blood pressure and the decrease in SpO(2) were statistically significant according to STST in COPD groups (P<0.05). The STST and 6MWT were strongly correlated with each other in both groups (P<0.05). Similarly, they were correlated with age, quality of life, peripheral muscle strength and dyspnea severity in COPD groups (P<0.05). CONCLUSION Similar to 6MWT, STST is also able to determine the functional state correctly. Additionally, it produces less hemodynamical stress compared to the 6MWT. In conclusion, STST can be used as an alternative of the 6MWT in patients with COPD.
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Affiliation(s)
- S Ozalevli
- Dokuz Eylul University, School of Physical Therapy and Rehabilitation, Inciralti, Izmir, Turkey.
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