Development and implementation of treadmill exercise testing protocols in COPD

Christopher B Cooper, Marlon Abrazado, Daniel Legg, Steven Kesten, Christopher B Cooper, Marlon Abrazado, Daniel Legg, Steven Kesten

Abstract

Background: Because treadmill exercise testing is more representative of daily activity than cycle testing, we developed treadmill protocols to be used in various clinical settings as part of a two-year, multicenter, chronic obstructive pulmonary disease (COPD) trial evaluating the effect of tiotropium on exercise.

Methods: We enrolled 519 COPD patients aged 64.6 ± 8.3 years with a postbronchodilator forced expiratory volume in one second (FEV(1)) of 1.25 ± 0.42 L, 44.3% ± 11.9% predicted. The patients performed symptom-limited treadmill tests where work rate (Ẇ) was increased linearly using speed and grade adjustments every minute. On two subsequent visits, they performed constant Ẇ tests to exhaustion at 90% of maximum Ẇ from the incremental test.

Results: Mean incremental test duration was 522 ± 172 seconds (range 20-890), maximum work rate 66 ± 34 watts. For the first and second constant Ẇ tests, both at 61 ± 33 watts, mean endurance times were 317 ± 61 seconds and 341 ± 184 seconds, respectively. The mean of two tests had an intraclass correlation coefficient of 0.85 (P < 0.001). During the second constant Ẇ test, 88.2% of subjects stopped exercise because of breathing discomfort; 87.1% for Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stage II, 88.5% for GOLD Stage III, and 90.2% for GOLD Stage IV.

Conclusion: The symptom-limited incremental and constant work treadmill protocol was well tolerated and appeared to be representative of the physiologic limitations of COPD.

Keywords: chronic obstructive pulmonary disease; endurance; exercise testing; tiotropium.

Figures

Figure 1
Figure 1
EXACTT instrument used to optimize maximal effort during incremental and endurance exercise tests.
Figure 2
Figure 2
Distribution of patients by endurance time for the incremental exercise tests at visit 1 (n = 512). The mean ± standard deviation exercise endurance time was 522 ± 172 seconds.
Figure 3
Figure 3
Distribution of endurance time for constant Ẇ exercise tests at visit 2 (n = 459). The mean ± standard deviation and median endurance times were 316 ± 200 and 260 seconds, respectively.
Figure 4
Figure 4
Distribution of endurance time for constant Ẇ exercise tests at visit 3 (n = 463). The mean ± standard deviation and median endurance times were 341 ± 184 and 290 seconds, respectively.
Figure 5
Figure 5
Comparison of endurance times for constant Ẇ exercise tests at visits 2 and 3. The means of the two tests had an intraclass correlation coefficient of 0.85 (P < 0.001).

References

    1. Cooper CB. Exercise in chronic pulmonary disease: Limitations and rehabilitation. Med Sci Sports Exerc. 2001;33:S643–S646.
    1. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117.
    1. Elpern EH, Stevens D, Kesten S. Variability in performance of timed walk tests in pulmonary rehabilitation programs. Chest. 2000;118:98–105.
    1. Mahler DA, Donohue JF, Barbee RA, et al. Efficacy of salmeterol xinafoate in the treatment of COPD. Chest. 1999;115:957–965.
    1. Oga T, Nishimura K, Tsukino M, et al. The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease. A comparison of three different exercise tests. Am J Respir Crit Care Med. 2000;161:1897–1901.
    1. O’Donnell DE, Fluge T, Gerken F, et al. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. 2004;23:832–840.
    1. Maltais F, Hamilton A, Marciniuk D, et al. Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD. Chest. 2005;128:1168–1178.
    1. Revill SM, Morgan MD, Singh SJ, et al. The endurance shuttle walk: A new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax. 1999;54:213–222.
    1. Man WD, Soliman MG, Gearing J, et al. Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;168:562–567.
    1. Saey D, Debigare R, LeBlanc P, et al. Contractile leg fatigue after cycle exercise: A factor limiting exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;168:425–430.
    1. Pepin V, Saey D, Whittom F, et al. Walking versus cycling: Sensitivity to bronchodilation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172:1517–1522.
    1. Kaminsky LA, Whaley MH. Evaluation of a new standardized ramp protocol: The BSU/Bruce Ramp protocol. J Cardiopulm Rehabil. 1998;18:438–444.
    1. Hsia D, Casaburi R, Pradhan A, et al. Physiological responses to linear treadmill and cycle ergometer exercise in COPD. Eur Respir J. 2009;34:605–615.
    1. Casaburi R, Kukafka D, Cooper CB, et al. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005;127:809–817.
    1. Buchfuhrer MJ, Hansen JE, Robinson TE, et al. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol. 1983;55:1558–1564.
    1. Cooper CB, Storer TW. Exercise Testing and Interpretation: A Practical Approach. New York, NY: Cambridge University Press; 2001.
    1. Porszasz J, Casaburi R, Somfay A, et al. A treadmill ramp protocol using simultaneous changes in speed and grade. Med Sci Sports Exerc. 2003;35:1596–1603.
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2:92–98.
    1. American Thoracic Society Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med. 1995;152:1107–1136.
    1. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–338.
    1. Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med. 1999;159:179–187.
    1. Petrie A, Sabin C. Medical Statistics at a Glance. 2nd ed. Malden, MA: Blackwell; 2005.
    1. Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull. 1979;86:420–428.
    1. Whipp BJ, Davis JA, Torres F, et al. A test to determine parameters of aerobic function during exercise. J Appl Physiol. 1981;50:217–221.
    1. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol. 1986;60:2020–2027.
    1. Marques-Magallanes JA, Smooke S, Sehdeva PS, et al. Reliability of gas exchange threshold detection (VO2H) comparing blinded investigators with computer algorithms. Am J Respir Crit Care Med. 1997;155:A170.
    1. Davis JA, Storer TW, Caiozzo VJ. Prediction of normal values for lactate threshold estimated by gas exchange in men and women. Eur J Appl Physiol Occup Physiol. 1997;76:157–164.
    1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO workshop summary, updated 2007. London: Global Initiative for Chronic Obstructive Lung Disease (GOLD); Dec, 2007. Available from: Accessed Jul 24, 2010.
    1. Verkindre C, Bart F, Aguilaniu B, et al. The effect of tiotropium on hyperinflation and exercise capacity in chronic obstructive pulmonary disease. Respiration. 2006;73:420–427.
    1. Bruce RA. Exercise testing of patients with coronary heart disease. Principles and normal standards for evaluation. Ann Clin Res. 1971;3:323–332.
    1. Pepin V, Brodeur J, Lacasse Y, et al. Six-minute walking versus shuttle walking: Responsiveness to bronchodilation in chronic obstructive pulmonary disease. Thorax. 2007;62:291–298.
    1. Brooks D, Solway S. Should the endurance shuttle walk test replace the six-minute walk test in individuals with chronic obstructive pulmonary disease. Chron Respir Dis. 2006;3:1–2.
    1. O’Donnell DE, Voduc N, Fitzpatrick M, et al. Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease. Eur Respir J. 2004;24:86–94.
    1. Benzo RP, Paramesh S, Patel SA, et al. Optimal protocol selection for cardiopulmonary exercise testing in severe COPD. Chest. 2007;132:1500–1505.

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