It is well established that the work rate increment size affects the duration of test and physiological responses to exercise during cycling in patients with COPD. However, this has never been tested for incremental step tests.
OBJECTIVE:
To compare the exercise tolerance time, cardiopulmonary stress, and perception of effort between the Chester step test (CST) and a modified incremental step test (MIST).
METHODS:
Thirty-two subjects with COPD (FEV1 50 ± 15% of predicted) were randomized to perform the CST and MIST on the same day, an hour apart, on a single step (20 cm high). During tests, pulmonary gas exchange was measured continuously by a portable metabolic system.
RESULTS:
CST had shorter duration and also lower number of steps, in comparison with MIST. However, similar cardiopulmonary responses were observed at exercise peak: oxygen uptake (V̇O2) 1.22 ± 0.59 L/min vs 1.24 ± 0.55 L/min, minute ventilation (V̇E) 30.8 ± 12.7 L/min vs 30.0 ± 11.7 L/min, heart rate 86 ± 13 beats/min vs 85 ± 13 beats/min, and SpO2 87 ± 7% vs 87 ± 6%. Dyspnea and leg fatigue scores when correcting for exercise duration were higher for CST.
CONCLUSIONS:
The slower the work rate increment during step test, the higher the exercise tolerance. Regardless of the work rate increment, cardiopulmonary stress and exertion effort at peak exercise were equivalent between tests.
HillK, GoldsteinRS. Limited functional performance in chronic obstructive pulmonary disease: nature, causes and measurement. COPD, 2007; 4(3):257–261.
2.
Dal CorsoS, DuarteSR, NederJA, MalagutiC, de FuccioMB, de Castro PereiraCA, NeryLE. A step test to assess exercise-related oxygen desaturation in interstitial lung disease. Eur Respir J, 2007; 29(2):330–336.
3.
StephanS, PereiraCCA, ColettaEM, FerreiraRG, OttaJS, NeryLE. Oxygen dessaturation during a 4-minute step test: predicting survival in idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis, 2007; 24(1):70–76.
4.
TancrediG, QuattrucciS, ScalercioF, De CastroG, ZicariAM, BonciE, et al. 3-min step test and treadmill exercise for evaluating exercise-induced asthma. Eur Respir J, 2004; 23(4):569–574.
5.
AuroraP, PrasadSA, Balfour-LynnIM, SladeG, WhiteheadB, DinwiddieR. Exercise tolerance in children with cystic fibrosis undergoing lung transplantation assessment. Eur Respir J, 2001; 18(2):293–297.
6.
SwinburnCR, WakefieldJM, JonesPW. Performance, ventilation, oxygen consumption in three different types of exercise test in patients with chronic obstructive pulmonary disease. Thorax, 1985; 40(8):581–586.
7.
SykesK. Capacity assessment in the workplace: a new step test. Occup Health, 1995; 47(1):20–22.
8.
LauHM, NgGY, JonesAY, LeeEW, SiuEH, HuiDS. A randomised controlled trial of the effectiveness of an exercise training program in patients recovering from severe acute respiratory syndrome. Aust J Physiother, 2005; 51(4):213–219.
9.
LauHM, LeeEW, WongCN, NgGY, JonesAY, HuiDS. The impact of severe acute respiratory syndrome on the physical profile and quality of life. Arch Phys Med Rehabil, 2005; 86(6):1134–1140.
10.
de CamargoAA, JustinoT, de AndradeCH, MalagutiC, Dal CorsoS. Chester step test in patients with COPD: reliability and correlations with pulmonary function test results. Respir Care, 2011; 56(7):995–1001.
11.
Dal CorsoS, OliveiraAN, IzbickiM, CianciRG, MalagutiC, NeryLE. Symptom-limited incremental step test in COPD patients: reproducibility and validity compared to incremental cycle ergometry (abstract). Am J Respir Crit Care Med, 2009; 179:A2364.
12.
DebigaréR, MaltaisF, MalletM, CasaburiR, LeBlancP. Influence of work rate incremental rate on the exercise responses in patients with COPD. Med Sci Sports Exerc, 2000; 32(8):1365–1368.
13.
GläserS, LodziewskiS, KochB, OpitzCF, VölzkeH, EwertR. Influence of the incremental step size in work rate on exercise response and gas exchange in patients with pulmonary hypertension. BMC Pulm Med, 2008; 8:3.
14.
BuchfuhrerMJ, HansenJE, RobinsonTE, SueDY, WhippBJ. Optimizing the exercise protocol for cardiopulmonary assessment. J Appl Physiol, 1983; 55(5):1558–1564.
15.
MiyaharaN, EdaR, TakeyamaH, MaedaT, AoeK, KunichikaN, et al. Cardiopulmonary responses during cycle ergometer exercise with different ramp slope increments in patients with chronic obstructive pulmonary disease. Intern Med, 2000; 39(1):15–19.
16.
BenzoRP, ParameshS, PatelSA, SlivkaWA, SciurbaFC. Optimal protocol selection for cardiopulmonary exercise testing in severe COPD. Chest, 2007; 132(5):1500–1505.
17.
DavidJA, WhippBJ, LamarraN, HuntsmanDJ, FrankMH, WassermanK. Effect of ramp slope on determination of parameters from the ramp exercise test. Med Sci Sports Exerc, 1982; 14(5):339–343.
18.
American Thoracic Society. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002; 166(1):111–117.
19.
OlsenGN, BoltonRJW, WeimanDS, HornungCA. Stair climbing as an exercise test to predict the postoperative complications of lung resection. Two years' experience. Chest, 1991; 99(3):587–590.
20.
HadeliKO, SiegelEM, SherrillDL, BeckKC, EnrightPL. Predictors of oxygen desaturation during submaximal exercise in 8,000 patients. Chest, 2001; 120(1):88–92.
21.
BorgGA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 1982; 14(5):377–381.
22.
KearonMC, SummersE, JonesNL, CampbellEJ, KillianKJ. Effort and dyspnoea during work of varying intensity and duration. Eur Respir J, 1991; 4(8):917–925.
23.
American Thoracic Society, American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med, 2003; 167(2):211–277.
24.
DreherM, WalterspacherS, SonntagF, PrettinS, KabitzHJ, WindischW. Exercise in severe COPD: is walking different from stair-climbing?. Respir Med, 2008; 102(6):912–918.
25.
TroostersT, VilaroJ, RabinovichR, CasasA, BarberàJA, Rodriquez-RoisinR, RocaJ. Physiological responses to the 6-min walk test in patients with chronic obstructive pulmonary disease. Eur Respir J, 2002; 20(3):564–569.
26.
TurnerSE, EastwoodPR, CecinsNM, HillmanDR, JenkinsSC. Physiologic responses to incremental and self-paced exercise in COPD. Chest, 2004; 126(3):766–773.
27.
WijkstraPJ, TenVergertEM, van der MarkTW, PostmaDS, Van AltenaR, KraanJ, KoëterGH. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax, 1994; 49(5):468–472.
28.
MarinJM, CarrizoSJ, GasconM, SanchezA, GallegoB, CelliBR. Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001; 163(6):1395–1399.
29.
SteinerMC, SinghSJ, MorganMD. The contribution of peripheral muscle function to shuttle walking performance in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil, 2005; 25(1):43–49.
30.
CarterR, PeavlerM, ZinkgrafS, WilliamsJ, FieldsS. Predicting maximal exercise ventilation in patients with chronic obstructive pulmonary disease. Chest, 1987; 92(2):253–259.
31.
OnoratiP, AntonucciR, ValliG, BertonE, De MarcoF, SerraP, PalangeP. Non-invasive evaluation of gas exchange during a shuttle walking test vs a 6-min walking test to assess exercise tolerance in COPD patients. Eur J Appl Physiol, 2003; 89(3-4):331–336.
32.
BehnkeM, JörresRA, KirstenD, MagnussenH. Clinical benefits of a combined hospital and home-based exercise programme over 18 months in patients with severe COPD. Monaldi Arch Chest Dis, 2003; 59(1):44–51.
33.
ProbstVS, TroosterT, PittaF, DecramerM, GosselinkR. Cardiopulmonary stress during exercise training in patients with COPD. Eur Respir J, 2006; 27(6):1110–1118.
34.
OhEG. The effects of home-based pulmonary rehabilitation in patients with chronic lung disease. Int J Nurs Stud, 2003; 40(8):873–879.
35.
NgaageDL, HasneyK, CowenME. The functional impact of an individualized, graded, outpatient in end-stage chronic obstructive pulmonary disease. Heart Lung, 2004; 33(6):381–389.
36.
KamaharaK, HommaT, NaitoA, MatsumuraT, NakayamaM, KadonoK, et al. Circuit training for elderly patients with chronic obstructive pulmonary disease: a preliminary study. Arch Gerontol Geriatr, 2004; 39(2):103–110.
37.
RiesAL, BauldoffGS, CarlinBW, CasaburiR, EmeryCF, MahlerDA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest, 2007; 131(5 Suppl):4S–42S.
