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Costa VAB, Midgley AW, Baumgart JK, Carroll S, Astorino TA, Schaun GZ, Fonseca GF, Cunha FA. Confirming the attainment of maximal oxygen uptake within special and clinical groups: A systematic review and meta-analysis of cardiopulmonary exercise test and verification phase protocols. PLoS One 2024; 19:e0299563. [PMID: 38547136 PMCID: PMC10977812 DOI: 10.1371/journal.pone.0299563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND AIM A plateau in oxygen uptake ([Formula: see text]) during an incremental cardiopulmonary exercise test (CPET) to volitional exhaustion appears less likely to occur in special and clinical populations. Secondary maximal oxygen uptake ([Formula: see text]) criteria have been shown to commonly underestimate the actual [Formula: see text]. The verification phase protocol might determine the occurrence of 'true' [Formula: see text] in these populations. The primary aim of the current study was to systematically review and provide a meta-analysis on the suitability of the verification phase for confirming 'true' [Formula: see text] in special and clinical groups. Secondary aims were to explore the applicability of the verification phase according to specific participant characteristics and investigate which test protocols and procedures minimise the differences between the highest [Formula: see text] values attained in the CPET and verification phase. METHODS Electronic databases (PubMed, Web of Science, SPORTDiscus, Scopus, and EMBASE) were searched using specific search strategies and relevant data were extracted from primary studies. Studies meeting inclusion criteria were systematically reviewed. Meta-analysis techniques were applied to quantify weighted mean differences (standard deviations) in peak [Formula: see text] from a CPET and a verification phase within study groups using random-effects models. Subgroup analyses investigated the differences in [Formula: see text] according to individual characteristics and test protocols. The methodological quality of the included primary studies was assessed using a modified Downs and Black checklist to obtain a level of evidence. Participant-level [Formula: see text] data were analysed according to the threshold criteria reported by the studies or the inherent measurement error of the metabolic analysers and displayed as Bland-Altman plots. RESULTS Forty-three studies were included in the systematic review, whilst 30 presented quantitative information for meta-analysis. Within the 30 studies, the highest mean [Formula: see text] values attained in the CPET and verification phase protocols were similar (mean difference = -0.00 [95% confidence intervals, CI = -0.03 to 0.03] L·min-1, p = 0.87; level of evidence, LoE: strong). The specific clinical groups with sufficient primary studies to be meta-analysed showed a similar [Formula: see text] between the CPET and verification phase (p > 0.05, LoE: limited to strong). Across all 30 studies, [Formula: see text] was not affected by differences in test protocols (p > 0.05; LoE: moderate to strong). Only 23 (53.5%) of the 43 reviewed studies reported how many participants achieved a lower, equal, or higher [Formula: see text] value in the verification phase versus the CPET or reported or supplied participant-level [Formula: see text] data for this information to be obtained. The percentage of participants that achieved a lower, equal, or higher [Formula: see text] value in the verification phase was highly variable across studies (e.g. the percentage that achieved a higher [Formula: see text] in the verification phase ranged from 0% to 88.9%). CONCLUSION Group-level verification phase data appear useful for confirming a specific CPET protocol likely elicited [Formula: see text], or a reproducible [Formula: see text], for a given special or clinical group. Participant-level data might be useful for confirming whether specific participants have likely elicited [Formula: see text], or a reproducible [Formula: see text], however, more research reporting participant-level data is required before evidence-based guidelines can be given. TRIAL REGISTRATION PROSPERO (CRD42021247658) https://www.crd.york.ac.uk/prospero.
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Affiliation(s)
- Victor A. B. Costa
- Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, England, United Kingdom
| | - Julia K. Baumgart
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norway, University of Science and Technology, Trondheim, Norway
| | - Sean Carroll
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, England, United Kingdom
| | - Todd A. Astorino
- Department of Kinesiology, California State University, San Marcos, CA, United States of America
| | - Gustavo Z. Schaun
- Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Guilherme F. Fonseca
- Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Felipe A. Cunha
- Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
- Laboratory of Physical Activity and Health Promotion, University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Tomlinson OW, Markham L, Wollerton RL, Knight BA, Duckworth A, Gibbons MA, Scotton CJ, Williams CA. Validity and repeatability of cardiopulmonary exercise testing in interstitial lung disease. BMC Pulm Med 2022; 22:485. [PMID: 36550475 PMCID: PMC9784077 DOI: 10.1186/s12890-022-02289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET), and its primary outcome of peak oxygen uptake (VO2peak), are acknowledged as biomarkers in the diagnostic and prognostic management of interstitial lung disease (ILD). However, the validity and repeatability of CPET in those with ILD has yet to be fully characterised, and this study fills this evidence gap. METHODS Twenty-six people with ILD were recruited, and 21 successfully completed three CPETs. Of these, 17 completed two valid CPETs within a 3-month window, and 11 completed two valid CPETs within a 6-month window. Technical standards from the European Respiratory Society established validity, and repeatability was determined using mean change, intraclass correlation coefficient and typical error. RESULTS Every participant (100%) who successfully exercised to volitional exhaustion produced a maximal, and therefore valid, CPET. Approximately 20% of participants presented with a plateau in VO2, the primary criteria for establishing a maximal effort. The majority of participants otherwise presented with secondary criteria of respiratory exchange ratios in excess of 1.05, and maximal heart rates in excess of their predicted values. Repeatability analyses identified that the typical error (expressed as percent of coefficient of variation) was 20% over 3-months in those reaching volitional exhaustion. CONCLUSION This work has, for the first time, fully characterised how patients with ILD respond to CPET in terms of primary and secondary verification criteria, and generated novel repeatability data that will prove useful in the assessment of disease progression, and future evaluation of therapeutic regimens where VO2peak is used as an outcome measure.
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Affiliation(s)
- Owen W. Tomlinson
- grid.8391.30000 0004 1936 8024Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Laura Markham
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Rebecca L. Wollerton
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Bridget A. Knight
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,grid.477603.1NIHR Exeter Clinical Research Facility, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
| | - Anna Duckworth
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Michael A. Gibbons
- Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK ,grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Chris J. Scotton
- grid.8391.30000 0004 1936 8024Department of Clinical and Biomedical Science, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK
| | - Craig A. Williams
- grid.8391.30000 0004 1936 8024Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Heavitree Road, Exeter, EX1 2LU UK ,Academic Department of Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW UK
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Wadey CA, Barker AR, Stuart G, Tran DL, Laohachai K, Ayer J, Cordina R, Williams CA. Scaling Peak Oxygen Consumption for Body Size and Composition in People With a Fontan Circulation. J Am Heart Assoc 2022; 11:e026181. [PMID: 36515232 PMCID: PMC9798799 DOI: 10.1161/jaha.122.026181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Peak oxygen consumption (peak V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$) is traditionally divided ("ratio-scaled") by body mass (BM) for clinical interpretation. Yet, it is unknown whether ratio-scaling to BM can produce a valid size-independent expression of peak V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$ in people with a Fontan circulation. Furthermore, people with a Fontan circulation have deficits in lean mass, and it is unexplored whether using different measures of body composition may improve scaling validity. The objective was to assess the validity of different scaling denominators (BM, stature, body surface area, fat-free mass, lean mass, and appendicular lean mass using ratio and allometric scaling). Methods and Results Eighty-nine participants (age: 23.3±6.7 years; 53% female) with a Fontan circulation had their cardiorespiratory fitness and body composition measured by cardiopulmonary exercise testing and dual-energy x-ray absorptiometry. Ratio and allometric (log-linear regression) scaling was performed and Pearson correlations assessed scaling validity. Scaling denominators BM (r=-0.25, P=0.02), stature (r=0.46, P<0.001), and body surface area (0.23, P=0.03) were significantly correlated with their respective ratio-scaled expressions of peak V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$, but fat-free mass, lean mass, or appendicular lean mass were not (r≤0.11; R2=1%). Allometrically expressed peak V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$ resulted in no significant correlation with any scaling denominator (r=≤0.23; R2=≤4%). Conclusions The traditional and accepted method of ratio-scaling to BM is invalid because it fails to create a size-independent expression of peak V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$ in people with a Fontan circulation. However, ratio-scaling to measures of body composition (fat-free mass, lean mass, and appendicular lean mass) and allometric techniques can produce size-independent expressions of peak V̇O2$$ \dot{\mathrm{V}}{\mathrm{O}}_2 $$ in people with a Fontan circulation.
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Affiliation(s)
- Curtis A. Wadey
- Children’s Health & Exercise Research Centre (CHERC)Public Health and Sport Science, Faculty of Health and Life Sciences, University of ExeterExeterUnited Kingdom
| | - Alan R. Barker
- Children’s Health & Exercise Research Centre (CHERC)Public Health and Sport Science, Faculty of Health and Life Sciences, University of ExeterExeterUnited Kingdom
| | - Graham Stuart
- Bristol Congenital Heart Centre, The Bristol Heart Institute, University Hospitals Bristol NHS Foundation TrustBristolUnited Kingdom
| | - Derek L. Tran
- Central Clinical School, The University of SydneyCamperdownNew South Wales,Department of CardiologyRoyal Prince Alfred HospitalCamperdownNew South Wales,Heart Research Institute, Charles Perkins Centre, The University of SydneyCamperdownNew South Wales
| | - Karina Laohachai
- Central Clinical School, The University of SydneyCamperdownNew South Wales,Department of CardiologyRoyal Prince Alfred HospitalCamperdownNew South Wales,Heart Research Institute, Charles Perkins Centre, The University of SydneyCamperdownNew South Wales
| | - Julian Ayer
- Central Clinical School, The University of SydneyCamperdownNew South Wales,Department of CardiologyRoyal Prince Alfred HospitalCamperdownNew South Wales,Heart Research Institute, Charles Perkins Centre, The University of SydneyCamperdownNew South Wales
| | - Rachael Cordina
- Central Clinical School, The University of SydneyCamperdownNew South Wales,Department of CardiologyRoyal Prince Alfred HospitalCamperdownNew South Wales,Heart Research Institute, Charles Perkins Centre, The University of SydneyCamperdownNew South Wales
| | - Craig A. Williams
- Children’s Health & Exercise Research Centre (CHERC)Public Health and Sport Science, Faculty of Health and Life Sciences, University of ExeterExeterUnited Kingdom
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Shei RJ, Mackintosh KA, Peabody Lever JE, McNarry MA, Krick S. Exercise Physiology Across the Lifespan in Cystic Fibrosis. Front Physiol 2019; 10:1382. [PMID: 31780953 PMCID: PMC6856653 DOI: 10.3389/fphys.2019.01382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/21/2019] [Indexed: 01/19/2023] Open
Abstract
Cystic fibrosis (CF), a severe life-limiting disease, is associated with multi-organ pathologies that contribute to a reduced exercise capacity. At present, the impact of, and interaction between, disease progression and other age-related physiological changes in CF on exercise capacity from child- to adult-hood is poorly understood. Indeed, the influences of disease progression and aging are inherently linked, leading to increasingly complex interactions. Thus, when interpreting age-related differences in exercise tolerance and devising exercise-based therapies for those with CF, it is critical to consider age-specific factors. Specifically, changes in lung function, chronic airway colonization by increasingly pathogenic and drug-resistant bacteria, the frequency and severity of pulmonary exacerbations, endocrine comorbidities, nutrition-related factors, and CFTR (cystic fibrosis transmembrane conductance regulator protein) modulator therapy, duration, and age of onset are important to consider. Accounting for how these factors ultimately influence the ability to exercise is central to understanding exercise impairments in individuals with CF, especially as the expected lifespan with CF continues to increase with advancements in therapies. Further studies are required that account for these factors and the changing landscape of CF in order to better understand how the evolution of CF disease impacts exercise (in)tolerance across the lifespan and thereby identify appropriate intervention targets and strategies.
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Affiliation(s)
- Ren-Jay Shei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kelly A. Mackintosh
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, United Kingdom
| | - Jacelyn E. Peabody Lever
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
- Medical Scientist Training Program, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Melitta A. McNarry
- Applied Sports, Technology, Exercise and Medicine Research Centre, College of Engineering, Swansea University, Swansea, United Kingdom
| | - Stefanie Krick
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham, Birmingham, AL, United States
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Commentary on the Article "Interpreting Aerobic Fitness in Youth: The Fallacy of Ratio Scaling"-Is Body Mass the Best Body Size Descriptor to Normalize Aerobic Fitness in the Pediatric Population? Pediatr Exerc Sci 2019; 31:386-387. [PMID: 31310999 DOI: 10.1123/pes.2019-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/02/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
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Vendrusculo FM, Heinzmann-Filho JP, Campos NE, Gheller MF, de Almeida IS, Donadio MVF. Prediction of peak oxygen uptake using the modified shuttle test in children and adolescents with cystic fibrosis. Pediatr Pulmonol 2019; 54:386-392. [PMID: 30614221 DOI: 10.1002/ppul.24237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/20/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Several tests may be used to assess exercise intolerance in cystic fibrosis (CF), including the gold standard cardiopulmonary exercise test (CPET) and the Modified Shuttle Test (MST). OBJECTIVE To evaluate the use of the MST as a predictor of peak oxygen uptake (VO2 peak) and to compare VO2 peak and maximal heart rate (HRmax) obtained in both tests. METHODS Cross-sectional study including individuals with CF aged between 6 and 20 years old. Participants who were unable to perform the tests and/or presented signs of pulmonary exacerbation were excluded. Demographic, anthropometric, clinical and spirometric values were collected. CPET and the MST were performed in two consecutive outpatient visits. HRmax, peripheral oxygen saturation, dyspnea, and VO2 peak measured and estimated were compared. RESULTS Twenty-four patients, mean age 15.7 ± 4.2 years and FEV1 (% predicted) 76.4 ± 23.8, were included. Mean values of HRmax (bpm) and HRmax in percent of predicted (HRmax%) were lower (P = 0.01) in the MST (171.6 ± 14.5 and 87.1 ± 7.5) compared to CPET (180.9 ± 10.0 and 91.9 ± 5.4). However, there was no significant differences between tests in the variation (delta) for HRmax and HRmax% (P = 0.17). A strong correlation (r = 0.79; P < 0.0001) was found between distance achieved (MST) and VO2 peak (CPET). The regression model to estimate VO2 peak resulted in the following equation: VO2 (mL · kg-1 · min-1 ) = 20.301 + 0.019 × MST distance (meters). There was no difference (P = 0.50) between VO2 peak measured (CPET) and estimated by the equation. CONCLUSION The MST may be an alternative method to evaluate exercise capacity and to predict VO2 peak in children and adolescents with CF.
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Affiliation(s)
- Fernanda M Vendrusculo
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - João P Heinzmann-Filho
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Natália E Campos
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Mailise F Gheller
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ingrid S de Almeida
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcio V F Donadio
- Laboratory of Pediatric Physical Activity, Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
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