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Palmer T, Obst SJ, Aitken CR, Walsh J, Sabapathy S, Adams L, Morris NR. Fixed-intensity exercise tests to measure exertional dyspnoea in chronic heart and lung populations: a systematic review. Eur Respir Rev 2023; 32:230016. [PMID: 37558262 PMCID: PMC10410401 DOI: 10.1183/16000617.0016-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Exertional dyspnoea is the primary diagnostic symptom for chronic cardiopulmonary disease populations. Whilst a number of exercise tests are used, there remains no gold standard clinical measure of exertional dyspnoea. The aim of this review was to comprehensively describe and evaluate all types of fixed-intensity exercise tests used to assess exertional dyspnoea in chronic cardiopulmonary populations and, where possible, report the reliability and responsiveness of the tests. METHODS A systematic search of five electronic databases identified papers that examined 1) fixed-intensity exercise tests and measured exertional dyspnoea, 2) chronic cardiopulmonary populations, 3) exertional dyspnoea reported at isotime or upon completion of fixed-duration exercise tests, and 4) published in English. RESULTS Searches identified 8785 papers. 123 papers were included, covering exercise tests using a variety of fixed-intensity protocols. Three modes were identified, as follows: 1) cycling (n=87), 2) walking (n=31) and 3) other (step test (n=8) and arm exercise (n=2)). Most studies (98%) were performed on chronic respiratory disease patients. Nearly all studies (88%) used an incremental exercise test. 34% of studies used a fixed duration for the exercise test, with the remaining 66% using an exhaustion protocol recording exertional dyspnoea at isotime. Exertional dyspnoea was measured using the Borg scale (89%). 7% of studies reported reliability. Most studies (72%) examined the change in exertional dyspnoea in response to different interventions. CONCLUSION Considerable methodological variety of fixed-intensity exercise tests exists to assess exertional dyspnoea and most test protocols require incremental exercise tests. There does not appear to be a simple, universal test for measuring exertional dyspnoea in the clinical setting.
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Affiliation(s)
- Tanya Palmer
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Central Queensland University, School of Health, Medical and Applied Sciences, College of Health Sciences, Bundaberg, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
| | - Steven J Obst
- Central Queensland University, School of Health, Medical and Applied Sciences, College of Health Sciences, Bundaberg, Australia
| | - Craig R Aitken
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - James Walsh
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
| | - Surendran Sabapathy
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Lewis Adams
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | - Norman R Morris
- Griffith University, School of Health Sciences and Social Work, Gold Coast, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Queensland Health, Chermside, Australia
- Heart and Lung Institute, The Prince Charles Hospital, Chermside, Australia
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Tufvesson E, Radner F, Simonsen A, Papapostolou G, Jarenbäck L, Jönsson S, Nihlen U, Tunsäter A, Ankerst J, Peterson S, Bjermer L, Eriksson G. A new protocol for exercise testing in COPD; improved prediction algorithm for WMAX and validation of the endurance test in a placebo-controlled double bronchodilator study. Ther Adv Respir Dis 2021; 15:17534666211037454. [PMID: 34590519 PMCID: PMC8488527 DOI: 10.1177/17534666211037454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Two new protocols have been developed for bicycle exercise testing in chronic obstructive pulmonary disease (COPD) with an individualized cardiopulmonary exercise test (ICPET) and subsequent customized endurance test (CET), which generate less interindividual spread in endurance time compared with the standard endurance test. Main objectives of this study were to improve the prediction algorithm for WMAX for the ICPET and validate the CET by examining treatment effects on exercise performance of indacaterol/glycopyrronium (IND/GLY) compared with placebo. Methods: COPD patients, with forced expiratory volume in 1 s (FEV1) 40–80% predicted, were recruited. Pooled baseline data from two previous studies (n = 38) were used for the development of an improved WMAX prediction algorithm. Additional COPD patients (n = 14) were recruited and performed the ICPET, using the new prediction formula at visit 1. Prior to the CET at visits 2 and 3, they were randomized to a single dose of IND/GLY (110/50 µg) or placebo. Results: The improved multiple regression algorithm for WMAX includes diffusing capacity for carbon monoxide (DLCO), FEV1, sex, age and height and correlated to measured WMAX (R2 = 0.89 and slope = 0.89). Treatment with IND/GLY showed improvement in endurance time versus placebo, mean 113 s [95% confidence interval (CI): 6–220], p = 0.037, with more prominent effect in patients with FEV1 < 70% predicted. Conclusion: The two new protocols for ICPET (including the new improved algorithm) and CET were retested with consistent results. In addition, the CET showed a significant and clinically relevant prolongation of endurance time for IND/GLY versus placebo in a small number of patients.
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Affiliation(s)
- Ellen Tufvesson
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, 221 85 Lund, Sweden
| | - Finn Radner
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Anton Simonsen
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Georgia Papapostolou
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Linnea Jarenbäck
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Saga Jönsson
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Ulf Nihlen
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Alf Tunsäter
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Jaro Ankerst
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | | | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Göran Eriksson
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund, Lund University, Skane University Hospital, Lund, Sweden
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Stringer WW, Porszasz J, Cao M, Rossiter HB, Siddiqui S, Rennard S, Casaburi R. The effect of long-acting dual bronchodilator therapy on exercise tolerance, dynamic hyperinflation, and dead space during constant work rate exercise in COPD. J Appl Physiol (1985) 2021; 130:2009-2018. [PMID: 33914661 PMCID: PMC8526332 DOI: 10.1152/japplphysiol.00774.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated whether dual bronchodilator therapy (glycopyrrolate/formoterol fumarate; GFF; Bevespi Aerosphere) would increase exercise tolerance during a high-intensity constant work rate exercise test (CWRET) and the relative contributions of dead space ventilation (VD/VT) and dynamic hyperinflation (change in inspiratory capacity) to exercise limitation in chronic obstructive pulmonary disease (COPD). In all, 48 patients with COPD (62.9 ± 7.6 yrs; 33 male; GOLD spirometry stage 1/2/3/4, n = 2/35/11/0) performed a randomized, double blind, placebo (PL) controlled, two-period crossover, single-center trial. Gas exchange and inspiratory capacity (IC) were assessed during cycle ergometry at 80% incremental exercise peak work rate. Transcutaneous [Formula: see text] (Tc[Formula: see text]) measurement was used for VD/VT estimation. Baseline postalbuterol forced expiratory volume in 1 s (FEV1) was 1.86 ± 0.58 L (63.6% ± 13.9 predicted). GFF increased FEV1 by 0.18 ± 0.21 L relative to placebo (PL; P < 0.001). CWRET endurance time was greater after GFF vs. PL (383 ± 184 s vs. 328 ± 115 s; difference 55 ± 125 s; P = 0.013; confidence interval: 20-90 s), a 17% increase. IC on GFF was above placebo IC at all time points and fell less with GFF vs. PL (P ≤ 0.0001). Isotime tidal volume (1.54 ± 0.50 vs. 1.47 ± 0.45 L; P = 0.022) and ventilation (52.9 ± 19.9 vs. 51.0 ± 18.9 L/min; P = 0.011) were greater, and respiratory rate was unchanged (34.9 ± 9.2 vs. 35.1 ± 8.0 br/min, P = 0.865). Isotime VD/VT did not differ between groups (GFF 0.28 ± 0.08 vs. PL 0.27 ± 0.09; P = 0.926). GFF increased exercise tolerance in patients with COPD, and the increase was accompanied by attenuated dynamic hyperinflation without altering VD/VT.NEW & NOTEWORTHY This study was a randomized clinical trial (NCT03081156) that collected detailed physiology data to investigate the effect of dual bronchodilator therapy on exercise tolerance in COPD, and additionally to determine the relative contributions of changes in dead space ventilation (VD/VT) and dynamic hyperinflation to alterations in exercise limitation. We utilized a unique noninvasive method to assess VD/VT (transcutaneous carbon dioxide, Tc[Formula: see text]) and found that dual bronchodilators yielded a moderate improvement in exercise tolerance. Importantly, attenuation of dynamic hyperinflation rather than change in dead space ventilation was the most important contributor to exercise tolerance improvement.
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Affiliation(s)
- William W Stringer
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Min Cao
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Harry B Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California.,Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Stephen Rennard
- BioPharmaceuticals R&D, AstraZeneca, Cambridge, United Kingdom.,Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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Saey D, Bellocq A, Gephine S, Lino A, Reychler G, Villiot-Danger E. [Which physical tests for which objectives in pulmonary rehabilitation?]. Rev Mal Respir 2021; 38:646-663. [PMID: 33895033 DOI: 10.1016/j.rmr.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 11/19/2022]
Abstract
Chronic respiratory disease is a major cause of morbidity and mortality worldwide and an important cause of disability including a reduction of exercise, functional and muscle capacity contributing to a decreased quality of life. In the context of pulmonary rehabilitation, a thorough patient-centered outcome assessment, including not only measures of lung function, but also exercise functional and muscle capacity, is imperative for a comprehensive disease management. Assessment of these impairments and dysfunctions with appropriate and change-sensitive procedures is thus necessary for personalizing the physical interventions and assessing the short- and long-term effectiveness of the intervention. The clinician currently has a wide variety of tests and measurements available to assess the physical and functional capacity of people with chronic respiratory disease. The aim of this review is to provide a pragmatic synthesis of the physical, functional and muscle capacity tests most commonly used in pulmonary rehabilitation. Ultimately, it should help the clinician to identify the relevant evaluations according to the objectives of the patients but also according to the available resources, the setting of pulmonary rehabilitation and the specific qualities of each test.
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Affiliation(s)
- D Saey
- Département de réadaptation, faculté de médecine, université Laval, Québec, Canada; Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, 2725, chemin Sainte-Foy, Pavillon U 4766, G1 V 4G5 Québec, Canada.
| | - A Bellocq
- Service des explorations fonctionnelles de la respiration, de l'exercice et de la dyspnée, département médico-universitaire « APPROCHES », Sorbonne Université, groupe hospitalier Pitié-Salpêtrière-Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, Paris, France; Inserm, Sorbonne Université, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - S Gephine
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, 2725, chemin Sainte-Foy, Pavillon U 4766, G1 V 4G5 Québec, Canada; Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000 Lille, France
| | - A Lino
- Centre médical de Bayère, 30, route du Vieux-Château, 69380 Charnay, France
| | - G Reychler
- Université catholique de Louvain-UCLouvain, Louvain, Belgique; Institute of Experimental and Clinical Research (IREC), Louvain, Belgique
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Abstract
Lung function testing has undisputed value in the comprehensive assessment and individualized management of chronic obstructive pulmonary disease, a pathologic condition in which a functional abnormality, poorly reversible expiratory airway obstruction, is at the core of its definition. After an overview of the physiologic underpinnings of the disease, the authors outline the role of lung function testing in this disease, including diagnosis, assessment of severity, and indication for and responses to pharmacologic and nonpharmacologic interventions. They discuss the current controversies surrounding test interpretation with these purposes in mind and provide balanced recommendations to optimize their usefulness in different clinical scenarios.
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