No abstract

Exercise intolerance is a key element in the pathophysiology and course of Chronic Obstructive Pulmonary Disease (COPD). As such, evaluating exercise tolerance has become an important part of the management of COPD. A wide variety of exercise-testing protocols is currently available, each protocol having its own strengths and weaknesses relative to their discriminative, methodological, and evaluative characteristics. This paper aims to review the responsiveness of several exercise-testing protocols used to evaluate the efficacy of pharmacological and nonpharmacological interventions to improve exercise tolerance in COPD. This will be done taking into account the minimally important difference, an important concept in the interpretation of the findings about responsiveness of exercise testing protocols. Among the currently available exercise-testing protocols (incremental, constant work rate, or self-paced), constant work rate exercise tests (cycle endurance test and endurance shuttle walking test) emerge as the most responsive ones for detecting and quantifying changes in exercise capacity after an intervention in COPD.

This study demonstrated that the six-minute stepper test is a reproducible, sensitive, secure, well-tolerated and feasible test for patients with COPD. The reproducibility and sensitivity of the six-minute stepper test suggests that this test could be used in the evaluation of exercise tolerance in patients with COPD.

This study aimed to investigate the involvement of cerebral oxygenation in limitation of maximal exercise. We hypothesized that O2 supplementation improves physical performance in relation to its effect on cerebral oxygenation during exercise. Eight untrained men (age 27 ± 6 years; VO2 max 45 ± 8 ml min(-1) kg(-1)) performed two randomized exhaustive ramp exercises on a cycle ergometer (1 W/3 s) under normoxia and hyperoxia (FIO2 = 0.3). Cerebral (ΔCOx) and muscular (ΔMOx) oxygenation responses to exercise were monitored using near-infrared spectroscopy. Power outputs corresponding to maximal exercise intensity, to threshold of ΔCOx decline (ThCOx) and to the respiratory compensation point (RCP) were determined. Power output (W max = 302 ± 20 vs. 319 ± 28 W) and arterial O2 saturation estimated by pulse oximetry (SpO2 = 95.7 ± 0.9 vs. 97.0 ± 0.5 %) at maximal exercise were increased by hyperoxia (P < 0.05). However, the ΔMOx response during exercise was not significantly modified with hyperoxia. RCP (259 ± 17 vs. 281 ± 25 W) and ThCOx (259 ± 23 vs. 288 ± 30 W) were, however, improved (P < 0.05) with hyperoxia and the ThCOx shift was related to the W max improvement with hyperoxia (r = 0.71, P < 0.05). The relationship between the change in cerebral oxygenation response to exercise and the performance improvement with hyperoxia supports that cerebral oxygenation is limiting the exercise performance in healthy young subjects.

This study focused on repeatability data and minimal important difference (MID) estimates of the endurance shuttle walking test (ESWT).255 chronic obstructive pulmonary disease patients (forced expiratory volume in 1 s 54.7¡13.2% predicted) completed four ESWTs at different times during the 8-week study: two under baseline conditions with tiotropium (1 week apart), one after a single dose and one after 4 weeks of either fluticasone propionate/salmeterol combination or placebo in addition to tiotropium. 97 patients performed all the tests with a portable metabolic system. Reproducibility of test performance and cardiorespiratory response was investigated with the data obtained on the first two ESWTs.The mean differences between the first two ESWT performances (-6.7¡72.2 s and -7.3¡113.1 m for endurance time and walking distance, respectively) were not statistically significant. The between-test end-exercise and isotime values for each cardiorespiratory parameter were not significantly different from each other. With the exception of arterial oxygen saturation by pulse oximetry, the repeatability of cardiorespiratory adaptations to ESWT was also confirmed with strong Pearson and intraclass correlation coefficients. Finally, changes of 56-61 s and 70-82 m in endurance time and distance walked, respectively, were perceived by patients.This study provides methodological information supporting the reliability of the ESWT and suggests MID estimates for this test.@ERSpublications This study provides a prospective validation of ESWT reliability and minimal important difference in COPD

The study of wheelchair propulsion strategies is important for better understanding physiological and biomechanical impacts of wheelchair propulsion for individuals with disabilities. From a kinematical point of view, this study highlights synchronous mode of propulsion to be more efficient, with regards to mean maximal velocity reaching during maximal sprinting exercises. Even if this study focuses on well-trained wheelchair athletes, results from this study could complement the knowledge on the physiological and biomechanical adaptations to wheelchair propulsion and therefore, might be interesting for wheelchair modifications for purposes of rehabilitation.

The hypothesis of this study was based on the assumption that mild cystic fibrosis could induce more frequent and more severe mechanical ventilatory constraints due to pulmonary impairment and breathing pattern disturbances. But, this study did not succeed to highlight an effect of mild cystic fibrosis on the mechanical ventilatory constraints (expFL and dynamic hyperinflation) that occur during an incremental exercise. This absence of effect could be due to the absence of an impact of the disease on spirometric data, breathing pattern regulation during exercise and breathing strategy.

The aim of this article is to determine correspondences between three levels of continuous and intermittent exercise (CE and IE, respectively) in terms of steady-state oxygen uptake (VO(2SS)) and heart rate (HR) in children. Fourteen healthy children performed seven exercises on a treadmill: one graded test for the determination of maximal aerobic speed (MAS), three CE at 60, 70 and 80% of MAS (CE60, CE70 and CE80) and three IE (alternating 15 s of exercise intercepted with 15 s of passive recovery) at 90, 100 and 110% of MAS (IE90, IE100 and IE110). Mean VO(2SS) and mean HR were determined for both continuous and intermittent exercises. For comparison, three associations were designed: CE60 versus IE90, CE70 versus IE100 and CE80 versus IE110. No VO(2SS) difference was observed for CE60 versus IE90 and CE70 versus IE100 whereas a significant difference (P < 0.01) was found for CE80 versus IE110 (1.36 +/- 0.45 vs. 1.19 +/- 0.38 L min(-1), respectively). Significant linear regressions were found for the three CE versus IE associations for VO(2SS) (0.60 < r (2) < 0.99, P < 0.05). For the three associations, mean HR presented no significant difference. Only one significant relation was found for CE80 versus IE110 association (r(2) = 0.49, P < 0.05). Correspondences between CE and IE intensities are possible in terms of VO(2SS) whatever the level of exercise; even if for high intensities, VO(2SS) was higher during CE. These results demonstrated that it is possible to diversify the exercise modality while conserving exercise individualization.