Application and Measurement Properties of the Talk Test in Cardiopulmonary Patients: A Systematic Review

Abstract

Background:The talk test (TT) evaluates the exercise intensity by measuring speech comfort level during aerobic exercise. There are several application protocols available to assess individuals with cardiopulmonary diseases. However, the measurement properties of the TT were not systematically reviewed yet. Methods: A systematic review was developed, registered (CRD420181068930), and reported according to PRISMA Statement. Randomized clinical trials, cross-sectional studies, or series cases were identified through multiple databases and were selected if they presented concomitant speech provocation and an exercise test. Included studies were evaluated based on methodological quality (adapted New Castle-Ottawa Scale), descriptive quality (STROBE Statement), and risk of bias (COSMIN bias risk scale). Results: Ten studies were included. Seven studies presented moderate to high quality and the majority presented good scores according to the STROBE statement. Four hundred and fourteen subjects performed the TT, the majority being patients with coronary artery disease. The test validity was supported by the included studies. Talk Test reliability was considered satisfactory, although only one study presented an adequate reliability analysis. The studies found a correlation between the last positive stage of the TT with the first ventilatory threshold. Workload, oxygen uptake, and heart rate in the last positive stage of the TT were not different from the same parameters related to the first ventilatory threshold. Conclusions: The evidence indicates that the TT is suitable as an alternative tool for the assessment and prescription of exercise in individuals with cardiovascular diseases. The stage when the individual is still able to speak comfortably is suggested as the intensity for aerobic exercise prescription. As there is still no well-defined and fully explored TT protocol, caution is required when interpreting the TT results.

Prescrição de Exercício Aeróbio na Reabilitação Cardíaca Baseada na Frequência Cardíaca dos Estágios do Teste da Fala e do Teste de Caminhada de 6 Minutos

“…O TF não possui um protocolo padronizado e pode ser realizado com diferentes equipamentos, progressões de carga e durações dos estágios, e a fala pode ser desafiada usando parágrafos ou contagem. 16 Apesar de utilizarem métodos diferentes, estudos demonstraram semelhanças entre a FC e o consumo de oxigênio nos estágios do TF e LV em pacientes com doenças cardíacas, sugerindo que os estágios do TF podem ser usadas para prescrever EA. 14,15,21,22 Nossos resultados foram semelhantes aos de Brawer et al (2006), que aplicaram o TF em pacientes com doença arterial coronariana estável e demonstraram nenhuma diferença na estimativa do LV1 e na viabilidade da prescrição de EA pela FC de acordo com o TF.…”

“…O TF não possui um protocolo padronizado e pode ser realizado com diferentes equipamentos, progressões de carga e durações dos estágios, e a fala pode ser desafiada usando parágrafos ou contagem. 16 Apesar de utilizarem métodos diferentes, estudos demonstraram semelhanças entre a FC e o consumo de oxigênio nos estágios do TF e LV em pacientes com doenças cardíacas, sugerindo que os estágios do TF podem ser usadas para prescrever EA. 14 , 15 , 21 , 22 …”

“…The TT does not have a standardized protocol and may be performed with different equipment, load progressions, and stage lengths, and the speech can be challenged using paragraphs or counting. 16 Despite using different methods, studies have demonstrated similarities between HR and oxygen uptake at TT stages and VTs in patients with cardiac disease, suggesting that TT stages may be used to prescribe AE. 14 , 15 , 21 , 22 …”

“…O último estágio (TF−) é considerado um critério para interrupção do teste. 12,[14][15][16] No entanto, estudos utilizando TF para prescrever EA são escassos, mesmo em pessoas saudáveis.…”

“…The last stage (TT−) is considered a criterion for interrupting the test. 12 , 14 - 16 Nevertheless, studies using TT to prescribe AE are scarce, even in healthy people.…”