Replacement of the 6-min Walk Test With Maximal Oxygen Consumption in the BODE Index Applied to Patients With COPD

Cardoso, Fábio; Tufanin, Andréa; Colucci, Marcelo; Nascimento, Oliver Augusto; Jardim, José Roberto

doi:10.1378/chest.07-0435

Cited by 49 publications

(41 citation statements)

References 29 publications

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“…Different modifications of the conventional BODE index have been proposed, among them one that incorporates V9O 2 and not the 6MWD. In one study, the modified BODE index was reported to have an excellent correlation with the conventional BODE (r50.97) but its predictive value for mortality was not evaluated [23]. In the present study, these findings of CARDOSO et al [23] were confirmed, and the modest n n n n n n n n n n n n but significant correlation between the 6MWD and V9O 2 % pred was further corroborated.…”

Section: Discussionsupporting

confidence: 70%

“…The mBODE% index was calculated by replacing the 6MWD by the V9O 2 expressed as % pred as follows: score 0 for .70% pred; score 1 for 60-69% pred; score 2 for 40-59% pred; and score 3 for ,40% pred [27]. In the study of CARDOSO et al [23], as well as in calculations conducted in the present cohort (data not presented), the V9O 2 expressed as % pred offered similar, if not better, discriminating power than the absolute value.…”

Section: The Bode Indicesmentioning

confidence: 99%

“…CARDOSO et al [23] recently developed a modified BODE index (mBODE) by replacing the 6MWD with V9O 2 . An excellent correlation between BODE and mBODE when the V9O 2 value was expressed as % predicted was reported (mBODE%), which was better than with that with mBODE when V9O 2 was expressed in mL?kg…”

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confidence: 99%

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The modified BODE index: validation with mortality in COPD

Côté¹,

Pinto-Plata²,

Marı́n³

et al. 2008

European Respiratory Journal

114

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Peak oxygen uptake (V9O 2 ) remains the gold standard measurement of exercise capacity and has been associated with survival. A modified BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index replacing the 6-min walk distance (6MWD) with V9O 2 as % predicted (mBODE%) has been developed and found to have excellent correlation with the conventional BODE index.The objectives of the present study were to compare the ability of the conventional BODE and the mBODE% to predict mortality in 444 patients with chronic obstructive pulmonary disease (COPD) followed for a mean¡SD period of 71¡34 months. Anthropometrics, spirometry, lung volumes, comorbidity, cardiopulmonary cyclo-ergometry test and 6MWD were determined at entry.The mean BODE indices for the cohort were: BODE 4.1¡2 and mBODE% 5.5¡2. Both indices were significantly correlated with mortality. Logistic regression analysis with COPD survival as the dependent variable identified the BODE index, Charlson's and exercise capacity (in W) as variables associated with this outcome.In conclusion, the conventional BODE index, which uses the 6-min walk distance, predicts mortality in chronic obstructive pulmonary disease as well as the modified index using peak oxygen uptake. The results support the use of the simpler index, which includes the 6-min walk distance in the comprehensive evaluation of patients with chronic obstructive pulmonary disease.KEYWORDS: Chronic obstructive pulmonary disease, exercise capacity, mortality T he oxygen uptake measured at peak exercise (V9O 2 ) during incremental cardiopulmonary exercise testing (CPET) is considered to be the gold standard for the evaluation of exercise capacity. V9O 2 helps predict survival in patients undergoing lung resection [1, 2] and lung volume reduction surgery (LVRS) [3], and in patients with chronic obstructive pulmonary disease (COPD) [4] and heart failure [5]. The 6-min walk test (6MWT) is easy to perform and has been standardised [6], and also predicts mortality in COPD [7,8] and in pulmonary hypertension [9].The 6MWT is considered a submaximal test; however, CASAS et al. [10] have shown that patients with COPD walk at a pace close to their maximal exercise capacity while the V9O 2 measured at the end of an incremental protocol in COPD is not a true maximal oxygen uptake [11,12]. This indicates that the differences between tests in the patients with COPD may not be as large as otherwise suspected. There is a modest but significant correlation between V9O 2 and 6-min walking distance (6MWD) [13,14], implying that the tests are not equal; however, as it relates to the capacity to predict survival in COPD, the current authors have recently shown that the 6MWD is equal to, if not better than, V9O 2 at predicting this outcome [15].The BODE index, which incorporates measurements of nutrition (body mass index), airflow obstruction (forced expiratory volume in one second (FEV1)), dyspnoea (Modified Medical Research Council dyspnoea scale) and exercise capacity as measured by the 6MWD,...

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Section: Discussionsupporting

confidence: 70%

Section: The Bode Indicesmentioning

confidence: 99%

See 1 more Smart Citation

The modified BODE index: validation with mortality in COPD

Côté¹,

Pinto-Plata²,

Marı́n³

et al. 2008

European Respiratory Journal

114

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“…This approach has been proposed and previously validated by Cardoso et al 29 Scores on the mBODE% index range from 0 to 10, indicating low to high risk of death, respectively. 14,30 The COTE index was calculated based on information reported verbally by the participant during the hospital visits and completed by a review of the participant's medical records.…”

Section: Evaluation Of Disease Prognosismentioning

confidence: 99%

Amplitude of the rest–activity cycle in chronic obstructive pulmonary disease: an exploratory study

Chan-Thim¹,

Dumont²,

Moullec³

et al. 2016

CPT

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Abstract:In chronic obstructive pulmonary disease (COPD), there is large individual variability in the progression of the disease. Low amplitude of rest-activity rhythms has been associated with worse prognosis in a variety of diseases, but it has not been investigated in COPD. The first aim of this exploratory study was to compare disease severity and prognosis indicators between COPD patients with relatively high or low amplitude of their rest-activity cycle, as measured with actigraphy. As a second objective, 24-hour profiles of both activity levels and nighttimesleep quality were compared between the two subgroups to assess the relative contribution of day-and night-activity levels to high and low rest-activity rhythm amplitude in this population. Rest-activity rhythms were measured with 8-14 days of wrist actigraphy in 14 patients (nine men), aged 58-79 years, suffering from moderate-to-severe COPD. Relative amplitude of 24-hour activity profiles ranged from 0.72 to 0.98. Participants were divided at the median into high-amplitude (mean ± standard deviation 0.9±0.04) and low-amplitude (0.79±0.05) subgroups. There was no significant difference between the two subgroups for pulmonary function or exercise capacity. However, the low-amplitude group had more severe symptoms of dyspnea and worse prognostic scores than the high-amplitude group (P<0.05). The 24-hour activity profiles revealed higher levels of activity in the high-amplitude group for the 12-3 pm interval (P<0.05). There was no significant difference between the two groups for subjective or actigraphic estimates of sleep quality, sleep duration, or proportion of daytime sleep. This exploratory study is a first step toward the identification of larger rest-activity rhythm amplitude as a marker of better prognosis in COPD and as another potential target for exercise-based rehabilitation programs in this population.

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“…To verify the EPAP use, the 6-minute walk test (6'WT) is well-tolerated by the patients for measurement of the functional capacity [8][9][10][11] . When EPAP is applied to patients with HF, it presents high reproducibility and good correlation with the variables measured in the test of cardiopulmonary exercise [12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

Thofehrn

Coutinho

Daros

et al. 2013

Rev Bras Med Esporte

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Introduction: New therapeutic approaches that aim to improve the sensation of dyspnea and fatigue in patients with heart failure, as the application of expiratory positive airway pressure (EPAP) should be tested in an attempt to improve functional capacity and quality of life. Objective: To evaluate the effects of the use of EPAP during exercise in patients with heart failure functional class II and III (NYHA). Methods: Of 390 patients, 28 were selected with LVEF <40%. The six-minute walk test (6'WT) was performed three times with and without the EPAP, reflecting the greater distance in the analysis. The comparison between the data obtained was performed by paired t test or Wilcoxon test as the normality of the data. Results: The use of EPAP increased volume without significant minutes, but the perceived exertion was higher after the walk with the use of the mask when compared in the absence of a mask. There was significant increase in oxygen saturation compared with the group that did not use the mask. There was no improvement in distance walked in 6'WT with the use of EPAP. Conclusion: Use of EPAP mask increases the perception of ventilatory effort and work, but its applicability in routine cardiac rehabilitation programs based on our preliminary data is questionable.

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Replacement of the 6-min Walk Test With Maximal Oxygen Consumption in the BODE Index Applied to Patients With COPD

Cited by 49 publications

References 29 publications

The modified BODE index: validation with mortality in COPD

The modified BODE index: validation with mortality in COPD

Amplitude of the rest–activity cycle in chronic obstructive pulmonary disease: an exploratory study

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

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Replacement of the 6-min Walk Test With Maximal Oxygen Consumption in the BODE Index Applied to Patients With COPD

Cited by 49 publications

References 29 publications

The modified BODE index: validation with mortality in COPD

The modified BODE index: validation with mortality in COPD

Amplitude of the rest&ndash;activity cycle in chronic obstructive pulmonary disease: an exploratory study

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

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Amplitude of the rest–activity cycle in chronic obstructive pulmonary disease: an exploratory study