Results From A Multi-Center Cardiopulmonary Exercise Physiological Quality Control Protocol

Blonshine, Susan; Cao, Robert; Casaburi, Richard; Paden, Heather; Pórszász, János

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a1545

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“…This trial is distinguished by its focus on mild-to-moderate COPD, a baseline characterization phase assessing the impact of dyspnea on daily activities, and ontreatment assessment of daily informal physical activity in addition to constant work-rate treadmill testing. Portions of this study were presented to the American Thoracic Society in May 2012 103,104 ; the full manuscript is in preparation.…”

Section: Can Inhaled Bronchodilators Improve Exercise Capacity In Patmentioning

confidence: 99%

Exercise and COPD: Therapeutic Responses, Disease-Related Outcomes, and Activity-Promotion Strategies

Maltais

2013

The Physician and Sportsmedicine

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Chronic obstructive pulmonary disease (COPD) reduces patients' exercise capacities and their abilities to perform daily physical activities, thereby increasing morbidity and mortality rates. The cycle of dyspnea, deconditioning, and declining physical activity not only accelerates the progression of COPD but also increases the risk for developing or aggravating metabolic and cardiovascular diseases. Cardiovascular and metabolic comorbidities also limit physical function, and their disabling effects in combination with COPD may be greater than the effects of each disease alone. The impact of COPD and its treatment on the ability to exercise, and the degree of physical activity in daily life, can be measured by field-based tests (eg, the 6-minute walk test or incremental and endurance shuttle-walk test), laboratory-based tests (eg, incremental or constant work-rate treadmill and cycle-ergometer tests), and physical activity assessments (eg, questionnaires and accelerometers). Walking tests increase oxygen consumption and desaturation in patients with COPD more than cycling tests with similar work-rate profiles and may more closely resemble patients' normal activities. Despite the questionable relevance of exercise testing to patients' daily functionality, exercise parameters remain important predictors of survival in patients with COPD. Treatment of COPD (pharmacotherapy, pulmonary rehabilitation, or both) can increase exercise capacity and physical activity in daily life, which potentially slows the decline of lung function, reduces the frequencies of exacerbations and hospitalizations, decreases mortality, slows the progression of comorbidities, improves health-related quality of life, and increases the activity reserve for routine function. This article examines the interactions of reduced physical activity and decreased exercise capacity with the progression of COPD, comorbidities, and mortality. The article also describes the available exercise tests for patients with COPD and reviews the evidence indicating that treating COPD improves exercise capacity. Notably, it appears that even mild COPD reduces exercise capacity and daily physical activity, indicating the need for early intervention.

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Section: Can Inhaled Bronchodilators Improve Exercise Capacity In Patmentioning

confidence: 99%

Exercise and COPD: Therapeutic Responses, Disease-Related Outcomes, and Activity-Promotion Strategies

Maltais

2013

The Physician and Sportsmedicine

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Biological quality control for cardiopulmonary exercise testing in multicenter clinical trials

et al. 2016

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BackgroundPrecision and accuracy assurance in cardiopulmonary exercise testing (CPET) facilitates multicenter clinical trials by maximizing statistical power and minimizing participant risk. Current guidelines recommend quality control that is largely based on precision at individual testing centers (minimizing test–retest variability). The aim of this study was to establish a multicenter biological quality control (BioQC) method that considers both precision and accuracy in CPET.MethodsBioQC testing was 6-min treadmill walking at 20 W and 70 W (below the lactate threshold) with healthy non-smoking laboratory staff (15 centers; ~16 months). Measurements were made twice within the initial 4 weeks and quarterly thereafter. Quality control was based on: 1) within-center precision (coefficient of variation [CV] for oxygen uptake [V̇O2], carbon dioxide output [V̇CO2], and minute ventilation [V̇E] within ±10 %); and 2) a criterion that V̇O2 at 20 W and 70 W, and ∆V̇O2/∆WR were each within ±10 % predicted. “Failed” BioQC tests (i.e., those outside the predetermined criterion) prompted troubleshooting and repeated measurements. An additional retrospective analysis, using a composite z-score combining both BioQC precision and accuracy of V̇O2 at 70 W and ∆V̇O2/∆WR, was compared with the other methods.ResultsOf 129 tests (5 to 8 per center), 98 (76 %) were accepted by within-center precision alone. Within-center CV was <9 %, but between-center CV remained high (9.6 to 12.5 %). Only 43 (33 %) tests had all V̇O2 measurements within the ±10 % predicted criterion. However, a composite z-score of 0.67 identified 67 (52 %) non-normal outlying tests, exclusion of which coincided with the minimum CV for CPET variables.ConclusionsStudy-wide BioQC using a composite z-score can increase study-wide precision and accuracy, and optimize the design and conduct of multicenter clinical trials involving CPET.Trial registrationClinicalTrials.gov identifier: NCT01072396; February 19, 2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0174-8) contains supplementary material, which is available to authorized users.

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Results From A Multi-Center Cardiopulmonary Exercise Physiological Quality Control Protocol

Abstract: The ATS/ACCP and ERS have published standards for cardiopulmonary exercise testing (CPET). Physiological quality control

Cited by 2 publications

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Exercise and COPD: Therapeutic Responses, Disease-Related Outcomes, and Activity-Promotion Strategies

Exercise and COPD: Therapeutic Responses, Disease-Related Outcomes, and Activity-Promotion Strategies

Biological quality control for cardiopulmonary exercise testing in multicenter clinical trials

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