Development and Evaluation of a Treadmill-Based Exercise Tolerance Test in Cardiac Rehabilitation

Dunagan, Julie; Adams, Jenny; Cheng, Dunlei; Barton, Stephanie; Bigej-Cerqua, Janet; Mims, Lisa D; Molden, Jennifer; Anderson, Valerie

doi:10.1080/08998280.2013.11928972

Cited by 7 publications

(9 citation statements)

References 6 publications

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“…The ETT is used to identify the METs that a patient can achieve during cardiac rehabilitation [1]. However, many limitations prevent patients from completing the ETT.…”

Section: Discussionmentioning

confidence: 99%

“…The treadmill is used for the exercise tolerance test (ETT) to objectively evaluate the physiological response of patients to cardiac rehabilitation [1]. However, many patients cannot complete the ETT due to general weakness, motor weakness associated with previous disease (e.g., stroke, traumatic spinal cord injury, or Parkinson disease), or pain.…”

Section: Introductionmentioning

confidence: 99%

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Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

et al. 2016

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ObjectiveTo quantify changes in cardiopulmonary function using a lower body positive pressure supported (LBPPS) treadmill during the exercise tolerance test (ETT) in healthy subjects before applying the LBPPS treadmill in patients with gait problems.MethodsWe evaluated 30 healthy subjects who were able to walk independently. The ETT was performed using the Modified Bruce Protocol (stages 1–5) at four levels (0%, 40%, 60%, and 80%) of LBPPS. The time interval at each level of the LBPPS treadmill test was 20 minutes to recover to baseline status. We measured systolic blood pressure, diastolic blood pressure, peak heart rate (PHR), rating of perceived exertion (RPE), metabolic equivalents (METs), and oxygen consumption rate (VO2) during each LBPPS condition.ResultsSystolic blood pressure increased as the LBPPS level was increased (40% to 80%). PHR, RPE, METs, and VO2 were negatively associated with the LBPPS condition, although they were not always significant different among the LBPPS levels. The equation from a random effect linear regression model was as follows: VO2 (mL/kg/min)=(2.75×stage)+(–0.14×LBPPS level)+11.9 (r2=0.69).ConclusionDetection of the changes in physiological parameters during a submaximal ETT using the LBPPS system may be helpful for applying the LBPPS treadmill in patients who cannot perform the ETT due to gait problems, even at submaximal intensity.

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“…The ETT is used to identify the METs that a patient can achieve during cardiac rehabilitation [1]. However, many limitations prevent patients from completing the ETT.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

et al. 2016

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“…Dunagan et al (2013) showed slight over-estimation of METs level by the DASI questionnaire when compared to exercise tolerance testing in the setting of cardiac rehabilitation, although this over-estimation did not represent a significant difference in their sample (Dunagan et al 2013). Formal activity questionnaires are traditionally validated by having participants complete the questionnaire and then subsequently asking patients to undergo a physiologic measure of functional capacity, such as exercise tolerance testing (Hlatky et al 1989; Struthers et al 2008).…”

Section: Discussionmentioning

confidence: 99%

“…Patient-completed versions of the DASI questionnaire have been shown to correlate moderately well with physiologic measures of functional capacity or exercise tolerance in several clinical settings (Dunagan et al 2013; Shaw et al 2006; Struthers et al 2008), and patient reported exercise capacity has been shown to be predictive of survival in vascular surgery patients (Boult et al 2015). Patient self-assessment of functional capacity by means of electronic questionnaires would allow METs estimates to be known prior to in-person, preoperative evaluations, enabling preoperative triage of patients based on estimated functional capacity, a core component of preoperative evaluation (Fleisher et al 2014).…”

Section: Introductionmentioning

confidence: 99%

Significant discrepancies exist between clinician assessment and patient self-assessment of functional capacity by validated scoring tools during preoperative evaluation

2016

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BackgroundPreoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity.MethodsPatients were recruited immediately prior to their preoperative evaluation. Study participants completed electronic versions of the Duke Activity Status Index (DASI) and the Patient-Reported Outcomes Measurement System (PROMIS)–Short Form 12a–Physical Function. DASI and PROMIS questionnaire responses were scored and evaluated for correlation with clinician assessments of functional capacity. Correlation was analyzed around the dichotomous outcome of <4 metabolic equivalents of task (METs) or ≥4 METs. Patients also evaluated the usability of the questionnaires.ResultsAfter IRB approval, 204 patients were enrolled and completed both DASI and PROMIS questionnaires. Clinicians assessed functional capacity at <4 METs for 109 patients (53.4 %) compared to 18 (8.8 %) patient self-assessments <4 METs as estimated by DASI. These results represent a significant discrepancy between assessments (Fisher’s exact, two-tailed P value <0.0001). The standard T-score of PROMIS estimates of functional capacity correlated with DASI estimates (R2 0.76). The mean and standard deviation for PROMIS T-scores were 43.3 and 9.86, respectively (mean 50.0; SD 10.0 for the general population).Of the 203 patients who completed the entire study survey, 192 (94.6 %) stated that they did not require assistance from another person, and 187 (94 %) responded either “agree” or “strongly agree” to the DASI questionnaire being “easy to understand” and “easy to complete;” 186 (93 %) and 188 (94 %), respectively, responded similarly to the PROMIS questionnaire.ConclusionsWhile both electronic questionnaires were easy to understand and complete for most study participants, there was a significant discrepancy between clinician assessments and patient self-assessments of functional capacity. Further study is needed to determine if either patient self-triage by means of activity questionnaires or clinician evaluation is valid and reliable in the preoperative setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-016-0041-4) contains supplementary material, which is available to authorized users.

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“…Functional capacity is a crucial parameter correlated with outcomes [1–4]. Currently, the gold standard for assessing the functional state is the cardiopulmonary gas exchange exercise test (CPET) [5, 6]. Because it requires instruments and is inconvenient to administer because it is time-consuming, the New York Heart Association functional classification (NYHA Fc) is widely used instead [7].…”

Section: Introductionmentioning

confidence: 99%

Amino Acid-Based Metabolic Profile Provides Functional Assessment and Prognostic Value for Heart Failure Outpatients

et al. 2019

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Functional capacity is a crucial parameter correlated with outcomes. The currently used New York Heart Association functional classification (NYHA Fc) system has substantial limitations, leading to inaccurate classification. This study investigated whether amino acid-based assessment on metabolic status provides an objective way to assess functional capacity and prognosis in heart failure (HF) outpatients. Plasma concentrations of histidine, ornithine, and phenylalanine (HOP) were measured on 890 HF outpatients to assess metabolic status by calculating the HOP score. Cardiopulmonary exercise testing (CPET) was performed in 387 patients to measure metabolic equivalents (MET) in order to define the functional class based on MET (MET Fc). Patients were followed for composite events (death/HF-related rehospitalization) up to one year. We found only 47% concordance between the MET Fc and NYHA Fc. HOP scores worked better than NYHA Fc for discriminating patients with MET Fc II and III from those with MET Fc I, with the optimal cutoff value set at 8.8. HOP scores≥8.8 were associated with risk factors for composite events in different kinds of HF populations and were a powerful predictor of composite events in univariate analysis. In multivariable analysis, HOP scores≥8.8 remained a powerful event predictor, independent of other risk factors. Kaplan-Meier curves revealed that HOP scores of ≥8.8 stratified patients at higher risk of composite events in a variety of HF populations. In conclusion, amino acid-based assessment of metabolic status correlates with functional capacity in HF outpatients and provides prognostic value for a variety of HF populations.

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Development and Evaluation of a Treadmill-Based Exercise Tolerance Test in Cardiac Rehabilitation

Cited by 7 publications

References 6 publications

Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

Significant discrepancies exist between clinician assessment and patient self-assessment of functional capacity by validated scoring tools during preoperative evaluation

Amino Acid-Based Metabolic Profile Provides Functional Assessment and Prognostic Value for Heart Failure Outpatients

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