Evaluation of the 3‐minute chair rise test as part of preoperative evaluation for patients with non‐small cell lung cancer

Abstract

Background Peak oxygen uptake (trueV˙O2peak) measured by a cardiopulmonary exercise test (CPX) is the gold‐standard for predicting surgical risk in patients with non‐small cell lung cancer (NSCLC). The 3‐minute chair rise test (3CRT) is a simple test requiring minimal resources. This study aimed to determine the ability of 3CRT to predict trueV˙O2peak in patients with NSCLC. Methods Retrospective data from CPX and 3CRT carried out in 36 patients with NSCLC between March 2018 and February 2019 were included. A multivariate analysis was undertaken to derive a predictive trueV˙O2peak equation based on performance on the 3CRT. In addition, sensitivity‐specificity analysis was carried out to estimate a threshold 3CRT value for the prediction of trueV˙O2peak ≥ 15 mL/kg/minute. Results The following equation was obtained: trueV˙O2peak predicted = (0.04765 × FEV1) ‐ (0.207 59 × BMI) ‐ (0.115 89 × age) + (0.386 09 × vertical distance) + 16.628 69; r2 = 0.75, P < 0.01. The bias between the trueV˙O2peak values predicted and measured during CPX was 0.0 ± 1.7 mL/kg/minute (95% limits of agreement [−3.5 to 3.5]). A performance ≥49 chair rises predicted trueV˙O2peak ≥ 15 mL/kg/minute with a sensitivity of 0.75 and a specificity of 0.81. Conclusions The level of error in the prediction of trueV˙O2peak from 3CRT performance was too great to recommend that 3CRT should replace CPX as the sole measurement of trueV˙O2peak. Nevertheless, the 3CRT could help to identify those patients that require CPX prior to lung resection surgery for NSCLC, larger prospective study is needed to confirm this hypothesis. Key points Significant findings of the study Cardiopulmonary exercise tests can stratify the surgical risk. Prediction of the peak oxygen uptake (trueV˙O2peak) value from the 3CRT yields an unacceptable level of error. However, a performance of 49 chair rises or more during the 3CRT could indicate a trueV˙O2peak ≥ 15 mL / kg / minute. What this study adds The 3CRT is a useful screening tool to determine the necessity for a comprehensive cardiopulmonary exercise test, whose access is limited in clinical practice. It could also allow early screening of patients requiring specific prehabilitation programs.

Direct and indirect evidence of efficacy and safety of rapid exercise tests for exertional desaturation in Covid-19: a rapid systematic review

“…We placed less weight on the final five studies—as the methodological quality was uncertain, or because methodological quality was considered to be poor on our risk of bias and applicability tool, though the findings from all these additional studies were similar to the above ones. These studies were Gruet et al (a prospective correlation study from France in 25 patients with cystic fibrosis, which concluded that the 1MSTST may be used as an alternative to the 6MWT and CPET for assessing exertional desaturation) [ 47 ]; Morita et al (a study in 23 patients with COPD which showed good correlation between various exercise desaturation tests) [ 48 ]; Kohlbrenner et al (a retrospective study from Switzerland in 38 lung transplant candidates which concluded that the 1MSTST is a safe alternative to 6MWT in such patients despite lower desaturation nadirs) [ 49 ]; Crook et al (a prospective study in 21 COPD patients which concluded that 1MSTST is a safe and accurate alternative to 6MWT); and Azzi et al (a retrospective study in 36 lung cancer patients whose main aim was to compare a 3-min chair-to-rise test, 3MCTRT, with the CPET in terms of maximal exercise capacity but which also found high correlation with the level of oxygen desaturation achieved) [ 50 ].…”

Respiratory muscle metabolic activity on PET/CT correlates with obstructive ventilatory defect severity and prognosis in patients undergoing lung cancer surgery

“…CPET has now been integrated to pretreatment risk assessment algorithms 34 and helps guide respiratory rehabilitation programs worldwide 35 . However, this test still suffers from a lack of accessibility in some centres due to resource limitations, 9,36 and poses the risk of over‐estimating risks in up to 30% of patients who cannot provide the necessary maximum effort to ensure validity of VO 2 measurements 37 . Additional tools to identify patients with respiratory fragility who could potentially benefit from rehabilitation programs are therefore needed 38,39 .…”

Direct and indirect evidence of efficacy and safety of rapid exercise tests for exertional desaturation in Covid-19: A rapid systematic review

“…We placed less weight on the nal ve studies -as the methodological quality was uncertain, or because methodological quality was considered to be poor on our risk of bias and applicability tool, though the ndings from all these additional studies were similar to the above ones. These studies were: Gruet et al (a prospective correlation study from France in 25 patients with cystic brosis, which concluded that the 1MSTST may be used as an alternative to the 6MWT and CPET for assessing exertional desaturation) [47]; Morita et al (a study in 23 patients with COPD which showed good correlation between various exercise desaturation tests) [48]; Kohlbrenner et al (a retrospective study from Switzerland in 38 lung transplant candidates which concluded that the 1MSTST is a safe alternative to 6MWT in such patients despite lower desaturation nadirs) [49]; Crook et al (a prospective study in 21 COPD patients which concluded that 1MSTST is a safe and accurate alternative to 6MWT); and Azzi et al (a retrospective study in 36 lung cancer patients whose main aim was to compare a 3-minute chair-to-rise test, 3MCTRT, with the CPET in terms of maximal exercise capacity but which also found high correlation with the level of oxygen desaturation achieved) [50].…”