Dataset Information

Reliability and responsiveness of cardiopulmonary exercise testing in fatigued persons with multiple sclerosis and low to mild disability.

ABSTRACT:

Background

Peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons with MS (PwMS) have not been extensively studied.

Objective

(1) to investigate the reliability of cardiopulmonary exercise parameters in PwMS; (2) to determine the responsiveness, in terms of the smallest detectable change (SDC), for each parameter.

Design

Two repeated measurements of cardiopulmonary exercise outcomes were obtained, with a median time interval of 16 days.

Methods

Thirty-two PwMS suffering from subjective fatigue performed cardiopulmonary exercise tests on a cycle ergometer, to voluntary exhaustion. We calculated the reliability, in terms of the intra-class correlation coefficient (ICC [2,k]; absolute agreement), and the measurement error, in terms of standard error of measurement (SEM) and SDC at individual (SDCindividual) and group level (SDCgroup).

Results

The ICC for VO2peak was 0.951, with an SEM of 0.131 L?min(-1) and an SDCindividual of 0.364 L?min(-1). When corrected for bodyweight, the ICC of VO2peak was 0.933, with an SEM of 1.7 mL?kg(-1)?min(-1) and in an SDCindividual of 4.6 mL?kg(-1)?min(-1).

Limitations

Generalization of our study results is restricted to fatigued PwMS with a low to mild level of disability.

Conclusions

At individual level, cardiopulmonary exercise testing can be used reliably to assess physical fitness in terms of VO2peak, but less so to determine significant changes. At group level, VO2peak can be reliably used to determine physical fitness status and establish change over time.

SUBMITTER: Heine M

PROVIDER: S-EPMC4366200 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Reliability and responsiveness of cardiopulmonary exercise testing in fatigued persons with multiple sclerosis and low to mild disability.

Heine Martin M van den Akker Lizanne Eva LE Verschuren Olaf O Visser-Meily Anne A Kwakkel Gert G

PloS one 20150319 3

<h4>Background</h4>Peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing is considered the gold standard for testing aerobic capacity in healthy participants and people with various medical conditions. The reliability and responsiveness of cardiopulmonary exercise testing outcomes in persons with MS (PwMS) have not been extensively studied.<h4>Objective</h4>(1) to investigate the reliability of cardiopulmonary exercise parameters in PwMS; (2) to determine the responsiveness, in terms ...[more]

PMID: 25789625

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Project description:BackgroundExercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke.Methods20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability.ResultsPeak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC?=0.82), relative peak oxygen uptake (ICC?=0.72), peak work rate (ICC?=0.91), peak heart rate (ICC?=0.80), absolute gas exchange threshold (ICC?=0.91), relative gas exchange threshold (ICC?=0.88), oxygen cost of work (ICC?=0.87), oxygen pulse at peak oxygen uptake (ICC?=0.92), ventilation rate versus carbon dioxide output slope (ICC?=0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied.ConclusionsThis study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.

Project description:Neurological impairments can limit the implementation of conventional cardiopulmonary exercise testing (CPET) and cardiovascular training strategies. A promising approach to provoke cardiovascular stress while facilitating task-specific exercise in people with disabilities is feedback-controlled robot-assisted end-effector-based stair climbing (RASC). The aim of this study was to evaluate the feasibility, reliability, and repeatability of augmented RASC-based CPET in able-bodied subjects, with a view towards future research and applications in neurologically impaired populations.Twenty able-bodied subjects performed a familiarisation session and 2 consecutive incremental CPETs using augmented RASC. Outcome measures focussed on standard cardiopulmonary performance parameters and on accuracy of work rate tracking (RMSEP-root mean square error). Criteria for feasibility were cardiopulmonary responsiveness and technical implementation. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean differences, limits of agreement, and coefficients of variation (CoV) were estimated to assess repeatability.All criteria for feasibility were achieved. Mean V'O2peak was 106±9% of predicted V'O2max and mean HRpeak was 99±3% of predicted HRmax. 95% of the subjects achieved at least 1 criterion for V'O2max, and the detection of the sub-maximal ventilatory thresholds was successful (ventilatory anaerobic threshold 100%, respiratory compensation point 90% of the subjects). Excellent reliability was found for peak cardiopulmonary outcome measures (ICC ? 0.890, SEM ? 0.60%, MDC ? 1.67%). Repeatability for the primary outcomes was good (CoV ? 0.12).RASC-based CPET with feedback-guided exercise intensity demonstrated comparable or higher peak cardiopulmonary performance variables relative to predicted values, achieved the criteria for V'O2max, and allowed determination of sub-maximal ventilatory thresholds. The reliability and repeatability were found to be high. There is potential for augmented RASC to be used for exercise testing and prescription in populations with neurological impairments who would benefit from repetitive task-specific training.

Dataset Information

Reliability and responsiveness of cardiopulmonary exercise testing in fatigued persons with multiple sclerosis and low to mild disability.

Background

Objective

Design

Methods

Results

Limitations

Conclusions

Publications

Reliability and responsiveness of cardiopulmonary exercise testing in fatigued persons with multiple sclerosis and low to mild disability.

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