Which functional outcome measures can we use as a surrogate for exercise capacity during remote cardiopulmonary rehabilitation assessments? A rapid narrative review

  1. Linzy Houchen-Wolloff1,2,3,4,
  2. Enya Daynes1,2,3,4,
  3. Amye Watt1,2,
  4. Emma Chaplin1,2,
  5. Nikki Gardiner1,2 and
  6. Sally Singh1,2,3
  1. 1Cardiopulmonary Rehabilitation, Glenfield Hospital, Leicester, UK
  2. 2Centre for Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Leicester, UK
  3. 3Department of Respiratory Sciences, University of Leicester, Leicester, UK
  4. 4Joint first author- equal contribution.
  1. Linzy Houchen-Wolloff. E-mail: linzy.Houchen{at}uhl-tr.nhs.uk

Abstract

Introduction The COVID-19 pandemic has seen many cardiopulmonary rehabilitation services delivering programmes remotely. One area of concern is how to assess exercise capacity when a supervised exercise test is not possible. The aim of this review was to examine the relationship between functional exercise tests with recommended exercise tests for cardiopulmonary rehabilitation.

Methods Rapid narrative review. Searches were conducted by 2 authors.

Participants: Adults, all long-term conditions.

Intervention: Any/none.

Outcome: Duke activity status index (DASI), Sit to stand (STS 30 s, 1 min and 5 repetition), short physical performance battery (SPPB), 4 metre gait speed (4MGS) or step test (Chester/others) AND directly compared to one of the recommended exercise tests for cardiopulmonary rehabilitation: 6 min walk test (6 MWT), incremental shuttle walk test (ISWT) or cardiopulmonary exercise test (CPET) in terms of reporting agreement/correlation.

Study design: primary research only, controlled trials or observational studies.

Results 16 articles (249 screened). N=2271 patients. Overall there was weak-strong correlations for the included tests with a recommended exercise test r=0.38–0.85. There were few reported issues with feasibility or safety of the tests. However all tests were supervised in a clinical setting. The test that correlated highest with field walking test was the 4MGS with the ISWT (r=0.78) and with the 6 MWT (r=0.85).

Discussion The 4MGS correlates highest with routine measures of exercise tolerance. However it may be difficult to standardise in a remote assessment or prescribe exercise from. Clinicians should strive for face-to-face standardised exercise tests where possible to be able to guide exercise prescription.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Houchen-Wolloff has nothing to disclose.

Conflict of interest: Dr. Daynes has nothing to disclose.

Conflict of interest: Dr. Watt has nothing to disclose.

Conflict of interest: Dr. Chaplin has nothing to disclose.

Conflict of interest: Dr. Gardiner has nothing to disclose.

Conflict of interest: Dr. Singh has nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received July 26, 2020.
  • Accepted September 29, 2020.
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.