Prueba de caminata de carga progresiva (shuttle test) en enfermedad pulmonar obstructiva crónica grave

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Abstract

La prueba de caminata de carga progresiva (shuttle test, PCCP) tiene escaso uso en nuestro país. Este estudio comparó diferentes variables de la PCCP con la de caminata de 6 minutos (PC6M) y el consumo de oxígeno (VO2max) en enfermedad pulmonar obstructiva crónica (EPOC) grave. A 21 pacientes con EPOC grave estable (estadios GOLD III-IV), se les realizó PC6M, PCCP, y VO2max. Se evaluaron frecuencia cardíaca, saturación de oxígeno y escala de disnea (Borg). Se realizaron espirometría, gases en sangre y cuestionario de calidad de vida (CRQ). Se utilizaron prueba t de Student para datos apareados y coeficiente de correlación de Pearson (significación < 0.05). La media de edad fue 65.27 ± 12.72 años y la obstrucción al flujo aéreo fue grave, (FEV1: 33.23 ± 4.94%). La respuesta al ejercicio para PC6M 297.85 ± 173.24 metros; PCCP: 318.8 ± 42.42 metros y VO2max 14.7 ± 5.44 ml/kg/min. El coeficiente de correlación del metraje caminado entre PC6M y PCCP fue r: 0.52 (p = 0.00085); entre PCCP y VO2max (l/min): r: 0.78 (p = 0.00079), y PCCP y VO2max (ml/kg/min): r: 0.81 (p = 0.00065). Se observó correlación moderada en la frecuencia cardíaca final (r: 0.41, p = 0.00091), escala de disnea máxima (r: 0.47, p = 0.00099), y alta en la saturación de oxígeno final (r: 0.81, p = 0.00087) entre PCCP y VO2max. No hubo correlación entre PCCP y FEV1 entre PCCP y calidad de vida. En conclusión, la PCCP como prueba de ejercicio de campo máxima es sencilla y de bajo costo, su correlación con la prueba de VO2max es alta, constituyendo una herramienta útil en lugares donde no existe disponibilidad de aparatos más costosos.

Translated abstract

The shuttle test (ST) is a maximal exercise field test with scarcely used in Argentina. Our objective was to compare different variables of exercise response to ST vs. other exercise tests such as six minute walking test (SMWT) and cardiopulmonary with maximal oxygen consumption (VO2max) in severe COPD patients. A total of 21 stable severe COPD patients (GOLD III and IV stages) were evaluated with SMWT, ST and VO2max test. In all patients spirometry was performed with bronchodilator response, arterial gas and chronic respiratory questionnaire to evaluate quality of life. Cardiac frequency, oxygen saturation and dyspnea scale by Borg in response to exercise tests were evaluated. Paired T Student and Pearson tests were used, defining p < 0.05 as significant. COPD patients were 65.27 ± 12.72 years old and had severe airflow obstruction (FEV1: 33.23 ± 4.94%). The exercise response to SMWT was 297.85 ± 173.24 meters; ST: 318.8 ± 42.42 meters and VO2max test: 14.7 ± 5.44 ml/kg/min. The correlation between SMWT and ST was: r: 0.52(p < 0.00085); between ST and VO2max (l/min): r: 0.78 (p < 0.00079), and ST and VO2max (ml/kg/min): r: 0.81 (p < 0.00065). Moderate correlation was observed in final heart rate (r: 0.41, p < 0.00091), maximal Borg dyspnea scale (r: 0.47, p < 0.00099) and high correlation with final oxygen saturation (r: 0.81, p < 0.00087) between ST and VO2max. There was no correlation between ST and FEV1 and ST and quality of life. Our conclusion: the ST is a maximal, simple and low cost test. It has high correlation with cardiopulmonary test with VO2max measurement. It is a useful tool in those laboratories for pulmonary evaluations without possible availability of expensive tests.

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Most cited references 55

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Development of a shuttle walking test of disability in patients with chronic airways obstruction.

S J Singh, M. Morgan, S. Scott … (1992)

The aim was to develop a standardised and externally paced field walking test, incorporating an incremental and progressive structure, to assess functional capacity in patients with chronic airways obstruction. The usefulness of two different shuttle walking test protocols was examined in two separate groups of patients. The initial 10 level protocol (group A, n = 10) and a subsequent, modified, 12 level protocol (group B, n = 10) differed in the number of increments and in the speeds of walking. Patients performed three shuttle walking tests one week apart. Then the performance of patients (group C, n = 15) in the six minute walking test was compared with that in the second (modified) shuttle walking test protocol. Heart rate was recorded during all the exercise tests with a short range telemetry device. The 12 level modified protocol provided a measure of functional capacity in patients with a wide range of disability and was reproducible after just one practice walk; the mean difference between trial 2 v 3 was -2.0 (95% CI -21.9 to 17.9) m. There was a significant relation between the distance walked in the six minute walking test and the shuttle walking test (rho = 0.68) but the six minute walking test appeared to overestimate the extent of disability in some patients. The shuttle test provoked a graded cardiovascular response not evident in the six minute test. Moreover, the maximal heart rates attained were significantly higher for the shuttle walking test than for the six minute test. The shuttle walking test constitutes a standardised incremental field walking test that provokes a symptom limited maximal performance. It provides an objective measurement of disability and allows direct comparison of patients' performance.

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The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.

M Mathier, Lawrence P Cahalin, G Dec … (1996)

The 6-min walk test (6'WT) is a simple measure of functional capacity and predicts survival in patients with moderate heart failure (HF). To assess the role of the 6'WT in the evaluation of patients with advanced HF, 45 patients (age 49 +/- 8 years, mean +/- SD; New York Heart Association class 3.3 +/- 0.6; left ventricular ejection fraction 0.20 +/- 0.06; right ventricular ejection fraction 0.31 +/- 0.11) underwent symptom-limited cardiopulmonary exercise testing and the 6'WT during cardiac transplant evaluation. Mean 6'WT distance ambulated was 310 +/- 100 m and peak oxygen uptake (peak Vo2) was 12.2 +/- 4.5 mL/kg/min. There was a significant correlation between 6'WT distance ambulated and peak Vo2 (r = 0.64, p < 0.001). Multivariate analysis of patient characteristics, resting hemodynamics, and 6'WT results identified the distance ambulated during the 6'WT as the strongest predictor of peak Vo2 (p < 0.001). 6'WT distance ambulated less than 300 m predicted an increased likelihood of death or pretransplant hospital admission for continuous inotropic or mechanical support within 6 months (p = 0.04), but did not predict long-term overall or event-free survival with a mean follow-up of 62 weeks. Peak Vo2 was the best predictor of long-term overall and event-free survival. In patients with advanced HF evaluated for cardiac transplantation, distance ambulated during the 6'WT predicts (1) peak Vo2 and (2) short-term event-free survival.

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Effect of encouragement on walking test performance.

Helen Jones, Cindy L Berman, E Fallen … (1984)

Walking tests, frequently used to document effects of treatment on exercise capacity, have never been standardised. We studied the effects of encouragement on walking test performance in a randomised study that controlled for the nature of the underlying disease, time of day, and order effects. We randomised 43 patients with chronic airflow limitation or chronic heart failure or both to receive or not receive encouragement as they performed serial two and six minute walks every fortnight for 10 weeks. Simple encouragement improved performance (p less than 0.02 for the six minute walk), and the magnitude of the effect was similar to that reported for patients in studies purporting to show beneficial effects of therapeutic manoeuvres. Age and test repetition also affected performance. These results demonstrate the need for careful standardisation of the performance of walking tests, and suggest caution in interpreting studies in which standardisation is not a major feature of the study design.