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      The six-minute stepper test is related to muscle strength but cannot substitute for the one repetition maximum to prescribe strength training in patients with COPD

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          There are many barriers to pulmonary rehabilitation, including a limited access to evaluation centers. To cope with these difficulties, field tests are often used to prescribe endurance training. As field tests are related to muscle strength, they could also be used to prescribe strength training and increase the access to pulmonary rehabilitation in rural area. However, their validity for this purpose has never been studied.

          Patients and methods

          The relationship between the 6-minute stepper test (6MST), 6-minute walk test, maximal workload achieved during cardiopulmonary exercise testing (Wpeak), and one repetition maximum (1RM) was assessed in 35 patients with COPD through a retrospective chart review to derive predictive equation of the 1RM from these tests. The effectiveness of these equations to prescribe strength training at 70% of the 1RM was assessed in an independent cross-validation group of 34 patients with COPD.


          There was a moderate relationship between the 6MST, Wpeak and the 1RM ( r=0.44 and r=0.41, respectively, both P≤0.01). Whatever the test, the prescription of strength training using the estimated 1RM compared with the measured 1RM resulted in a mean absolute difference and a mean bias of about 30 kg.


          The use of the 6MST and Wpeak for the prescription of strength training would result in a clinically not acceptable error. Therefore, they should not be used as a substitute for the 1RM to prescribe strength training.

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          Most cited references 34

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          Pulmonary rehabilitation for chronic obstructive pulmonary disease.

          Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006.
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            Understanding Power and Rules of Thumb for Determining Sample Sizes

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              The reliability of the 1RM strength test for untrained middle-aged individuals.

              The one-repetition maximum (1RM) test is considered the gold standard for assessing muscle strength in non-laboratory situations. Since most previous 1RM reliability studies have been conducted with experienced young participants, it is unclear if acceptable test-retest reliability exists for untrained middle-aged individuals. This study examined the reliability of the 1RM strength test of untrained middle-aged individuals. Fifty-three untrained males (n=25) and females (n=28) aged 51.2+/-0.9 years participated in the study. Participants undertook the first 1RM test (T1) 4-8 days after a familiarisation session with the same exercises. 1RM was assessed for seven different exercises. Four to eight days after T1, participants underwent another identical 1RM test (T2). Ten weeks later, 27 participants underwent a third test (T3). Intraclass correlation coefficients (ICC), typical error as a coefficient of variation (TEcv), retest correlation, repeated measures ANOVA, Bland-Altman plots, and estimation of 95% confidence limits were used to assess reliability. A high ICC (ICC>0.99) and high correlation (r>0.9) were found for all exercises. TEcv ranged from 2.2 to 10.1%. No significant change was found for six of the seven exercises between T1 and T2. Leg press was slightly higher at T2 compared to T1 (1.6+/-0.6%, p=0.02). No significant change was found between T2 and T3 for any exercise. 1RM is a reliable method of evaluating the maximal strength in untrained middle-aged individuals. It appears that 1RM-testing protocols that include one familiarisation session and one testing session are sufficient for assessing maximal strength in this population.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                29 March 2019
                : 14
                : 767-774
                [1 ]Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France, rehabilitation@
                [2 ]ADIR Association, Rouen University Hospital, Rouen, France, rehabilitation@
                [3 ]Rouen University Hospital, School of Physiotherapy, Rouen, France
                [4 ]Intensive Care Unit Department, Le Havre Hospital, Hôpital Jacques Monod, Montivilliers, France
                [5 ]Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium
                [6 ]Physiotherapy Department, Le Havre Hospital, Le Havre, France
                [7 ]Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
                [8 ]Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
                Author notes
                Correspondence: Tristan Bonnevie, ADIR Association, Rouen University Hospital, Rouen, France, Tel +332 35 59 2970, Fax +332 35 59 2971, Email rehabilitation@
                © 2019 Bonnevie et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Respiratory medicine

                copd, six-minute stepper test, strength training, pulmonary rehabilitation


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