Home-based or remote exercise testing in chronic respiratory disease,
during the COVID-19 pandemic and beyond: A rapid review

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Abstract

Objectives:

To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease.

Methods:

Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties.

Results:

84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported.

Discussion:

The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.

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Most cited references 80

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What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review

Michelle Haby, Evelina Chapman, Rachel Clark … (2016)

Background Rapid reviews have the potential to overcome a key barrier to the use of research evidence in decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice? Methods This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42015015998). A comprehensive search strategy was used, including published and grey literature, written in English, French, Portuguese or Spanish, from 2004 onwards. Eleven databases and two websites were searched. Two review authors independently applied the eligibility criteria. Data extraction was done by one reviewer and checked by a second. The methodological quality of included studies was assessed independently by two reviewers. A narrative summary of the results is presented. Results Five systematic reviews and one randomised controlled trial (RCT) that investigated methodologies for rapid reviews met the inclusion criteria. None of the systematic reviews were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews. While a wide range of ‘shortcuts’ are used to make rapid reviews faster than a full systematic review, the included studies found little empirical evidence of their impact on the conclusions of either rapid or systematic reviews. There is some evidence from the included RCT (that had a low risk of bias) that rapid reviews may improve clarity and accessibility of research evidence for decision makers. Conclusions Greater care needs to be taken in improving the transparency of the methods used in rapid review products. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way. We offer an improved definition of rapid reviews to guide future research as well as clearer guidance for policy and practice. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0155-7) contains supplementary material, which is available to authorized users.

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Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease.

A Akkoclu, A Ozden, O Itil … (2007)

To discuss the utility of Sit-to-Stand Test (STST) compared to the 6min walking test (6MWT) for the evaluation of functional status in patients with chronic obstructive pulmonary disease (COPD). Fifty-three patients with stable COPD (mean forced expiratory volume in 1s (FEV(1)) 46+/-9% predicted, mean age 71+/-12 year) and 15 healthy individuals (mean FEV(1) 101+/-13% predicted and mean age 63+/-8) were included. Functional performance was evaluated by STST and 6MWT. During the tests, severity of dyspnea (by Modified Borg Scale), heart rate, pulsed oxygen saturation (SpO(2), by Modified Borg Scale) (by pulse oxymeter), blood pressure were measured. The pulmonary function (by spirometry), quadriceps femoris muscle strength (by manual muscle test) and quality of life (by Nottingham Health Profile Survey) were evaluated. The STST and 6MWT results were lower in COPD group than the healthy group (P<0.05). During the 6MWT the rise in the heart rate, systolic blood pressure and the decrease in SpO(2) were statistically significant according to STST in COPD groups (P<0.05). The STST and 6MWT were strongly correlated with each other in both groups (P<0.05). Similarly, they were correlated with age, quality of life, peripheral muscle strength and dyspnea severity in COPD groups (P<0.05). Similar to 6MWT, STST is also able to determine the functional state correctly. Additionally, it produces less hemodynamical stress compared to the 6MWT. In conclusion, STST can be used as an alternative of the 6MWT in patients with COPD.

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Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial

Henrik Hansen, Theresa Bieler, Nina Beyer … (2020)

Rationale Pulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the benefits achieved through alternative approaches, such as pulmonary tele-rehabilitation (PTR). Objective To investigate whether PTR is superior to conventional PR on 6 min walk distance (6MWD) and secondarily on respiratory symptoms, quality of life, physical activity and lower limb muscle function in patients with COPD and FEV1 <50% eligible for routine hospital-based, outpatient PR. Methods In this single-blinded, multicentre, superiority randomised controlled trial, patients were assigned 1:1 to 10 weeks of groups-based PTR (60 min, three times weekly) or conventional PR (90 min, two times weekly). Assessments were performed by blinded assessors at baseline, end of intervention and at 22 weeks’ follow-up from baseline. The primary analysis was based on the intention-to-treat principle. Measurements and main results The primary outcome was change in 6MWD from baseline to 10 weeks; 134 participants (74 females, mean±SD age 68±9 years, FEV1 33%±9% predicted, 6MWD 327±103 metres) were included and randomised. The analysis showed no between-group differences for changes in 6MWD after intervention (9.2 metres (95% CI: −6.6 to 24.9)) or at 22 weeks’ follow-up (−5.3 metres (95% CI: −28.9 to 18.3)). More participants completed the PTR intervention (n=57) than conventional PR (n=43) (χ2 test p<0.01). Conclusion PTR was not superior to conventional PR on the 6MWD and we found no differences between groups. As more participants completed PTR, supervised PTR would be relevant to compare with conventional PR in a non-inferiority design. Trial registration number ClinicalTrials.gov (NCT02667171), 28 January 2016.

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Author and article information

Journal

Journal ID (nlm-ta): Chron Respir Dis

Journal ID (iso-abbrev): Chron Respir Dis

Journal ID (publisher-id): CRD

Journal ID (hwp): spcrd

Title: Chronic Respiratory Disease

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1479-9723

ISSN (Electronic): 1479-9731

Publication date (Electronic): 25 August 2020

Publication date Collection: Jan-Dec 2020

Volume: 17

Electronic Location Identifier: 1479973120952418

Affiliations

[1 ]Department of Allergy, Immunology and Respiratory Medicine, Ringgold 2541, universityMonash University; , Clayton, Victoria, Australia

[2 ]Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia

[3 ]Institute for Breathing and Sleep, Australia

[4 ]Department of Cardiorespiratory and Skeletal muscle, Ringgold 28113, universityFederal University of Juiz de Fora; , São Pedro, Juiz de Fora, Brazil

[5 ]School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia

[6 ]Allied Health, Ringgold 5392, Alfred Health; , Melbourne, Victoria, Australia

Author notes

[*]Anne E Holland, Department of Allergy, Immunology and Respiratory Medicine, Monash University, Commercial Rd, Melbourne 3004, Victoria, Australia. Email: a.holland@ 123456alfred.org.au

Author information

Anne E Holland https://orcid.org/0000-0003-2061-845X

Joanna YT Lee https://orcid.org/0000-0003-2567-6990

Article

Publisher ID: 10.1177_1479973120952418 Publisher-manuscript ID: 10.1101/2020.07.15.20154930

DOI: 10.1177/1479973120952418

PMC ID: 7450293

PubMed ID: 32840385

SO-VID: ed6148da-3355-4a78-9ddc-1965279032c3

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 19 June 2020

Date accepted : 3 August 2020

Funding

Funded by: Conselho Nacional de Desenvolvimento Científico e TecnolÓgico;

Award ID: 200042/2019-0

Custom metadata

cover-date January-December 2020

typesetter ts3

ScienceOpen disciplines: Respiratory medicine

Keywords: exercise test,lung diseases,rehabilitation,home care services,telemedicine

Data availability:

ScienceOpen disciplines: Respiratory medicine

Keywords: exercise test, lung diseases, rehabilitation, home care services, telemedicine

Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review

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Novel Coronavirus Disease COVID-19

Most cited references 80

What are the best methodologies for rapid reviews of the research evidence for evidence-informed decision making in health policy and practice: a rapid review

Comparison of the Sit-to-Stand Test with 6 min walk test in patients with chronic obstructive pulmonary disease.

Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial

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