COPD_A_268894 3003..3012

1Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Skane University Hospital, Lund, Sweden; 2Regional Cancer Centre South, Region Skane, Lund, Sweden Purpose: For exercise testing of COPD patients, a standard endurance test (ET) with constant workload is recommended. The test suffers from large inter-individual variability and need for large sample sizes in order to evaluate treatment effects. Methods: A new protocol for ET in COPD was designed. In contrast to the standard ET, the new ET involved an increasing workload in order to reduce the standard deviation of endurance time. Two new ETs were compared with the standard ET. In Study A, the new ET started at 75% of the patient’s maximum workload (WMAX) and increased stepwise with 3%/2 min until exhaustion. Study B started at 70% of WMAX and increased linearly with 1%/ min. Results: In Study A, that included 15 patients, the standard deviation and range for endurance time and work capacity were narrower for the new versus the standard ET. However, the higher mean workload at end and the low mean work capacity relative to the standard ET indicated that the stepwise increase was too aggressive. In Study B, that included 18 patients, with a modified protocol, the averages for endurance time, workload at end and work capacity were similar for new and standard ET, while the standard deviations and ranges for endurance time and work capacity were kept more narrow in the new ET. The variances for endurance time were not equal between the standard ET and the two new ETs (p<0.05 for both according to Levene’s test). Conclusion: The new ET reduced the number of patients with extreme endurance times (short and long) compared to the standard test. The new test showed a significant lower variance for endurance time, which potentially can lead to fewer patients needed in comparative studies. The overall best results were observed with a low linear increase during endurance.

[1]  R. Casaburi,et al.  ERS statement on standardisation of cardiopulmonary exercise testing in chronic lung diseases , 2019, European Respiratory Review.

[2]  F. Radner,et al.  A new maximal bicycle test using a prediction algorithm developed from four large COPD studies , 2019, European clinical respiratory journal.

[3]  J. Neder,et al.  Effects of lung deflation induced by tiotropium/olodaterol on the cardiocirculatory responses to exertion in COPD. , 2019, Respiratory medicine.

[4]  Sally J. Singh,et al.  Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement , 2016, European Respiratory Journal.

[5]  Martijn A Spruit,et al.  Characteristics and determinants of endurance cycle ergometry and six-minute walk distance in patients with COPD , 2014, BMC Pulmonary Medicine.

[6]  R. Casaburi,et al.  Selecting Constant Work Rates for Endurance Testing in COPD: The Role of the Power-Duration Relationship , 2013, COPD.

[7]  H. Magnussen,et al.  Effect of combination treatment on lung volumes and exercise endurance time in COPD. , 2012, Respiratory medicine.

[8]  F. Maltais,et al.  Physiological Correlates of Endurance Time Variability during Constant-Workrate Cycling Exercise in Patients with COPD , 2011, PloS one.

[9]  Stefan Peterson,et al.  Budesonide added to formoterol contributes to improved exercise tolerance in patients with COPD. , 2010, Respiratory medicine.

[10]  S. Ward,et al.  Quantifying intervention-related improvements in exercise tolerance , 2009, European Respiratory Journal.

[11]  H. Magnussen,et al.  Reliability of ventilatory parameters during cycle ergometry in multicentre trials in COPD , 2009, European Respiratory Journal.

[12]  J. E. Cotes,et al.  Recommendations on the use of exercise testing in clinical practice , 2007, European Respiratory Journal.

[13]  Robert Wise,et al.  Predictors of mortality in patients with emphysema and severe airflow obstruction. , 2006, American journal of respiratory and critical care medicine.

[14]  F. Maltais,et al.  Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD: Chest 2005;128:1168–78 , 2006 .

[15]  F. Maltais,et al.  Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD. , 2005, Chest.

[16]  B. Whipp,et al.  Effects of Training on the Tolerance to High-Intensity Exercise in Patients with Severe COPD , 2003, Respiration.

[17]  M. Tsukino,et al.  Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. , 2003, American journal of respiratory and critical care medicine.

[18]  G. Borg.  Psychophysical bases of perceived exertion. , 1982, Medicine and science in sports and exercise.