Estimating Maximum Work Rate During Incremental Cycle Ergometry Testing From Six-Minute Walk Distance in Patients With Chronic Obstructive Pulmonary Disease

doi:10.1016/j.apmr.2008.01.020

Archives of Physical Medicine and Rehabilitation

Volume 89, Issue 9, September 2008, Pages 1782-1787

https://doi.org/10.1016/j.apmr.2008.01.020 Get rights and content

Abstract

Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease.

Objective

To develop a predictive equation to permit estimation of the maximum work rate (Wmax) achieved during an incremental cycle ergometry test from the measurement of 6-minute walk distance (6MWD) and its derivative, 6-minute walk work, which is the product of 6MWD and body weight.

Design

Cross-sectional observational study.

Setting

Outpatient physiotherapy and pulmonary physiology clinics in a tertiary hospital.

Participants

Patients (N=50; 36 men) with chronic obstructive pulmonary disease (forced expiratory volume in 1 second [FEV₁]=37%±11% of predicted).

Interventions

Not applicable.

Main Outcome Measures

Measurements were obtained of 6MWD and Wmax achieved during a laboratory-based, symptom-limited incremental cycle ergometry test. Linear regression analyses were performed using 6MWD, height, weight, and FEV₁ and using 6-minute walk work, height, and FEV₁ to determine their contribution to Wmax and to develop predictive equations for estimating Wmax.

Results

The equations derived to estimate Wmax using 6MWD and 6-minute walk work, respectively, were as follows: Wmax (W)=(0.122×6MWD)+(72.683×height [m])–117.109 (r²=.67, standard error of the estimate [SEE]=10.8W) and Wmax (W)=17.393+(1.442×6-minute walk work) (r²=.60, SEE=11.8W).

Conclusions

Wmax can be estimated from equations based on measurements of 6MWD or 6-minute walk work. The estimate of Wmax derived from either equation may provide a basis on which to prescribe cycle ergometry training work rates that comply with the current guidelines for pulmonary rehabilitation.

Section snippets

Methods

A prospective cross-sectional study was undertaken. During a 2-week period, measurements were made of body anthropometrics, resting lung function, 6MWD, and Wmax achieved during an incremental cycle ergometry test.

Results

A total of 50 subjects (36 men) participated in this study. Data from an additional 4 subjects were excluded because they showed a decrease in Spo₂ to less than 80% during the 6MWT. As a result, the supervising investigator terminated their tests prematurely. Anthropometry and lung function data for the 50 subjects are shown in table 1. Of the 50 subjects, 7 (14%) were classified as current smokers based on either their self-reported smoking status or measured carboxyhemoglobin levels.

Discussion

To our knowledge, this study is the first to develop a regression equation that can estimate the Wmax achieved during an incremental cycle ergometry test using the results of a 6MWT in subjects with moderate-to-severe COPD. Regression analyses met the assumption of linearity. In addition, a similar proportion of variance in Wmax was explained whether 6MWD or 6-minute walk work was used in the equation. In the absence of a direct measurement of Wmax, either equation could be used to estimate

Conclusions

The estimate of Wmax derived from either 6MWD or 6-minute walk work and the strength of these associations provide a basis on which to prescribe initial cycle ergometry training work rates that comply with the current guidelines for pulmonary rehabilitation for those programs without access to the results of an incremental cycle ergometry test.¹ It is important to note that, although the estimate derived using the equations in this study will be most accurate when our 6MWT protocol is adopted,

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: Supported by the National Health and Medical Research Council (Australia) (grant no. 212016).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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Original articleEstimating Maximum Work Rate During Incremental Cycle Ergometry Testing From Six-Minute Walk Distance in Patients With Chronic Obstructive Pulmonary Disease

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Chest

Chest

Respir Med

Respir Med

Chest

Chest

Chest

American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation

Am J Respir Crit Care Med

Physiologic benefits of exercise training in rehabilitation of patients with severe chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Intensity of training and physiologic adaptation in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Characterization of pulmonary rehabilitation programs in Canada in 2005

Can Respir J

ATS/ACCP Statement on cardiopulmonary exercise testing

Am J Respir Crit Care Med

Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Histochemical and morphological characteristics of the vastus lateralis muscle in COPD patientsComparison with normal subjects and effects of exercise training

Med Sci Sports Exerc

Skeletal muscle adaptation to endurance training in patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Pulmonary rehabilitation programmes in the UK: a national representative survey

Clin Rehabil

Twelve-minute walking test for assessing disability in chronic bronchitis

Br Med J

Original article
Estimating Maximum Work Rate During Incremental Cycle Ergometry Testing From Six-Minute Walk Distance in Patients With Chronic Obstructive Pulmonary Disease