Elsevier

Heart & Lung

Volume 31, Issue 5, September–October 2002, Pages 374-381
Heart & Lung

Issues in Pulmonary Nursing
Relationship between different indices of exercise capacity and clinical measures in patients with chronic obstructive pulmonary disease*,**

https://doi.org/10.1067/mhl.2002.127941Get rights and content

Abstract

Purpose: The purpose of this study was to make comparisons between different types of exercise tests used in chronic obstructive pulmonary disease (COPD) to better interpret the results and to select the most suitable testing procedure. Therefore, we evaluated the relationship between exercise capacity and other clinical measures and their relative contributions to exercise capacity in patients with COPD. Method: We studied 36 patients with stable COPD. All patients underwent baseline pulmonary function testing. Dyspnea during activities of daily living was assessed with the Oxygen Cost Diagram (OCD). The Hospital Anxiety and Depression Scale and the St George's Respiratory Questionnaire were used to assess psychologic status and health-related quality of life, respectively. All patients performed the 6-minute walking test, progressive cycle ergometry, and the cycle endurance test. Results: Each exercise capacity result correlated significantly with pulmonary function, the OCD, and the Activity and Total scores of the St George's Respiratory Questionnaire. Multiple regression analyses revealed that the OCD was an important predictor of exercise capacity, especially for the walking test. Diffusing capacity was also a significant predictor on progressive cycle ergometry. Body mass index was the most significant predictor of the endurance time. Conclusion: The 3 different exercise tests had similar characteristics in relation to pulmonary function, dyspnea, and health-related quality of life in patients with COPD. However, some differences were found in the aspects they evaluated. (Heart Lung® 2002;31:374-81.)

Section snippets

Patients and pulmonary function tests

We recruited 41 consecutive male patients with stable COPD (age, 47 to 80 years; FEV1, 0.32 to 1.94 L) as defined by the American Thoracic Society.8 We then compared the 3 exercise tests in evaluation of the effects of oxitropium bromide on exercise performance in a randomized, double-blind, placebo-controlled, crossover way, as previously reported.9 In this study, we reviewed the data on these patients and selected complete cases in which we could investigate the relationship between exercise

Results

We studied a total of 36 male patients with COPD with complete data sets who had a wide range of percentages of predicted FEV1 values (%FEV1, 13.6% to 75.4%). Among these patients, %FEV1 values were below 35% in 16 patients, 35% to 50% in 10 patients, and 50% to 79% in 10 patients, according to the categorization based on %FEV1 proposed by the American Thoracic Society.8 The FEV1/vital capacity ratios were 39.2% ± 11.1%. The results of pulmonary function tests, exercise tests, the clinical

Discussion

We found that exercise capacity on the walking test, progressive cycle ergometry, and the cycle endurance test all had moderately significant correlations with airflow limitation, hyperinflation, diffusing capacity, dyspnea, and HRQoL of patients with COPD. However, the interrelationships between exercise capacity evaluated with the different methods were moderate, and we found some differences among them. Noseda et al7 compared these commonly used exercise tests from the point of

Conclusion

Exercise capacity on 3 different exercise tests had statistically significant correlations with airflow limitation, hyperinflation, diffusing capacity, dyspnea during the activities of daily living, and HRQoL in patients with COPD. Although the 3 exercise tests are believed to evaluate approximately the same aspects, some differences were observed. Exercise capacity is an important outcome measure in patients with COPD, and acknowledgment of the different aspects evaluated is also important in

Acknowledgements

We thank Ms Kazuyo Haruna and Ms Yumiko Tomita for conducting the pulmonary function tests. We also thank Paul W. Jones, MD, (St George's Hospital Medical School, London, United Kingdom) for the use of the Japanese version of the St George's Respiratory Questionnaire.

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    *

    Supported in part by the Smoking Research Foundation of Japan.

    **

    Reprint requests: Toru Oga, MD, Respiratory Division, Kyoto-Katsura Hospital, 17 Yamadahirao, Nishikyo-ku, Kyoto, 615-8256, Japan.

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