Differences in symptoms and cardiopulmonary responses to Treadmill versus Cycle cardiopulmonary exercise testing and comparison with the 6MWT in ILD

D. Nikoletou; I. Chis-Ster; M. Papadakis; C.Y. Lech; I.S. McNaughton; F. Chua; R. Aul; P. Jones

Differences in symptoms and cardiopulmonary responses to Treadmill versus Cycle cardiopulmonary exercise testing and comparison with the 6MWT in ILD

D. Nikoletou
, I. Chis-Ster
, M. Papadakis
, C.Y. Lech
, I.S. McNaughton
, F. Chua
, R. Aul
, P. Jones

Research output: Contribution to conference › Paper › peer-review

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Abstract

Aims: Cardiopulmonary exercise testing (CPET) is used for diagnostic and prognostic reasons in Interstitial Lung Disease (ILD). Our aims were to compare symptoms and cardiopulmonary responses between a) cycle and treadmill walking and b) between CPET and the 6MWT. Methods: 18 ILD patients (6 IPF; 12M), mean (SD) age 65.4 (12.6), FVC% pred. 72.7 (20.7), DLCO% pred. 42.2 (13.4) underwent CPET by cycle ergometry (C-CPET) and treadmill walking (T-CPET) in random order, with 30-45 min rest between tests, on a single session. On a second session 3-7 days apart, patients performed the 6MWT. Oxygen saturation (SpO2), heart rate (HR), breathlessness (BORG score) and leg fatigue/exertion (RPE scale) were recorded at rest, peak and at each minute of the 3-min recovery. We used the sign rank test with the null hypothesis of no difference between responses to the 3 tests of multiple CPET and symptom parameters. Results: Data were consistent with no differences between C-CPET and T-CPET in cardiopulmonary parameters (PeakVO2 p value=0.4, AT_VO2 p= 0.5, Peak VE/VCO2 p= 0.5, Peak VE/VO2 = 0.8). Desaturation (ÔêåSpO2) was similar between T- CPET and C-CPET (p= 0.4) or 6MWT (0.7) but differed between C-CPET and 6MWT (p=0.03). The 3-minute SpO2 recovery was slower in T-CPET than the other tests. Change in HR (ÔêåHR) and 3-min recovery was similar between CPET modes (p=0.1) but statistically lower in the 6MWT (p= 0.001). Breathlessness was greater in T-CPET than C-CPET (ÔêåBORG p= 0.04) and recovery slower than the other two tests. Patients with CTD-ILD reported a preference for T-CPET. Summary/Conclusions: Cardiopulmonary parameters can be derived accurately from both types of CPET. The drop in oxygen saturation at the 6MWT was similar to that of the maximal T-CPET so, it can be used in ILD patients to estimate level of desaturation, even though the 6MWT underestimates the delay in SpO2 recovery. Funding source: This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health, UK.

Original language	English
Publication status	Published - 1 Mar 2019
Event	8th International Meeting on Pulmonary Rare Diseases and Orphan Drugs - Milan, Italy Duration: 1 Mar 2019 → 2 Mar 2019

Conference

Conference	8th International Meeting on Pulmonary Rare Diseases and Orphan Drugs
Period	1/03/19 → 2/03/19

Bibliographical note

Note: This work was supported by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067.

Impact: This project was investigating differences in cardiopulmonary responses between three tests often used in clinical practice. The message of this presentation is a) there is no difference in various cardiopulmonary responses when cycle or treadmill testing is used and b) that people with Interstitial Lung Disease desaturate more during walking and that a simple submaximal test (6MWT) that can be used in most clinical settings is a good measure of the total drop of oxygen saturation.
These are important for clinical practice and for our understanding of disease processes. For clinical practice, it means that we can be confident that key parameters can be dirived equally well when we use cycle or treadmill testing and it is only down to patient preference which test to use. The results also mean that simple submaximal tests can be very important in this disease as they often reflect the oxygen saturation responses seen in maximal, specialised tests.
Therefore, the project is important for clinicians, clinical exercise physiologists and patients who wish to monitor the progression of their disease without having to engage in specialised tests.I have already presented these results to an ILD patient/family support group and there was great interest from patients and carers.

Organising Body: Victory Project endorsed by the European Respiratory Society

Keywords

Other hospital based clinical subjects

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@conference{44d51ae0b8384d1091a4763cfeb42a8b,

title = "Differences in symptoms and cardiopulmonary responses to Treadmill versus Cycle cardiopulmonary exercise testing and comparison with the 6MWT in ILD",

abstract = "Aims: Cardiopulmonary exercise testing (CPET) is used for diagnostic and prognostic reasons in Interstitial Lung Disease (ILD). Our aims were to compare symptoms and cardiopulmonary responses between a) cycle and treadmill walking and b) between CPET and the 6MWT. Methods: 18 ILD patients (6 IPF; 12M), mean (SD) age 65.4 (12.6), FVC\% pred. 72.7 (20.7), DLCO\% pred. 42.2 (13.4) underwent CPET by cycle ergometry (C-CPET) and treadmill walking (T-CPET) in random order, with 30-45 min rest between tests, on a single session. On a second session 3-7 days apart, patients performed the 6MWT. Oxygen saturation (SpO2), heart rate (HR), breathlessness (BORG score) and leg fatigue/exertion (RPE scale) were recorded at rest, peak and at each minute of the 3-min recovery. We used the sign rank test with the null hypothesis of no difference between responses to the 3 tests of multiple CPET and symptom parameters. Results: Data were consistent with no differences between C-CPET and T-CPET in cardiopulmonary parameters (PeakVO2 p value=0.4, AT\_VO2 p= 0.5, Peak VE/VCO2 p= 0.5, Peak VE/VO2 = 0.8). Desaturation ({\^O}{\^e}{\aa}SpO2) was similar between T- CPET and C-CPET (p= 0.4) or 6MWT (0.7) but differed between C-CPET and 6MWT (p=0.03). The 3-minute SpO2 recovery was slower in T-CPET than the other tests. Change in HR ({\^O}{\^e}{\aa}HR) and 3-min recovery was similar between CPET modes (p=0.1) but statistically lower in the 6MWT (p= 0.001). Breathlessness was greater in T-CPET than C-CPET ({\^O}{\^e}{\aa}BORG p= 0.04) and recovery slower than the other two tests. Patients with CTD-ILD reported a preference for T-CPET. Summary/Conclusions: Cardiopulmonary parameters can be derived accurately from both types of CPET. The drop in oxygen saturation at the 6MWT was similar to that of the maximal T-CPET so, it can be used in ILD patients to estimate level of desaturation, even though the 6MWT underestimates the delay in SpO2 recovery. Funding source: This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health, UK.",

keywords = "Other hospital based clinical subjects",

author = "D. Nikoletou and I. Chis-Ster and M. Papadakis and C.Y. Lech and I.S. McNaughton and F. Chua and R. Aul and P. Jones",

note = "Note: This work was supported by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067. Impact: This project was investigating differences in cardiopulmonary responses between three tests often used in clinical practice. The message of this presentation is a) there is no difference in various cardiopulmonary responses when cycle or treadmill testing is used and b) that people with Interstitial Lung Disease desaturate more during walking and that a simple submaximal test (6MWT) that can be used in most clinical settings is a good measure of the total drop of oxygen saturation. These are important for clinical practice and for our understanding of disease processes. For clinical practice, it means that we can be confident that key parameters can be dirived equally well when we use cycle or treadmill testing and it is only down to patient preference which test to use. The results also mean that simple submaximal tests can be very important in this disease as they often reflect the oxygen saturation responses seen in maximal, specialised tests. Therefore, the project is important for clinicians, clinical exercise physiologists and patients who wish to monitor the progression of their disease without having to engage in specialised tests.I have already presented these results to an ILD patient/family support group and there was great interest from patients and carers. Organising Body: Victory Project endorsed by the European Respiratory Society; 8th International Meeting on Pulmonary Rare Diseases and Orphan Drugs ; Conference date: 01-03-2019 Through 02-03-2019",

year = "2019",

month = mar,

day = "1",

language = "English",

}

TY - CONF

T1 - Differences in symptoms and cardiopulmonary responses to Treadmill versus Cycle cardiopulmonary exercise testing and comparison with the 6MWT in ILD

AU - Nikoletou, D.

AU - Chis-Ster, I.

AU - Papadakis, M.

AU - Lech, C.Y.

AU - McNaughton, I.S.

AU - Chua, F.

AU - Aul, R.

AU - Jones, P.

N1 - Note: This work was supported by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067. Impact: This project was investigating differences in cardiopulmonary responses between three tests often used in clinical practice. The message of this presentation is a) there is no difference in various cardiopulmonary responses when cycle or treadmill testing is used and b) that people with Interstitial Lung Disease desaturate more during walking and that a simple submaximal test (6MWT) that can be used in most clinical settings is a good measure of the total drop of oxygen saturation. These are important for clinical practice and for our understanding of disease processes. For clinical practice, it means that we can be confident that key parameters can be dirived equally well when we use cycle or treadmill testing and it is only down to patient preference which test to use. The results also mean that simple submaximal tests can be very important in this disease as they often reflect the oxygen saturation responses seen in maximal, specialised tests. Therefore, the project is important for clinicians, clinical exercise physiologists and patients who wish to monitor the progression of their disease without having to engage in specialised tests.I have already presented these results to an ILD patient/family support group and there was great interest from patients and carers. Organising Body: Victory Project endorsed by the European Respiratory Society

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Aims: Cardiopulmonary exercise testing (CPET) is used for diagnostic and prognostic reasons in Interstitial Lung Disease (ILD). Our aims were to compare symptoms and cardiopulmonary responses between a) cycle and treadmill walking and b) between CPET and the 6MWT. Methods: 18 ILD patients (6 IPF; 12M), mean (SD) age 65.4 (12.6), FVC% pred. 72.7 (20.7), DLCO% pred. 42.2 (13.4) underwent CPET by cycle ergometry (C-CPET) and treadmill walking (T-CPET) in random order, with 30-45 min rest between tests, on a single session. On a second session 3-7 days apart, patients performed the 6MWT. Oxygen saturation (SpO2), heart rate (HR), breathlessness (BORG score) and leg fatigue/exertion (RPE scale) were recorded at rest, peak and at each minute of the 3-min recovery. We used the sign rank test with the null hypothesis of no difference between responses to the 3 tests of multiple CPET and symptom parameters. Results: Data were consistent with no differences between C-CPET and T-CPET in cardiopulmonary parameters (PeakVO2 p value=0.4, AT_VO2 p= 0.5, Peak VE/VCO2 p= 0.5, Peak VE/VO2 = 0.8). Desaturation (ÔêåSpO2) was similar between T- CPET and C-CPET (p= 0.4) or 6MWT (0.7) but differed between C-CPET and 6MWT (p=0.03). The 3-minute SpO2 recovery was slower in T-CPET than the other tests. Change in HR (ÔêåHR) and 3-min recovery was similar between CPET modes (p=0.1) but statistically lower in the 6MWT (p= 0.001). Breathlessness was greater in T-CPET than C-CPET (ÔêåBORG p= 0.04) and recovery slower than the other two tests. Patients with CTD-ILD reported a preference for T-CPET. Summary/Conclusions: Cardiopulmonary parameters can be derived accurately from both types of CPET. The drop in oxygen saturation at the 6MWT was similar to that of the maximal T-CPET so, it can be used in ILD patients to estimate level of desaturation, even though the 6MWT underestimates the delay in SpO2 recovery. Funding source: This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health, UK.

AB - Aims: Cardiopulmonary exercise testing (CPET) is used for diagnostic and prognostic reasons in Interstitial Lung Disease (ILD). Our aims were to compare symptoms and cardiopulmonary responses between a) cycle and treadmill walking and b) between CPET and the 6MWT. Methods: 18 ILD patients (6 IPF; 12M), mean (SD) age 65.4 (12.6), FVC% pred. 72.7 (20.7), DLCO% pred. 42.2 (13.4) underwent CPET by cycle ergometry (C-CPET) and treadmill walking (T-CPET) in random order, with 30-45 min rest between tests, on a single session. On a second session 3-7 days apart, patients performed the 6MWT. Oxygen saturation (SpO2), heart rate (HR), breathlessness (BORG score) and leg fatigue/exertion (RPE scale) were recorded at rest, peak and at each minute of the 3-min recovery. We used the sign rank test with the null hypothesis of no difference between responses to the 3 tests of multiple CPET and symptom parameters. Results: Data were consistent with no differences between C-CPET and T-CPET in cardiopulmonary parameters (PeakVO2 p value=0.4, AT_VO2 p= 0.5, Peak VE/VCO2 p= 0.5, Peak VE/VO2 = 0.8). Desaturation (ÔêåSpO2) was similar between T- CPET and C-CPET (p= 0.4) or 6MWT (0.7) but differed between C-CPET and 6MWT (p=0.03). The 3-minute SpO2 recovery was slower in T-CPET than the other tests. Change in HR (ÔêåHR) and 3-min recovery was similar between CPET modes (p=0.1) but statistically lower in the 6MWT (p= 0.001). Breathlessness was greater in T-CPET than C-CPET (ÔêåBORG p= 0.04) and recovery slower than the other two tests. Patients with CTD-ILD reported a preference for T-CPET. Summary/Conclusions: Cardiopulmonary parameters can be derived accurately from both types of CPET. The drop in oxygen saturation at the 6MWT was similar to that of the maximal T-CPET so, it can be used in ILD patients to estimate level of desaturation, even though the 6MWT underestimates the delay in SpO2 recovery. Funding source: This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1112-29067). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health, UK.

KW - Other hospital based clinical subjects

M3 - Paper

T2 - 8th International Meeting on Pulmonary Rare Diseases and Orphan Drugs

Y2 - 1 March 2019 through 2 March 2019

ER -

Differences in symptoms and cardiopulmonary responses to Treadmill versus Cycle cardiopulmonary exercise testing and comparison with the 6MWT in ILD

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