Abstract
ObjectiveTo evaluate the criterion validity and responsiveness of the steep ramp test (SRT) compared with the cardiopulmonary exercise test (CPET) in evaluating aerobic capacity in survivors of cancer participating in a rehabilitation program. DesignA prospective cohort study in which survivors of cancer performed an SRT and CPET before (T=0) and after (T=1) a 10-week exercise rehabilitation program. Peak work rate achieved during the SRT (SRT-WRpeak) was compared with peak oxygen consumption measured during the CPET (CPET-Vo2peak), which is the criterion standard for aerobic capacity. Correlation coefficients were calculated between SRT-WRpeak and CPET-Vo2peak at T=0 to examine criterion validity and between changes in SRT-WRpeak and CPET-Vo2peak from T=0 to T=1 to determine responsiveness. Receiver operating characteristic analysis was performed to examine the ability of the SRT to detect a true improvement (6%) in CPET-Vo2peak. SettingUniversity medical center. ParticipantsSurvivors of cancer (N=106). InterventionsExercise rehabilitation. Main Outcome MeasuresCorrelation coefficients between CPET-Vo2peak and SRT-WRpeak and between changes in CPET-Vo2peak and SRT-WRpeak. ResultsAn r of 0.86 (N=106) was found for the relation between SRT-WRpeak and CPET-Vo2peak at T=0. An r of 0.51 was observed for the relation between changes in SRT-WRpeak and CPET-Vo2peak (n=59). Receiver operating characteristic analysis showed an area under the curve of 0.74 for the SRT to detect a true improvement in CPET-Vo2peak, with an optimal cutoff value of +0.26 W/kg (sensitivity 70.7%, specificity 66.7%). ConclusionsBecause SRT-WRpeak and CPET-Vo2peak were strongly correlated, the SRT seems a valid tool to estimate aerobic capacity in survivors of cancer. The responsiveness to measure changes in aerobic capacity appears moderate. Nevertheless, the SRT seems able to detect improvement in aerobic capacity, with a cutoff value of 0.26 W/kg.
Highlights
For 31 of the 47 participants (66.0%) who were lost to www.archives-pmr.org follow-up, the rehabilitation program and tests at T=1 were postponed or canceled because of the coronavirus disease 2019 pandemic, during which all outpatient activities were canceled for 4 months
This period was too long for the purpose of this study; no catch-up measurements were undertaken for these participants
receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.74 of the steep ramp test (SRT) to discriminate between participants who did or did not improve in aerobic capacity after the rehabilitation program
Summary
To determine the intensity of the resistance training, a submaximal repetition maximum test was performed on each exercise machine to calculate the true 1-repetition maximum. In the other training session, participants performed 2 sets of 10 minutes of interval training on a cycle ergometer, 1 set before and 1 after the resistance training program. Participants performed a CPET and SRT before the start of the exercise program (T=0) and after 10 weeks of exercise training (T=1). To evaluate the responsiveness of the SRT, the correlation coefficient with corresponding 95% CI was calculated between the absolute change in SRT-WRpeak and CPET-VO2peak from T=0 to T=1 for participants who completed the exercise tests at both time points. The AUC of the ROC curve with corresponding 95% CI was calculated to evaluate the ability of the SRT to detect a true improvement in CPET-VO2peak of ≥6% over time. Sensitivity, specificity, and predictive values (%) were calculated for the cutoff value(s)
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