Exercise Testing and Training in a Cancer Rehabilitation Program: The Advantage of the Steep Ramp Test

Abstract

De Backer IC, Schep G, Hoogeveen A, Vreugdenhil G, Kester AD, van Breda E. Exercise testing and training in a cancer rehabilitation program: the advantage of the steep ramp test. Objective To compare the short maximal exercise capacity test (steep ramp test) with the submaximal test to determine the most appropriate exercise test in cancer rehabilitation. Design A prospective study in which a submaximal test, a maximal short exercise capacity test (steep ramp test), and a maximal oxygen consumption test (V̇ o 2max test) were performed before and after an 18-week training program. V̇ o 2max testing, the criterion standard for the measurement of physical capacity, was compared with the submaximal test and the steep ramp test. Setting Community hospital and physiotherapy. Participants Thirty-seven cancer survivors (10 men, 27 women) treated with chemotherapy. The subjects’ mean age ± standard deviation (SD) was 48±11 years. Intervention An 18-week training program including strength training, interval aerobic training, and home-based activities (endurance). Main Outcome Measures Estimated V̇ o 2max (submaximal test) and maximal workload (steep ramp test) were assessed during the exercise tests and compared with the results of the V̇ o 2max test. Results A paired t test showed a significant improvement in V̇ o 2max (+13%, P<.001) and maximal workload (+19%, P<.001) after the training program. This improvement was confirmed in the steep ramp test (maximal workload, +13%, P<.001) but not in the submaximal test (estimated V̇ o 2max, +4%, P=.192). Pearson correlation quantified only a moderate correlation between the V̇ o 2max test and the submaximal test and a high correlation between the V̇ o 2max test and the steep ramp test. Intraclass correlation determined the test-retest reliability of the submaximal test (.873) and the steep ramp test (.996). A linear regression model (V̇ o 2max, 6.7; steep ramp Wmax, +356.7) was estimated to predict V̇ o 2max from the steep ramp test outcome, implying a prediction margin of ±2 SDs (616mL/min). Conclusions The submaximal test proved to be invalid, whereas the steep ramp test seems to be a practicable, reliable, and valid test for the assessment of the training dose. The steep ramp test can be regularly repeated during the training program, providing information needed to readjust the training dose according to the progress made.