Abstract
Pulmonary rehabilitation is based on a thorough patient assessment, including peripheral oxygen saturation (SpO2) and heart rate (HR) at rest and on exertion. To understand whether exercise-field tests identify patients who desaturate (SpO2 < 90%) during physical activities, this study compared the six-minute walk test (6MWT) and daily-life telemonitoring. Cross-sectional study including 100 patients referred for pulmonary rehabilitation. The 6MWT was performed in hospital with continuous assessment of SpO2, HR, walked distance and calculated metabolic equivalent of tasks (METs). Patients were also evaluated in real-life by SMARTREAB telemonitoring, a combined oximetry-accelerometery with remote continuous assessment of SpO2, HR and METs. SMARTREAB telemonitoring identified 24% more desaturators compared with the 6MWT. Moreover, there were significant mean differences between 6MWT and SMARTREAB in lowest SpO2 of 7.2 ± 8.4% (P < 0.0005), in peak HR of − 9.3 ± 15.5% (P < 0.0005) and also in activity intensity of − 0.3 ± 0.8 METs (P < 0.0005). The 6MWT underestimates the proportion of patients with exercise-induced oxygen desaturation compared to real-life telemonitoring. These results help defining oximetry-guided interventions, such as telemedicine algorithms, oxygen therapy titration and regular physical activity assessment in pulmonary rehabilitation.
Highlights
A convenience sample of N = 100 patients was enrolled and the main respiratory diagnoses for pulmonary rehabilitation referral were: Chronic Obstructive Pulmonary Disease (COPD) (41%), interstitial lung disease (ILD) (22%, mostly idiopathic pulmonary fibrosis), asthma (15%), bronchiectasis (10%) and other (12%, including post-thoracic surgery, lung cancer, tuberculosis sequelae, lung disorder associated with connective tissue disease and pulmonary ossification)
Our results show a higher sensitivity of daily-life telemonitoring compared to the 6MWT in detecting patients with chronic lung disease who desaturate, as 91% engaged on desaturating physical activities in daily-life (PADL) and only 67% desaturated in the 6MWT
The García-Talavera group found that COPD patients who desaturated within the 1st minute of the 6MWT desaturated in the 24-h oximetry, whereas those that only desaturated after 3min30s of the 6MWT did not desaturate in the 24-h oximetry[30]
Summary
The aim of the present study was to compare the 6MWT of patients with chronic lung disease and PADL telemonitoring outcomes to analyse differences on nadir S pO2, peak HR and activity intensity
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