Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Skane University Hospital, Lund, Sweden.
Regional Cancer Centre South, Region Skane, Lund, Sweden.
Int J Chron Obstruct Pulmon Dis. 2020 Nov 19;15:3003-3012. doi: 10.2147/COPD.S268894. eCollection 2020.
For exercise testing of COPD patients, a standard endurance test (ET) with constant workload is recommended. The test suffers from large inter-individual variability and need for large sample sizes in order to evaluate treatment effects.
A new protocol for ET in COPD was designed. In contrast to the standard ET, the new ET involved an increasing workload in order to reduce the standard deviation of endurance time. Two new ETs were compared with the standard ET. In Study A, the new ET started at 75% of the patient's maximum workload (W) and increased stepwise with 3%/2 min until exhaustion. Study B started at 70% of W and increased linearly with 1%/min.
In Study A, that included 15 patients, the standard deviation and range for endurance time and work capacity were narrower for the new versus the standard ET. However, the higher mean workload at end and the low mean work capacity relative to the standard ET indicated that the stepwise increase was too aggressive. In Study B, that included 18 patients, with a modified protocol, the averages for endurance time, workload at end and work capacity were similar for new and standard ET, while the standard deviations and ranges for endurance time and work capacity were kept more narrow in the new ET. The variances for endurance time were not equal between the standard ET and the two new ETs (p<0.05 for both according to Levene's test).
The new ET reduced the number of patients with extreme endurance times (short and long) compared to the standard test. The new test showed a significant lower variance for endurance time, which potentially can lead to fewer patients needed in comparative studies. The overall best results were observed with a low linear increase during endurance.
对于 COPD 患者的运动测试，建议使用恒定负荷的标准耐力测试（ET）。该测试个体间差异较大，需要较大的样本量才能评估治疗效果。
设计了一种 COPD 的新 ET 方案。与标准 ET 相比，新 ET 采用递增负荷的方式，以降低耐力时间的标准差。比较了两种新的 ET 与标准 ET。在研究 A 中，新 ET 从患者最大工作量（W）的 75%开始，以 3%/2 分钟的步长递增，直到衰竭。研究 B 从 W 的 70%开始，以 1%/分钟的线性递增。
在包括 15 名患者的研究 A 中，与标准 ET 相比，新 ET 的耐力时间和工作能力的标准差和范围更窄。然而，终末的平均工作负荷较高，相对于标准 ET 的平均工作能力较低，表明递增的幅度过于激进。在包括 18 名患者的研究 B 中，采用改良方案，新 ET 和标准 ET 的耐力时间、终末工作负荷和工作能力的平均值相似，而新 ET 的耐力时间和工作能力的标准差和范围保持更窄。耐力时间的方差在标准 ET 和两种新 ET 之间不相等（根据 Levene 检验，两种情况均 p<0.05）。
与标准测试相比，新的 ET 减少了具有极端耐力时间（短和长）的患者数量。新测试的耐力时间方差显著降低，这可能导致比较研究所需的患者数量减少。在耐力过程中采用低线性递增的方式，观察到整体最佳结果。
