Harvey-Dunstan Theresa C, Baldwin Molly M, Tal-Singer Ruth, Allinder Matthew, Polkey Michael I, Hamilton Alan, Richardson Matthew, Edwards Sarah A, Steiner Michael C, Morgan Mike D, Singh Sally J
Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory, Leicester, England.
Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory, Leicester, England; Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, England.
Chest. 2025 Jan;167(1):98-111. doi: 10.1016/j.chest.2024.05.051. Epub 2024 Aug 21.
COPD is characterized by reduced exercise tolerance, and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these various tests to common COPD interventions is yet to be compared, but the results may inform test selection in clinical and research settings.
What exercise test possesses the greatest sensitivity to change from before to after intervention in patients with COPD?
One hundred fifty-four patients with symptomatic COPD were recruited and randomized (2:1:1) to 6 weeks of long-acting muscarinic antagonist, pulmonary rehabilitation (PR), or usual care. Before and after intervention, participants performed an incremental cycle exercise test and constant work rate cycle test (CWRCT), incremental shuttle walk test and endurance shuttle walk test (ESWT), 6-min walk test, and 4-m gait speed test.
One hundred three participants (mean ± SD age, 67 ± 8 years; 75 male participants [73%]; FEV, 50.6 ± 16.8% predicted) completed the study. Significant improvements in the incremental cycle exercise test, CWRCT, incremental cycle exercise test, ESWT, and 6-min walk test results were observed after PR (P < .05), with the greatest improvements seen in the constant work rate protocols (percentages change: CWRCT, 42%; ESWT, 41%).
The ESWT and CWRCT seemed to be the most responsive exercise test protocols to long-acting muscarinic antagonist and PR therapy. The magnitude of change was much greater after a program of rehabilitation compared with bronchodilator therapy.
International Standard Randomised Controlled Trial Number (ISRCTN): No. 64759523; URL: https://www.isrctn.com/ISRCTN64759523.
慢性阻塞性肺疾病（COPD）的特征是运动耐力下降，提高身体机能是一项重要的治疗目标。多种运动测试常用于评估运动耐力，包括实验室测试和实地测试。这些不同测试对常见COPD干预措施的反应性尚未进行比较，但结果可能为临床和研究环境中的测试选择提供参考。
哪种运动测试对COPD患者干预前后的变化具有最大的敏感性？
招募了154例有症状的COPD患者，并将其随机分组（2:1:1），分别接受为期6周的长效毒蕈碱拮抗剂治疗、肺康复治疗（PR）或常规治疗。在干预前后，参与者进行递增式自行车运动测试和恒功率自行车测试（CWRCT）、递增式往返步行测试和耐力往返步行测试（ESWT）、6分钟步行测试以及4米步速测试。
103名参与者（平均年龄±标准差为67±8岁；75名男性参与者[73%]；第1秒用力呼气容积占预计值百分比为50.6±16.8%）完成了研究。PR治疗后，递增式自行车运动测试、CWRCT、递增式往返步行测试、ESWT和6分钟步行测试结果均有显著改善（P < 0.05），其中恒功率测试方案的改善最为明显（变化百分比：CWRCT为42%；ESWT为41%）。
ESWT和CWRCT似乎是对长效毒蕈碱拮抗剂和PR治疗反应最敏感的运动测试方案。与支气管扩张剂治疗相比，康复计划后的变化幅度要大得多。
国际标准随机对照试验编号（ISRCTN）：No. 64759523；网址：https://www.isrctn.com/ISRCTN64759523 。
