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Validation and Refinement of Prediction Models to Estimate Exercise Capacity in Cancer Survivors Using the Steep Ramp Test

Published:March 18, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.013

      Highlights

      • Peak oxygen consumption and peak power output can be estimated from the steep ramp test in cancer survivors.
      • A multivariable nomogram yields better predictions than does a univariable nomogram.
      • The validity of the estimations is likely to vary across different populations.
      • The estimations can be used cautiously to aid exercise prescription.
      • The estimations should not be used for clinical decision making for individuals.

      Abstract

      Objective

      To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (Vo2peak) and peak power output (Wpeak).

      Design

      Cross-sectional study.

      Setting

      Multicenter.

      Participants

      Cancer survivors (N=283) in 2 randomized controlled exercise trials.

      Interventions

      Not applicable.

      Main Outcome Measures

      Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions.

      Results

      ICCs of SRT-predicted Vo2peak and Wpeak with these values as obtained by the cardiopulmonary exercise test were .61 and .73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for Vo2peak and ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of Vo2peak (ICC, .73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak (ICC, .81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for Wpeak.

      Conclusions

      Predictions of Vo2peak and Wpeak based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.

      Keywords

      List of abbreviations:

      CI (confidence interval), CPET (cardiopulmonary exercise test), ICC (intraclass correlation coefficient), LOA (limits of agreement), MET (metabolic equivalent), MSEC (maximal short exercise capacity), SRT (steep ramp test), Vo2peak (peak oxygen consumption), Wpeak (peak power output)
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