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Construct Validity of the Steep Ramp Test for Assessing Cardiorespiratory Fitness in Patients With Breast Cancer and the Effect of Chemotherapy-Related Symptom Burden

  • Hester J. Van de Wiel
    Affiliations
    Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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  • Wim G. Groen
    Affiliations
    Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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  • Caroline S. Kampshoff
    Affiliations
    Department of Primary Care, NIVEL, Utrecht, the Netherlands
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  • Laurien M. Buffart
    Affiliations
    Department of Physiology, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, the Netherlands

    Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia
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  • Willem van Mechelen
    Affiliations
    Department of Public and Occupational Health and Amsterdam Public Health Research Insitute, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands

    School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia

    Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
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  • Goof Schep
    Affiliations
    Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands
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  • Gabe S. Sonke
    Affiliations
    Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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  • Rosalie Huijsmans
    Affiliations
    Department of Rehabilitation Medicine, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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  • Wim H. van Harten
    Affiliations
    Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands

    Rijnstate Hospital, Arnhem, the Netherlands

    Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
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  • Neil K. Aaronson
    Affiliations
    Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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  • Martijn M. Stuiver
    Correspondence
    Corresponding author Martijn Stuiver, PhD, Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
    Affiliations
    Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands

    Center for Quality of Life, the Netherlands Cancer Institute, Amsterdam, the Netherlands

    Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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      Abstract

      Objective

      To investigate the construct validity of the Steep Ramp Test (SRT) by longitudinally comparing the correlation between maximum short exercise capacity of the SRT and direct measurements of peak oxygen consumption (Vo2peak) during or shortly after treatment in patients with breast cancer and the potential effect of chemotherapy-induced symptom burden.

      Design

      Cross-sectional.

      Setting

      Multicenter.

      Participants

      We used data from 2 studies that included women with breast cancer treated with chemotherapy, resulting in 274 observations. A total of 161 patients (N=161) performed the cardiopulmonary exercise test and the SRT in 2 test sessions on different time points around chemotherapy treatment.

      Interventions

      Not applicable.

      Main Outcome Measures

      Fatigue was assessed with the Multidimensional Fatigue Inventory, and nausea and vomiting and pain by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. The longitudinal correlation between the maximum short exercise capacity and Vo2peak was investigated using a linear mixed model. Interaction terms were added to the model to investigate whether the correlation varied by symptom burden.

      Results

      We found a statistically significant moderate correlation between Vo2peak and maximum short exercise capacity (0.61; 95% confidence interval, 0.51-0.70; P<.01) over time. This correlation was slightly attenuated (−0.07; 95% confidence interval, −0.13 to 0.00; P=.04) in patients with chemotherapy-related nausea and vomiting, indicating smaller correlations of Vo2peak with the maximum short exercise capacity with increasing symptom burden. Pain and fatigue did not significantly modify the correlation.

      Conclusions

      The SRT can only be used as a proxy for changes in aerobic capacity with great caution and with attention for the level of nausea and vomiting.

      Keywords

      List of abbreviations:

      CI (confidence interval), CPET (cardiopulmonary exercise test), MSEC (maximum short exercise capacity), REACT (Resistance and Endurance Exercise After Chemotherapy), RPM (revolutions per minute), SRT (Steep Ramp Test), START (Vo2peak, peak oxygen consumption)
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