Key result
Functional exercise tests showed weak to strong correlations with recommended cardiopulmonary exercise tests, with the 4-metre gait speed test demonstrating the highest correlation (r=0.78-0.85).
Why the study?
During the COVID-19 pandemic, remote cardiopulmonary rehabilitation raised concerns about how to assess exercise capacity when supervised exercise tests are not possible.
Do functional exercise tests correlate with recommended exercise tests for cardiopulmonary rehabilitation in adults with long-term conditions?
Do functional exercise tests correlate with recommended exercise tests for cardiopulmonary rehabilitation in adults with long-term conditions?
Effect estimate: r=0.38-0.85
While the 4-metre gait speed test correlates strongly with routine measures of exercise tolerance, face-to-face standardized exercise tests remain preferable for guiding exercise prescription in cardiopulmonary rehabilitation.
4MGS correlates most strongly with standard tests; leaves open validation for unsupervised remote use in cardiopulmonary rehabilitation.
Introduction The coronavirus disease 2019 (COVID-19) pandemic has seen many cardiopulmonary rehabilitation services delivering programmes remotely. One area of concern is how to assess exercise capacity when a supervised exercise test is not possible. The aim of this review was to examine the relationship between functional exercise tests and recommended exercise tests for cardiopulmonary rehabilitation. Methods A rapid narrative review was carried out. Searches were conducted by two of the study authors. The study had the following features. Participants: adults, all with long-term conditions; intervention: any/none; outcome: Duke activity status index (DASI), sit to stand (STS, 30 s, 1 min and 5 repetitions), short physical performance battery (SPPB), 4-metre gait speed (4MGS) or step test (Chester/others) AND directly compared to one of the recommended exercise tests for cardiopulmonary rehabilitation: 6-min walk test (6MWT), incremental shuttle walk test (ISWT) or cardiopulmonary exercise test (CPET) in terms of reporting agreement/correlation; Study design: primary research only, controlled trials or observational studies. Results Sixteen articles out of 249 screened were included (n=2271 patients). Overall, there were weak–strong correlations for the included tests with a recommended exercise test (r=0.38–0.85). There were few reported issues with feasibility or safety of the tests. However, all tests were supervised in a clinical setting. The test that had the highest correlation with the field walking test was the 4MGS with the ISWT (r=0.78) and with the 6MWT (r=0.85). Discussion The 4MGS has the highest correlation with routine measures of exercise tolerance. However, it may be difficult to standardise in a remote assessment or to prescribe exercise from. Clinicians should strive for face-to-face standardised exercise tests where possible to be able to guide exercise prescription.
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Houchen-Wolloff et al. (2020) conducted a review in Long-term conditions requiring cardiopulmonary rehabilitation (n=2,271). Functional exercise tests (e.g., 4-metre gait speed) vs. Recommended exercise tests (6MWT, ISWT, CPET) was evaluated on Correlation with recommended exercise tests (r=0.38-0.85). Functional exercise tests showed weak to strong correlations with recommended cardiopulmonary exercise tests, with the 4-metre gait speed test demonstrating the highest correlation (r=0.78-0.85).
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