Criterion Validity and Responsiveness of the Steep Ramp Test to Evaluate Aerobic Capacity in Survivors of Cancer Participating in a Supervised Exercise Rehabilitation Program

Anouk T R Weemaes; Milou Beelen; Bart C Bongers; Matty P Weijenberg; Antoine F Lenssen

doi:10.1016/j.apmr.2021.04.016

Criterion Validity and Responsiveness of the Steep Ramp Test to Evaluate Aerobic Capacity in Survivors of Cancer Participating in a Supervised Exercise Rehabilitation Program

Arch Phys Med Rehabil. 2021 Nov;102(11):2150-2156. doi: 10.1016/j.apmr.2021.04.016. Epub 2021 May 21.

Authors

Anouk T R Weemaes¹, Milou Beelen², Bart C Bongers³, Matty P Weijenberg⁴, Antoine F Lenssen⁵

Affiliations

¹ Department of Physical Therapy, Maastricht University Medical Center+, Maastricht; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht. Electronic address: anouk.weemaes@mumc.nl.
² Department of Physical Therapy, Maastricht University Medical Center+, Maastricht; Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht.
³ Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht; Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht.
⁴ Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
⁵ Department of Physical Therapy, Maastricht University Medical Center+, Maastricht; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht.

PMID: 34023324
DOI: 10.1016/j.apmr.2021.04.016

Abstract

Objective: To evaluate the criterion validity and responsiveness of the steep ramp test (SRT) compared with the cardiopulmonary exercise test (CPET) in evaluating aerobic capacity in survivors of cancer participating in a rehabilitation program.

Design: A prospective cohort study in which survivors of cancer performed an SRT and CPET before (T=0) and after (T=1) a 10-week exercise rehabilitation program. Peak work rate achieved during the SRT (SRT-WRpeak) was compared with peak oxygen consumption measured during the CPET (CPET-Vo₂peak), which is the criterion standard for aerobic capacity. Correlation coefficients were calculated between SRT-WRpeak and CPET-Vo₂peak at T=0 to examine criterion validity and between changes in SRT-WRpeak and CPET-Vo₂peak from T=0 to T=1 to determine responsiveness. Receiver operating characteristic analysis was performed to examine the ability of the SRT to detect a true improvement (6%) in CPET-Vo₂peak.

Setting: University medical center.

Participants: Survivors of cancer (N=106).

Interventions: Exercise rehabilitation.

Main outcome measures: Correlation coefficients between CPET-Vo₂peak and SRT-WRpeak and between changes in CPET-Vo₂peak and SRT-WRpeak.

Results: An r of 0.86 (N=106) was found for the relation between SRT-WRpeak and CPET-Vo₂peak at T=0. An r of 0.51 was observed for the relation between changes in SRT-WRpeak and CPET-Vo₂peak (n=59). Receiver operating characteristic analysis showed an area under the curve of 0.74 for the SRT to detect a true improvement in CPET-Vo₂peak, with an optimal cutoff value of +0.26 W/kg (sensitivity 70.7%, specificity 66.7%).

Conclusions: Because SRT-WRpeak and CPET-Vo₂peak were strongly correlated, the SRT seems a valid tool to estimate aerobic capacity in survivors of cancer. The responsiveness to measure changes in aerobic capacity appears moderate. Nevertheless, the SRT seems able to detect improvement in aerobic capacity, with a cutoff value of 0.26 W/kg.

Keywords: Cancer survivors; Exercise test; Exercise therapy; Rehabilitation; Validation study.

MeSH terms

Academic Medical Centers
Adult
Aged
Body Weights and Measures
Cancer Survivors
Exercise Test / methods*
Exercise Test / standards*
Exercise Therapy
Exercise Tolerance / physiology*
Female
Humans
Male
Middle Aged
Neoplasms / rehabilitation*
Oxygen Consumption
Prospective Studies
ROC Curve
Reproducibility of Results

Associated data

ISRCTN/ISRCTN10373531