Original article
Exercise Testing and Training in a Cancer Rehabilitation Program: The Advantage of the Steep Ramp Test

https://doi.org/10.1016/j.apmr.2007.02.013Get rights and content

Abstract

De Backer IC, Schep G, Hoogeveen A, Vreugdenhil G, Kester AD, van Breda E. Exercise testing and training in a cancer rehabilitation program: the advantage of the steep ramp test.

Objective

To compare the short maximal exercise capacity test (steep ramp test) with the submaximal test to determine the most appropriate exercise test in cancer rehabilitation.

Design

A prospective study in which a submaximal test, a maximal short exercise capacity test (steep ramp test), and a maximal oxygen consumption test (V̇o2max test) were performed before and after an 18-week training program. V̇o2max testing, the criterion standard for the measurement of physical capacity, was compared with the submaximal test and the steep ramp test.

Setting

Community hospital and physiotherapy.

Participants

Thirty-seven cancer survivors (10 men, 27 women) treated with chemotherapy. The subjects’ mean age ± standard deviation (SD) was 48±11 years.

Intervention

An 18-week training program including strength training, interval aerobic training, and home-based activities (endurance).

Main Outcome Measures

Estimated V̇o2max (submaximal test) and maximal workload (steep ramp test) were assessed during the exercise tests and compared with the results of the V̇o2max test.

Results

A paired t test showed a significant improvement in V̇o2max (+13%, P<.001) and maximal workload (+19%, P<.001) after the training program. This improvement was confirmed in the steep ramp test (maximal workload, +13%, P<.001) but not in the submaximal test (estimated V̇o2max, +4%, P=.192). Pearson correlation quantified only a moderate correlation between the V̇o2max test and the submaximal test and a high correlation between the V̇o2max test and the steep ramp test. Intraclass correlation determined the test-retest reliability of the submaximal test (.873) and the steep ramp test (.996). A linear regression model (V̇o2max, 6.7; steep ramp Wmax, +356.7) was estimated to predict V̇o2max from the steep ramp test outcome, implying a prediction margin of ±2 SDs (616mL/min).

Conclusions

The submaximal test proved to be invalid, whereas the steep ramp test seems to be a practicable, reliable, and valid test for the assessment of the training dose. The steep ramp test can be regularly repeated during the training program, providing information needed to readjust the training dose according to the progress made.

Section snippets

Participants

Thirty-seven patients treated curatively with chemotherapy were included in the study. Patient characteristics are depicted in table 1. Training started a minimum of 6 weeks after completing chemotherapy to counteract bias resulting from spontaneous recovery after chemotherapy.

The following patients were excluded: (1) patients who were not capable of performing basic skills like sitting or lying down, (2) patients who had cognitive disorders or severe emotional instability, and (3) patients who

Results

All patients selected for the study were able to complete the training program. All exercise tests were tolerated well without complication.

Discussion

The physical limitations after treatment for cancer vary widely among patients.34 Physical capacity may be affected by a variety of factors such as stage and type of cancer, previous history of physical activity, psychologic variables, type of treatment, and obesity.12 Consequently, there is a need to evaluate exercise tests used for assessing the initial physical fitness state, readjustment of the training load, and monitoring of the effects of a training intervention.

o2max testing is widely

Conclusions

The steep ramp test has proved to be a valid, safe, and practical means for prescribing the training load and for monitoring training progress in the rehabilitation of cancer patients. Submaximal testing proves to have only limited value in the assessment of exercise capacity and is less feasible and less reliable than the steep ramp test. Consequently, a steep ramp test should be recommended in cancer rehabilitation programs for the individual assessment of training.

References (41)

  • A. Jemal et al.

    Cancer statistics, 2005 [published erratum appears in CA Cancer J Clin 2005;55:259]

    CA Cancer J Clin

    (2005)
  • M. Talback et al.

    Cancer survival in Sweden 1960-1998—developments across four decades

    Acta Oncol

    (2003)
  • K.S. Courneya

    Exercise in cancer survivors: an overview of research

    Med Sci Sports Exerc

    (2003)
  • K.S. Courneya et al.

    Physical exercise and quality of life following cancer diagnosis: a literature review

    Ann Behav Med

    (1999)
  • F.C. Dimeo

    Effects of exercise on cancer-related fatigue

    Cancer

    (2001)
  • P. Stone et al.

    Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum

    Ann Oncol

    (2000)
  • T.R. Burnham et al.

    Effects of exercise on physiological and psychological variables in cancer survivors

    Med Sci Sports Exerc

    (2002)
  • M.L. Irwin et al.

    Physical activity interventions following cancer diagnosis: methodologic challenges to delivery and assessment

    Cancer Invest

    (2004)
  • E. van Weert et al.

    Physical functioning and quality of life after cancer rehabilitation

    Int J Rehabil Res

    (2004)
  • T. Watson et al.

    Exercise as an intervention for cancer-related fatigue

    Phys Ther

    (2004)
  • Cited by (0)

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    View full text