The PAY test: a new approach for assessing functional performance in children and adolescents with asthma.

OBJECTIVE: To develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth). METHODS: participants without and with asthma were included in the development and validation phases, respectively. The PAY test includes five activities: transition from sitting to standing, walking 10 m, step climbing, shoulder extension and flexion, and star jumps. Participants underwent the Pediatric Glittre test (TGlittre-P test time), modified shuttle test (MST), and cardiopulmonary exercise test (CPET). OUTCOMES: PAY test and TGlittre-P test times, oxygen uptake (VO2peak), and distance walked in the MST. RESULTS: 8 healthy volunteers, aged 12 (7 - 15) years old were included in the development phase and 34 participants with asthma, aged 11 (7 -14) years old, in the validation phase. The PAY test elicited greater physiological responses (VO2peak 33.5 ± 6.9 mL/kg) than the TGlittre-P (VO2peak: 27.4 ± 9.0 mL/kg), but lower than the MST (VO2peak: 48.9 ± 14.2 mL/kg) and CPET (VO2peak: 42.0 ± 8.8 mL/kg), p < .05. Moderate correlation between the PAY test time and the TGlittre-P time (r = 0.70, p < .001) and distance walked in the MST (r = -0.72, p < .001). The PAY test time was longer in participants with asthma than in healthy participants (3.1 [3.0 - 3.3] min vs. 2.3 [2.1 - 2.4 min]), p < .001.; and the test was reproducible (ICC 0.78, CI 95% 0.55-0.90, p < .001). CONCLUSIONS: The PAY test is a valid and reproducible tool for assessing functional performance in children and adolescents with asthma.

The PAY test: a new approach for assessing functional performance in children and adolescents with asthma

Abstract Objective: To develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth). Methods: participants without and with asthma were included in the development and validation phases, respectively. The PAY test includes five activities: transition from sitting to standing, walking 10 m, step climbing, shoulder extension and flexion, and star jumps. Participants underwent the Pediatric Glittre test (TGlittre-P test time), modified shuttle test (MST), and cardiopulmonary exercise test (CPET). Outcomes: PAY test and TGlittre-P test times, oxygen uptake (VO2peak), and distance walked in the MST. Results: 8 healthy volunteers, aged 12 (7 -15) years old were included in the development phase and 34 participants with asthma, aged 11 (7-14) years old, in the validation phase. The PAY test elicited greater physiological responses (VO2peak 33.5 ± 6.9 mL/kg) than the TGlittre-P (VO2peak: 27.4 ± 9.0 mL/kg), but lower than the MST (VO2peak: 48.9 ± 14.2 mL/kg) and CPET (VO2peak: 42.0 ± 8.8 mL/kg), p < .05. Moderate correlation between the PAY test time and the TGlittre-P time (r = 0.70, p < .001) and distance walked in the MST (r = -0.72, p < .001). The PAY test time was longer in participants with asthma than in healthy participants (3.1 [3.0 - 3.3] min vs. 2.3 [2.1 - 2.4 min]), p < .001.; and the test was reproducible (ICC 0.78, CI 95% 0.55-0.90, p < .001). Conclusions: The PAY test is a valid and reproducible tool for assessing functional performance in children and adolescents with asthma.

Is the modified shuttle test a maximal effort test in children and adolescents with asthma?

PURPOSE: Whether the modified shuttle test (MST) achieves maximal effort in children and adolescents with asthma is unclear. The aim was to compare the physiological responses of MST to the cardiopulmonary exercise test (CPET) in pediatric patients with asthma, to observe its convergent validity. PATIENTS AND METHODS: A cross-sectional study with volunteers with asthma (6-17 years of age) under regular treatment. The MST is an external-paced test, and the participants were allowed to walk/run. CPET was performed on a cycle ergometer to compare with MST. Gas exchange (VO2 , VCO2 , and VE) and heart rate (HR) were the outcomes and were continuously assessed in both tests. RESULTS: Forty-seven volunteers were included, normal lung function expiratory forced volume at 1st second/forced vital capacity (FEV1 /FVC) 88.6 (7.7). VO2peak was higher at MST (2.0 ± 0.6 L/min) compared to CPET (1.6 ± 0.5 L/min), p < 0.001. Similar results was observed to VE at MST (50 ± 16 L/min) versus VE at CPET (40 ± 13 L/min), and to VCO2 at MST (2.1 ± 0.8 L/min) versus VCO2 at CPET (1.7 ± 0.6 L/min), p < 0.001. HR was also higher at MST (94 ± 6%pred) versus CPET (87 ± 8%pred), p = 0.002. VO2peak in MST correlated to the CPET (r = 0.78, p < 0.001). The ICC of VO2peak between tests was 0.73 (0.06-0.89), p < 0.001, and VO2peak Bland-Altman analysis showed a bias of 0.46 L/min. CONCLUSION: The MST showed a maximal physiologic response in children and adolescents with asthma. It is a valid test and can be used as an alternative to evaluating exercise capacity.

Home-based pulmonary rehabilitation in people with bronchiectasis: a randomised controlled trial.

AIM: To investigate the short- and long-term effects of home-based pulmonary rehabilitation (HBPR) on functional capacity, quality of life, peripheral muscle strength, dyspnoea and daily physical activity in people with bronchiectasis. METHODS: Randomised controlled trial with 63 participants with bronchiectasis. The HBPR group performed three sessions per week for 8 weeks (aerobic exercise: step training for 20 min; resistance training: exercises for quadriceps, hamstrings, deltoids and biceps brachii using elastic bands). The control group received a recommendation to walk at moderate intensity, three times per week. A weekly phone call was conducted for all participants, and the HBPR group received a home visit every 15 days. The primary outcome was distance in the incremental shuttle walk test (ISWT). Secondary outcomes were time in the endurance shuttle walk test (ESWT), number of steps in the incremental step test, quality of life, quadriceps muscle strength and daily physical activity. Measures were taken before and after intervention and 6 months later. RESULTS: After the intervention, the HBPR group had increased ISWT distance compared with the control group with between-group difference 87.9 m (95% CI 32.4-143.5 m). In addition, between-group differences were found in the ESWT, incremental step test, quality of life and quadriceps muscle strength, favouring the HBPR group. After 6 months, no differences were observed between the groups. CONCLUSION: HBPR is an effective alternative offering of pulmonary rehabilitation for people with bronchiectasis. However, the programme was not effective in maintaining the benefits after 6 months of follow-up.

Ventilatory Demand During Stepping and Running: Implications for Exercise-Induced Bronchoconstriction in Children.

BACKGROUND: Single-step tests have been proposed as simple and inexpensive challenges to diagnose exercise-induced bronchoconstriction (EIB) in the pediatric population. Work performed and the resulting ventilation, however, might be substantially lower in stepping than running. This might decrease the diagnostic yield of step-based challenges. METHODS: In a cross-sectional study, 53 children with asthma with exercise-related symptoms (34 boys, age 6-18 y) underwent an incremental stepping test, a 6-min constant stepping test, and a treadmill running test on different days. RESULTS: Constant and incremental stepping tests presented with lower metabolic demands (V̇O2 1.42 ± 0.48 and 1.34 ± 0.55 L/min, respectively), ventilatory demands (V̇O2 45 ± 14 and 43 ± 16 L/min, respectively), and cardiovascular demands (160 ± 20 and 161 ± 19 beats/min, respectively) than the treadmill running test (1.65 ± 0.60 L/min, 54 ± 17 L/min, and 172 ± 7 beats/min, respectively) (P < .05). Between-test agreement in diagnosing EIB was poor (kappa 0.217-0.361). Although EIB prevalence was higher after the treadmill running test (60%) compared to constant (53%) and incremental (47%) stepping tests, 7 subjects developed EIB only in stepping. Clinical and resting functional characteristics did not differ in discordant subjects (ie, EIB negative in a given test but positive in another) versus concordant subjects (ie, EIB negative or positive in both tests). EIB was not related to individual test ability in eliciting high to very-high ventilation (≥ 40% or ≥ 60% maximum voluntary ventilation, respectively). Moreover, a negative stepping test but a positive treadmill test (and vice versa) was not associated with greater ventilatory demands. CONCLUSIONS: Lower prevalence of EIB in stepping compared to treadmill running is not related to less ventilation demand in the former modality. Although stepping might be useful as a screening EIB test due its portability and low cost, a negative test should be confirmed with a running-based test in symptomatic children.

Incremental Shuttle Walk Test to Assess and Prescribe Exercise for Subjects With Bronchiectasis: Hallway Versus Treadmill.

INTRODUCTION: The incremental shuttle walk test was initially developed to be carried out in a hallway (ISWT-H) but has been modified to be performed on a treadmill (ISWT-T). However, it is still unknown whether performance on ISWT-H and ISWT-T are similar in patients with bronchiectasis. In this study, we compared the performance, physiological responses, and perception of effort between the ISWT-T with a handrail and ISWT-H for subjects with bronchiectasis. We also sought to estimate and compare the prescription for training intensity with both tests. METHODS: This was a cross-sectional study in which 24 subjects with bronchiectasis were evaluated on 2 different days (24 h apart). Distance walked (m) was compared between the ISWT-H and ISWT-T. A training session was held on a treadmill at 75% of the speed obtained from both tests. The walking distance, oxygen uptake (V̇O2 ), carbon dioxide production (V̇CO2 ), heart rate, and ventilation (V̇E) were measured. RESULTS: There was a difference in the walking distance between the ISWT-T and ISWT-H, but physiological responses for V̇O2 , V̇CO2 , heart rate, and V̇E were similar. However, the speed estimated for training was different, as were the V̇O2 , V̇CO2 , and heart rate. CONCLUSIONS: The ISWT-T with handrail and the ISWT-H are not interchangeable in subjects with bronchiectasis. A slower speed of training intensity may occur when the test is performed in a hallway, as originally described, and this may underestimate responses to aerobic training.

Does home-based pulmonary rehabilitation improve functional capacity, peripheral muscle strength and quality of life in patients with bronchiectasis compared to standard care?

BACKGROUND: Home-based pulmonary rehabilitation is a promising intervention that may help patients to overcome the barriers to undergoing pulmonary rehabilitation. However, home-based pulmonary rehabilitation has not yet been investigated in patients with bronchiectasis. OBJECTIVES: To investigate the effects of home-based pulmonary rehabilitation in patients with bronchiectasis. METHODS: An open-label, randomized controlled trial with 48 adult patients with bronchiectasis will be conducted. INTERVENTIONS: The program will consist of three sessions weekly over a period of 8 weeks. Aerobic exercise will consist of stepping on a platform for 20min (intensity: 60-80% of the maximum stepping rate in incremental step test). Resistance training will be carried out using an elastic band for the following muscles: quadriceps, hamstrings, deltoids, and biceps brachii (load: 70% of maximum voluntary isometric contraction). CONTROL: The patients will receive an educational manual and a recommendation to walk three times a week for 30min. All patients will receive a weekly phone call to answer questions and to guide the practice of physical activity. The home-based pulmonary rehabilitation group also will receive a home visit every 15 days. MAIN OUTCOME MEASURES: incremental shuttle walk test, quality of life, peripheral muscle strength, endurance shuttle walk test, incremental step test, dyspnea, and physical activity in daily life. The assessments will be undertaken at baseline, after the intervention, and 8 months after randomization. DISCUSSION: The findings of this study will determine the clinical benefits of home-based pulmonary rehabilitation and will contribute to future guidelines for patients with bronchiectasis. TRIAL REGISTRATION: www.ClinicalTrials.gov (NCT02731482). https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00060X6&selectaction=Edit&uid=U00028HR&ts=2&cx=1jbszg.