Validation and Refinement of Prediction Models to Estimate Exercise Capacity in Cancer Survivors Using the Steep Ramp Test

Martijn M. Stuiver, Caroline S. Kampshoff, Saskia Persoon, Wim Groen, Willem van Mechelen, Mai J.M. Chinapaw, Johannes Brug, Frans Nollet, Marie José Kersten, Goof Schep, Laurien M. Buffart

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (VO2peak) and peak power output (Wpeak). Design Cross-sectional study. Setting Multicenter. Participants Cancer survivors (N=283) in 2 randomized controlled exercise trials. Interventions Not applicable. Main Outcome Measures Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions. Results ICCs of SRT-predicted VO2peak and Wpeak with these values as obtained by the cardiopulmonary exercise test were.61 and.73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for VO2peak and ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of VO2peak (ICC,.73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak (ICC,.81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for Wpeak. Conclusions Predictions of VO2peak and Wpeak based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.

Original languageEnglish
Pages (from-to)2167-2173
Number of pages7
JournalArchives of Physical Medicine and Rehabilitation
Volume98
Issue number11
DOIs
Publication statusPublished - 1 Nov 2017

Cite this

@article{7d79a57097bd43e5aa81614273dafdd4,
title = "Validation and Refinement of Prediction Models to Estimate Exercise Capacity in Cancer Survivors Using the Steep Ramp Test",
abstract = "Objective To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (VO2peak) and peak power output (Wpeak). Design Cross-sectional study. Setting Multicenter. Participants Cancer survivors (N=283) in 2 randomized controlled exercise trials. Interventions Not applicable. Main Outcome Measures Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions. Results ICCs of SRT-predicted VO2peak and Wpeak with these values as obtained by the cardiopulmonary exercise test were.61 and.73, respectively, using the previously published prediction models. 95{\%} LOA were ±705mL/min with a bias of 190mL/min for VO2peak and ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of VO2peak (ICC,.73; 95{\%} LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak (ICC,.81; 95{\%} LOA, ±48W). Accuracy of endurance exercise prescription improved from 57{\%} accurate prescriptions to 68{\%} accurate prescriptions with the new prediction model for Wpeak. Conclusions Predictions of VO2peak and Wpeak based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.",
keywords = "Exercise test, Exercise therapy, Neoplasms, Rehabilitation, Validation studies",
author = "Stuiver, {Martijn M.} and Kampshoff, {Caroline S.} and Saskia Persoon and Wim Groen and {van Mechelen}, Willem and Chinapaw, {Mai J.M.} and Johannes Brug and Frans Nollet and Kersten, {Marie Jos{\'e}} and Goof Schep and Buffart, {Laurien M.}",
year = "2017",
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language = "English",
volume = "98",
pages = "2167--2173",
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Validation and Refinement of Prediction Models to Estimate Exercise Capacity in Cancer Survivors Using the Steep Ramp Test. / Stuiver, Martijn M.; Kampshoff, Caroline S.; Persoon, Saskia; Groen, Wim; van Mechelen, Willem; Chinapaw, Mai J.M.; Brug, Johannes; Nollet, Frans; Kersten, Marie José; Schep, Goof; Buffart, Laurien M.

In: Archives of Physical Medicine and Rehabilitation, Vol. 98, No. 11, 01.11.2017, p. 2167-2173.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Validation and Refinement of Prediction Models to Estimate Exercise Capacity in Cancer Survivors Using the Steep Ramp Test

AU - Stuiver, Martijn M.

AU - Kampshoff, Caroline S.

AU - Persoon, Saskia

AU - Groen, Wim

AU - van Mechelen, Willem

AU - Chinapaw, Mai J.M.

AU - Brug, Johannes

AU - Nollet, Frans

AU - Kersten, Marie José

AU - Schep, Goof

AU - Buffart, Laurien M.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objective To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (VO2peak) and peak power output (Wpeak). Design Cross-sectional study. Setting Multicenter. Participants Cancer survivors (N=283) in 2 randomized controlled exercise trials. Interventions Not applicable. Main Outcome Measures Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions. Results ICCs of SRT-predicted VO2peak and Wpeak with these values as obtained by the cardiopulmonary exercise test were.61 and.73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for VO2peak and ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of VO2peak (ICC,.73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak (ICC,.81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for Wpeak. Conclusions Predictions of VO2peak and Wpeak based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.

AB - Objective To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (VO2peak) and peak power output (Wpeak). Design Cross-sectional study. Setting Multicenter. Participants Cancer survivors (N=283) in 2 randomized controlled exercise trials. Interventions Not applicable. Main Outcome Measures Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions. Results ICCs of SRT-predicted VO2peak and Wpeak with these values as obtained by the cardiopulmonary exercise test were.61 and.73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for VO2peak and ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of VO2peak (ICC,.73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak (ICC,.81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for Wpeak. Conclusions Predictions of VO2peak and Wpeak based on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.

KW - Exercise test

KW - Exercise therapy

KW - Neoplasms

KW - Rehabilitation

KW - Validation studies

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