REVIEW   

Minerva Pneumologica 2018 December;57(4):104-20

DOI: 10.23736/S0026-4954.18.01833-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Evaluation of the effect of interventions on exercise capacity in pulmonary patients

Luis PUENTE-MAESTU ^{1, 2} ✉

¹ Faculty of Medicine, Complutense University of Madrid, Madrid, Spain; ² Service of Pneumology, Gregorio Marañón Sanitary Research Institute, Madrid, Spain

From an evidence-based perspective, performance during standardized exercise testing is of considerable importance in the multidimensional evaluation of most respiratory diseases. In this article we summarize the available information on the limiting factors for the different types of exercise usually employed for respiratory patients testing. We also review the most common test formats and the physiology determining their results. We finally review the most relevant outcomes and their properties. A standard test to evaluate interventions has not yet been defined and therefore there are several available formats with different responsiveness to interventions. Thresholds for clinically-important changes are available for several tests. The mechanism of improvement is different depending on the disease process: when moderate or severe airflow limitation is present, as in COPD, the primary mechanisms are reduced ventilatory requirement, which includes the amelioration of muscle dysfunction, and/or enhanced ventilatory capacity via reduction of dynamic hyperinflation. In pulmonary arterial hypertension the effect of treatment typically is associated to hemodynamic improvement while in interstitial lung diseases, correcting desaturation and improvement of muscle function seem to be the predominant physiological factor. Most human beings require exercising to make the living and keep healthy. It is also a major contributor for people’s quality of life a hence major source of happiness. In respiratory patients exercise testing is, therefore, relevant in clinical and research setting to assess the effects of interventions aimed to restore the lost capacity. Several methods for evaluating exercise performance are available. We have attempted to summarize the available evidence on the physiology and properties of the most relevant exercise tests. As yet, a “standard” test has not been identified, and the choice of testing modality is both disease, and intervention specific. In addition, the mechanism of improvement from the intervention is different depending on the disease process: With COPD focusing on dynamic hyperinflation, pulmonary hypertension on improvements in cardiac function, and patients with interstitial lung disease on both gas exchange/hypoxia as well as cardiac function. Exercise testing is safe and stands as an important tool in the evaluation of patients with exercise intolerance.

KEY WORDS: Exercise - Exercise test - Quality of life - Lung diseases