Oncology Section EDGE Task Force Breast Cancer Outcomes: A Systematic Review of Clinical Measures of Cardiorespiratory Fitness Tests

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Abstract

Background:

Outcomes from standardized exercise tests (SET) are used by physical therapists (PTs) to define cardiorespiratory fitness (CRF) and develop safe and effective prescriptions for aerobic exercise training programs; however, the psychometric properties and clinical utility of standard exercise testing has not been evaluated in the breast cancer survivor population.

Objective:

To evaluate the psychometric properties, safety, and clinical utility of SET and provide informed recommendations for their use in clinical practice involving female breast cancer survivors.

Design:

The study was a systematic review with a measurement focused design.

Methods:

A comprehensive search was performed with a health sciences librarian to identify articles that reported psychometric data on SET among women with breast cancer. Criterion articles were evaluated using the Cancer EDGE Task Force Outcome Measure Rating Form.

Results:

Sixty-eight articles met initial inclusion criteria, but only 5 were found that reported useable psychometric data. Maximal treadmill and cycle ergometer tests involving expired gas analysis were valid and accurate in this population, but are not safe or efficient for use in a clinical setting. Submaximal tests (treadmill, cycle ergometer, step, and walk/run tests) that use prediction equations to estimate CRF had large errors for minimal detectable differences (3.32-15.80 ml/kg/min) which approached or exceeded the minimal clinically important difference (3.5 ml/kg/min). Furthermore, these prediction equations have not been validated in this population.

Discussion:

Limited evidence was found describing the psychometric properties of SETs used to determine CRF in breast cancer survivors. Available studies suggest clinically efficient SETs have moderate to poor concurrent validity with a moderate to high standard error; however, standardized exercise testing can serve to screen for exercise safety and provide estimates of CRF. Exercise prescriptions developed from the outcomes of SET will require follow up for potential modifications. Appreciating SET limitations enables proper client education and training adjustments needed for safety and exercise efficacy.

Conclusions:

Further understanding of the psychometric properties of SET used in the breast cancer survivor population is needed in order to make these tests safe, accurate, and clinically useful.

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