Construct Validity of the Steep Ramp Test for Assessing Cardiorespiratory Fitness in Patients With Breast Cancer and the Effect of Chemotherapy-Related Symptom Burden

Hester J Van de Wiel; Wim G Groen; Caroline S Kampshoff; Laurien M Buffart; Willem van Mechelen; Goof Schep; Gabe S Sonke; Rosalie Huijsmans; Wim H van Harten; Neil K Aaronson; Martijn M Stuiver

doi:10.1016/j.apmr.2022.05.014

Construct Validity of the Steep Ramp Test for Assessing Cardiorespiratory Fitness in Patients With Breast Cancer and the Effect of Chemotherapy-Related Symptom Burden

Arch Phys Med Rehabil. 2022 Dec;103(12):2362-2367. doi: 10.1016/j.apmr.2022.05.014. Epub 2022 Jun 19.

Affiliations

¹ Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
² Department of Primary Care, NIVEL, Utrecht, the Netherlands.
³ Department of Physiology, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia.
⁴ Department of Public and Occupational Health and Amsterdam Public Health Research Insitute, Amsterdam University Medical Centres, location VUmc, Amsterdam, the Netherlands; School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia; Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland.
⁵ Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands.
⁶ Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁷ Department of Rehabilitation Medicine, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁸ Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Rijnstate Hospital, Arnhem, the Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands.
⁹ Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Center for Quality of Life, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. Electronic address: m.stuiver@nki.nl.

PMID: 35732249
DOI: 10.1016/j.apmr.2022.05.014

Abstract

Objective: To investigate the construct validity of the Steep Ramp Test (SRT) by longitudinally comparing the correlation between maximum short exercise capacity of the SRT and direct measurements of peak oxygen consumption (Vo₂peak) during or shortly after treatment in patients with breast cancer and the potential effect of chemotherapy-induced symptom burden.

Design: Cross-sectional.

Setting: Multicenter.

Participants: We used data from 2 studies that included women with breast cancer treated with chemotherapy, resulting in 274 observations. A total of 161 patients (N=161) performed the cardiopulmonary exercise test and the SRT in 2 test sessions on different time points around chemotherapy treatment.

Interventions: Not applicable.

Main outcome measures: Fatigue was assessed with the Multidimensional Fatigue Inventory, and nausea and vomiting and pain by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. The longitudinal correlation between the maximum short exercise capacity and Vo₂peak was investigated using a linear mixed model. Interaction terms were added to the model to investigate whether the correlation varied by symptom burden.

Results: We found a statistically significant moderate correlation between Vo₂peak and maximum short exercise capacity (0.61; 95% confidence interval, 0.51-0.70; P<.01) over time. This correlation was slightly attenuated (-0.07; 95% confidence interval, -0.13 to 0.00; P=.04) in patients with chemotherapy-related nausea and vomiting, indicating smaller correlations of Vo₂peak with the maximum short exercise capacity with increasing symptom burden. Pain and fatigue did not significantly modify the correlation.

Conclusions: The SRT can only be used as a proxy for changes in aerobic capacity with great caution and with attention for the level of nausea and vomiting.

Keywords: Breast neoplasms; Exercise Test; Rehabilitation.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / drug therapy
Cardiorespiratory Fitness*
Cross-Sectional Studies
Exercise Therapy / methods
Fatigue / chemically induced
Female
Humans
Nausea / chemically induced
Oxygen Consumption
Pain
Quality of Life
Vomiting / chemically induced