title: Evaluation of expiratory volume, diffusion capacity, and exercise tolerance following major lung resection: a prospective follow-up analysis. Predictors of exercise oxygen desaturation following major lung resection. Is Hand-Held Dynamometry Useful for the Measurement of Quadriceps Strength in Older People? A Comparison with the Gold Standard Biodex Dynamometry Prediction of cardiopulmonary morbidity after resection for lung cancer: stair climbing test complications after lung cancer surgery. Do patients with lung cancer benefit from physical exercise? Value of the average basal daily walked distance measured using a pedometer to predict maximum oxygen consumption per minute in patients undergoing lung resection. Predictors of quality-of-life improvement following pulmonary resection due to lung cancer. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments Relationship of shuttle walk test and lung cancer surgical outcome. Stairs climbing test with pulse oximetry as predictor of early postoperative complications in functionally impaired patients with lung cancer and elective lung surgery: prospective trial of consecutive series of patients. Stair Climbing in the Functional Assessment of Lung Resection Candidates Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer Preliminary report of the 6-minute walk test as a predictor of radiation-induced pulmonary toxicity. Predicting length of stay out of hospital following lung resection using preoperative health status measures Stair climbing test predicts cardiopulmonary complications after lung resection. Performance at preoperative stair-climbing test is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. Randomized controlled pilot study of neuromuscular electrical stimulation of the quadriceps in patients with non-small cell lung cancer. Preoperative assessment of the high-risk patient for lung resection. Peak Oxygen Consumption Measured during the Stair-Climbing Test in Lung Resection Candidates Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis.
abstract: BACKGROUND Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation . The objectives of this study were to prospect ively investigate the postoperative changes in FEV(1 ) , carbon monoxide lung diffusion capacity ( Dlco ) , and exercise tolerance after major lung resection at repeated evaluation times . METHODS  FEV(1 ) , Dlco , and peak oxygen consumption ( Vo(2)peak ) calculated using the stair climbing test were measured in 200 patients preoperatively , at discharge , and 1 month and 3 months after lobectomy or pneumonectomy .  Preoperative and repeated postoperative measures were compared , and a time-series , cross-sectional regression analysis was performed to identify factors associated with postoperative Vo(2)peak . RESULTS One month after lobectomy , FEV(1 ) , Dlco , and Vo(2)peak values were 79.5 % , 81.5 % , and 96 % of preoperative values and recovered up to 84 % , 88.5 % , and 97 % after 3 months , respectively . One month after pneumonectomy , FEV(1 ) percentage of predicted , Dlco percentage of predicted , and Vo(2)peak values were 65 % , 75 % , and 87 % of preoperative values , and were 66 % , 80 % , and 89 % after 3 months , respectively . Three months after lobectomy , 27 % of patients with COPD had improved FEV(1 ) , 34 % had improved Dlco , and 43 % had improved Vo(2)peak compared to preoperative values . The time-series , cross-sectional regression analysis showed that postoperative Vo(2)peak values were directly associated with preoperative values of Vo(2)peak , and postoperative values of FEV(1 ) and Dlco , and were inversely associated with age and body mass index . CONCLUSIONS Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome OBJECTIVE To identify predictors of postoperative exercise oxygen desaturation ( EOD ) in patients su bmi tted to lobectomy or pneumonectomy for lung carcinoma . PATIENTS AND METHODS A consecutive series of 227 patients with non-small cell lung cancer su bmi tted to lobectomy or pneumonectomy from January 2000 through October 2002 were prospect ively analyzed . Maximal stair-climbing tests were performed preoperatively ( the day before the operation ) and postoperatively ( on average , 9.2 days after operation ) in room air for all patients . A fall in oxygen saturation during the exercise below 90 % was termed ' desaturation ' . Univariate and multivariate analyses were performed to identify predictors of postoperative EOD . RESULTS Thirty-five patients ( 15.4 % ) developed postoperative EOD . After multivariate analysis , the only independent predictor of postoperative EOD result ed a reduction in oxygen saturation during the preoperative exercise ( P=0.0004 ) . CONCLUSIONS Patients with a reduction in oxygen saturation during the preoperative exercise test are at increased risk to develop a postoperative EOD below 90 % . A postoperative exercise test should be performed in all these patients . Should EOD be confirmed , an intermittent home oxygen therapy is recommended in order to facilitate recovery from operation and improve the quality of life Background : The lower limb muscle strength is an important determinant of physical function in older people . However , measurement in clinical and epidemiological setting s has been limited because of the requirement for large-scale equipment . A protocol using a novel , versatile h and -held dynamometer ( HHD ) has been developed to measure the quadriceps strength in a supine position . Objective : The objective of this study was to assess the validity of this new methodology for measuring the lower limb muscle strength compared to the gold st and ard Biodex dynamometer . Methods : The supine quadriceps strength was measured twice with each of the Biodex and the HHD  in 20 men and women , aged 61–81 years , on their non-dominant leg . The agreement between the peak torques obtained by Biodex and HHD was analyzed . Results : The mean peak Biodex and HHD results were 83.4 ± ( SD ) 28.0 Nm and 68.9 ± 19.6 Nm , respectively . The HHD undermeasured the quadriceps strength by an average of 14.5 Nm ( 95 % CI 8.5 , 20.6 ) compared to the Biodex , and this effect was most marked in the strongest participants . Nevertheless , there was a good correlation between the measures ( r = 0.91 , p < 0.0001 ) . Classification of individuals into tertiles of muscle strength showed good agreement between the two methods ( Kappa = 0.69 , p < 0.0001 ) . Conclusions : Our findings suggest that the HHD using a supine positioning offers a feasible , inexpensive , and portable test of quadriceps muscle strength for use in healthy older people . It underestimates the absolute quadriceps strength compared to the Biodex particularly in stronger people , but is a useful tool for ranking muscle strength of older people in epidemiological studies . It may also be of value for quick and objective assessment of physical function in the clinical setting BACKGROUND The objective of this study was to assess the role of a modified stair climbing test in predicting postoperative cardiopulmonary complications . METHODS A consecutive series of 150 patients who had undergone pulmonary resection for lung carcinoma formed the prospect i ve data base of this study . All patients performed a preoperative modified stair climbing test .  Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications . RESULTS With univariate analysis , the patients with complications had a lower pre-exercise and postexercise percentage of oxygen saturation . PaO ( 2 ) levels were found to be lower and a greater change in oxygen desaturation during exercise was noted . Logistic regression analysis showed that the percent of oxygen saturation pre-exercise and the change in percent of oxygen desaturation during exercise were independent and reliable predictors of cardiopulmonary morbidity . CONCLUSIONS A modified stair climbing test is a safe , economical and simple test capable of predicting cardiopulmonary complications Abstract Background . Patients with lung cancer are often burdened by dyspnoea , fatigue , decreased physical ability and loss of weight . Earlier studies of physical exercise of patients with COPD have shown promising results . The aim of this study was to investigate , if a well-documented COPD rehabilitation protocol can improve physical fitness and quality of life ( QoL ) in patients with lung cancer . Material and methods . Forty-five patients , with a minimum walking distance of 50 meters , absence of cognitive deficits or severe heart disease and motivated for physical training were invited to an exercise intervention .  The intervention consisted of seven weeks of twice weekly training , focusing on walking training , circuit training , h and ling of dyspnoea and instructions in daily diary-based training at home . Prior to , and after the intervention , Incremental- and Endurance Shuttle Walk Test ( ISWT and ESWT ) were performed , and pulmonary function as well as self-reported QoL ( EORTC-QLQ-C30 and LC13 ) were measured . Results . Fourteen subjects dropped out before commencement of the intervention . Seven were excluded after physiotherapeutic evaluation . Of the remaining 24 , three were excluded because of insufficient attendance ( < 65 % of scheduled exercise sessions ) thus 21 patients completed the intervention . For 17 patients with complete pre- and post intervention data , ISWT increased 9 % ( −77 to 39 % ) ( median and range ) ( p = 0.021 ) , while ESWT increased 109 % ( −70 to 432 % ) ( p = 0.002 ) . Twelve of 17 improved in ISWT , while 15 improved in ESWT . No changes in pulmonary function and improvements in QoL were observed . Conclusion . Patients with pulmonary cancer can achieve significant improvements in physical fitness measured with ISWT and ESWT after completion of the intervention program . No changes in pulmonary function and QoL were observed . In addition , we found that a large number of patients dropped out before intervention and that the patients , who succeeded , often discontinued training at home OBJECTIVES Maximum oxygen consumption per min ( VO(₂max ) ) is currently considered the most accurate test for the preoperative risk assessment in patients scheduled for pulmonary resection . Due to its high-technology requirements and cost , VO(₂max ) is performed less frequently than is desired . The objective of this investigation is to determine if the measurement of the basal daily ambulatory activity of the patients , with a pedometer , can be used to predict VO(₂max ) values . METHODS This is a prospect i ve study on 38 patients referred for scheduled lobectomy or pneumonectomy .  Daily basal preoperative activity  of the patients was measured 3 weeks before surgery by means of an OMROM HJ-72OIT-E2 pedometer . Before surgery , VO(₂max ) ( dependent variable ) was calculated using a Master Screen CPX module of Jaeger-Vyasis-Healthcare . The following independent variables were studied : age , sex , preoperative forced expiratory volume in 1s percentage ( FEV1 % ) and carbon monoxide diffusing capacity percentage ( DLCO% ) , mean number of steps per day ( aerobic and non-aerobic ) , mean daily time of aerobic activity ( in min ) and mean daily walked distance ( in km ) . Two linear regression models with bootstrap robust estimation of the st and ard error of the coefficients were adjusted and the estimated values of VO(₂max ) were kept as a new variable for comparison . To avoid collinearity problems , only one of the pedometer records entered the regression model . RESULTS Data of the series ( mean ± SD ) : age 62.8 ± 10.14 years ; FEV1 % 90.1 ± 21.8 ; DLCO% 82.8 ± 20.1 . After collinearity analysis , mean daily walked distance was chosen as the most representative variable . In the first regression model , ' Distance ' ( p = 0.000 ) was highly correlated to the dependent variable ( adjusted R² : 0.812 ) . The second model improved the predictive value of the first one adding DLCO% to the model . In this model , DLCO% ( p = 0.000 ) and ' Distance ' ( p = 0.002 ) were correlated to the dependent variable . The adjusted R² of the second lineal model was 0.935 . CONCLUSION These preliminary data show that a combination of the measured daily ambulatory activity using a pedometer , especially the mean daily walked distance in km , and the DLCO% of the patient could predict the VO(₂max ) value . Larger data series are needed for conclusive results CONTEXT AND OBJECTIVE There is increasing involvement of health professionals in organizing protocol s to determine the impact of lung surgery on functional state and activities of daily living , with the aim of improving quality of life ( QoL ) . The objective of this study was to investigate predictors of QoL improvement among patients undergoing parenchyma resection due to lung cancer . DESIGN AND SETTING Prospect i ve study , at teaching hospital of Universidade Estadual de Campinas ( Unicamp ) . METHODS 36 patients with lung cancer diagnosis were assessed before surgery and on the 30th , 90th and 180th days after surgery . The  Short-Form Health Survey ( SF-36 )  was used as the dependent variable . The independent variables were the  Hospital Anxiety and Depression ( HAD ) scale , a six-minute walking test ( 6-MWT ) , a visual analogue scale for pain , forced vital capacity ( FVC ) , type of surgery and use of radiotherapy and chemotherapy .  Generalized estimation equations ( GEE ) were utilized . RESULTS The median age for these 20 men and 16 women was 55.5 + /- 13.4 years . Both FVC and 6-MWT were predictors of improvement in the physical dimensions of QoL ( p = 0.011 and 0.0003 , respectively ) , as was smaller extent of surgical resection ( p = 0.04 ) . The social component of QoL had improved by the third postoperative month ( p = 0.0005 ) . CONCLUSION The predictors that affected QoL positively were better FVC and 6-MWT results and less extensive lung resection . Three months after the surgery , an improvement in social life was already seen Objectives For the measurement of  patient-reported outcomes , such as ( health-related ) quality of life , often many measurement instruments exist that intend to measure the same construct . To facilitate instrument selection , our aim was to develop a highly sensitive search filter for finding studies on measurement properties of measurement instruments in PubMed and a more precise search filter that needs less abstract s to be screened , but at a higher risk of missing relevant studies . Methods A r and om sample of 10,000 PubMed records ( 01 - 01 - 1990 to 31 - 12 - 2006 ) was used as a gold st and ard . Studies on measurement properties were identified using an exclusion filter and h and search ing . Search terms were selected from the relevant records in the gold st and ard as well as from 100 systematic review s of measurement properties and combined based on sensitivity and precision . The performance of the filters was tested in the gold st and ard as well as in two validation sets , by calculating sensitivity , precision , specificity , and number needed to read . Results We identified 116 studies on measurement properties in the gold st and ard . The sensitive search filter was able to retrieve 113 of these 116 studies ( sensitivity 97.4 % , precision 4.4 % ) . The precise search filter had a sensitivity of 93.1 % and a precision of 9.4 % . Both filters performed very well in the validation sets . Conclusion The use of these search filters will contribute to evidence -based selection of measurement instruments in all medical fields OBJECTIVE Surgery remains the treatment of choice in patients with potentially resectable lung carcinoma . Both the British Thoracic Society and American Chest Physician guidelines for the selection of patients with lung cancer surgery suggest the use of a shuttle walk test to predict outcome in patients with borderline lung function . The guidelines suggest that if the patient is unable to walk 250 m during a shuttle walk test , they are high risk for surgery . However , there is no published evidence to support this recommendation . Therefore , we undertook a prospect i ve study to examine the relationship between shuttle walk test  and surgical outcome in 139 patients undergoing assessment for possible lung cancer surgery . METHODS The shuttle walk test was performed in 139 potentially resectable patients , recruited over a 2 year period , prior to surgery . One hundred and eleven patients underwent surgery . Outcome of surgery , including duration of hospital stay , complication and mortality rates was recorded . Student 's t-test was used to compare the shuttle walk distance in patients with good and poor outcome from surgery . RESULTS Mean age of patients undergoing surgery was 69 years ( 42 - 85 ) .  Mean shuttle walk distance was 395 m ( 145 - 780 ) , with a mean oxygen desaturation of 4 % ( 0 - 14 ) during the test . Sixty nine patients had a good surgical outcome and 34 had a poor outcome . The shuttle walk distance was not statistically different in the two outcome groups . CONCLUSION Shuttle walk distance  should not be used to predict poor surgical outcome in lung cancer patients , contrary to current recommendations . It is therefore advisable to perform a formal cardiopulmonary exercise test if at all possible . The usefulness of a shuttle walk test might be improved . It could be compared to a predicted value , as for a formal cardiopulmonary exercise test AIM To test the predictive value of stairs climbing test for the development of postoperative complications in lung cancer patients with forced expiratory volume in one second (FEV1)<2 L , selected for an elective lung surgery . METHODS The prospect i ve study was conducted in 101 consecutive patients with an FEV1<2 L selected for elective lung surgery for lung cancer . Preoperative examination included medical history and physical examination , lung function testing , electrocardiography , laboratory testing , and chest radiography . All patients underwent stairs climbing with pulse oximetry before the operation with the number of steps climbed and the time to complete the test recorded .  Oxygen saturation and pulse rate were measured every 20 steps . Data on postoperative complications including oxygen use , prolonged mechanical ventilation , and early postoperative mortality were collected . RESULTS Eighty-seven of 101 patients ( 86 % ) had at least one postoperative complication . The type of surgery was significantly associated with postoperative complications ( 25.5 % patients with lobectomy had no early postoperative complications ) , while age , gender , smoking status , postoperative oxygenation , and artificial ventilation were not . There were more postoperative complications in more extensive and serious types of surgery ( P<0.001 ) . The stairs climbing test produced a significant decrease in oxygen saturation ( -1 % ) and increase in pulse rate ( by 10/min ) for every 20 steps climbed . The stairs climbing test was predictive for postoperative complications only in lobectomy group , with the best predictive parameter being the quotient of oxygen saturation after 40 steps and test duration ( positive likelihood ratio [ LR ] , 2.4 ; 95 % confidence interval [ CI ] , 1.71 - 3.38 ; negative LR , 0.53 ; 95 % CI , 0.38 - 0.76 ) . In patients with other types of surgery the only significant predictive parameter for incident severe postoperative complications was the number of days on artificial ventilation ( P=0.006 ) . CONCLUSION Stairs climbing test should be done in routine clinical practice as a st and ard test for risk assessment and prediction of the development of postoperative complications in lung cancer patients selected for elective surgery ( lobectomy ) . Comparative to spirometry , it detects serious disorders in oxygen transport that are a baseline for a later development of cardiopulmonary postoperative complications and mortality in this subgroup of patients Background : Algorithms for the pre-operative evaluation of lung resection c and i date s with impaired lung function invariably include maximum oxygen uptake ( v̇O2MAX ) as a critical parameter of functional reserves , with a v̇O2MAX ≧20 ml/kg/min generally considered sufficient for pneumonectomy . Stair climbing is a low-cost alternative to assess exercise capacity . Objectives : As stair climbing is not st and ardised , we aim ed to compare the altitude reached and the speed of ascent with v̇O2MAX measured by cycle ergometry . Methods : We prospect ively enrolled 44 pulmonary resection c and i date s ( mean age : 47.6 ± 12.5 years ) with an FEV1 < 80 % . Patients were asked to climb as high and as fast as they could , to a maximum elevation of 20 m. The altitude reached and the average speed of ascent were compared to v̇O2MAX . Results : Forty-three patients reached a 20-metre elevation  . Thirteen of them , as well as the patient who did not reach this height , had a v̇O2MAX < 20 ml/kg/min . There was a linear correlation between speed of ascent and v̇O2MAX/kg ( R2 = 0.67 ) , but not between altitude and v̇O2MAX/kg . All 24 patients with a speed ≧15 m/min had a v̇O2MAX ≧20 ml/kg/min . Thirty-nine of 40 patients with a speed ≧12 m/min had a v̇O2MAX ≧15 ml/kg/min . Conclusions : The average speed of ascent  during stair climbing was an accurate semiquantitative predictor of v̇O2MAX/kg , whereas altitude was not . We were able to identify potential cut-off values for lobectomy or pneumonectomy . Pending validation with clinical endpoints , stair climbing may replace formal exercise testing at much lower costs in a large proportion of lung resection c and i date BACKGROUND The objective of this study was to assess the role of a symptom-limited stair climbing test in predicting postoperative cardiopulmonary complications in elderly c and i date s for lung resection . METHODS A consecutive series of 109 patients more than 70 years of age who underwent pulmonary lobectomy for lung carcinoma from January 2000 through May 2003 formed the prospect i ve data base of this study . All patients in the analysis performed a preoperative symptom-limited stair climbing test . Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications . RESULTS At univariate analysis , the patients with complications had a lower forced expiratory capacity percentage of predicted ( p = 0.048 ) , predicted postoperative forced expiratory volume in 1 second percentage of predicted ( p = 0.049 ) , climbed a lower height at preoperative stair climbing test ( p = 0.0004 ) , and presented a greater proportion of cardiac comorbiditiy with respect to the patients without complications ( p = 0.02 ) . After logistic regression analysis , significant predictors of postoperative complications result ed in the presence of a concomitant cardiac disease ( p = 0.04 ) and a low height climbed preoperatively ( p = 0.0015 ) . CONCLUSIONS A symptom-limited stair climbing test was a safe and simple instrument capable of predicting cardiopulmonary complications in the elderly after lung resection Background : The relationship between the shuttle walk test and peak oxygen consumption in patients with lung cancer has not previously been reported . A study was undertaken to examine this relationship in patients referred for lung cancer surgery to test the hypothesis that the shuttle walk test would be useful in this clinical setting . Methods : 125 consecutive patients with potentially operable lung cancer were prospect ively recruited . Each performed same day shuttle walking and treadmill walking tests . Results : Shuttle walk distances ranged from 104 m to 1020 m and peak oxygen consumption ranged from 9 to 35 ml/kg/min . The shuttle walk distance significantly correlated with peak oxygen consumption ( r = 0.67 , p<0.001 ) . All 55 patients who achieved more than 400 m on the shuttle test had a peak oxygen consumption of at least 15 ml/kg/min . Seventy of 125 patients failed to achieve 400 m on the shuttle walk test ; in 22 of these the peak oxygen consumption was less than 15 ml/kg/min . Nine of 17 patients who achieved less than 250 m had a peak oxygen consumption of more than 15 ml/kg/min . Conclusion : The shuttle walk is a useful exercise test to assess potentially operable lung cancer patients with borderline lung function . However , it tends to underestimate exercise capacity at the lower range compared with peak oxygen consumption . Our data suggest that patients achieving 400 m on the shuttle walk test do not require formal measurement of oxygen consumption . In patients failing to achieve this distance we recommend assessment of peak oxygen consumption , particularly in those unable to walk 250 m , because a considerable proportion would still qualify for surgery as they had an acceptable peak oxygen consumption PURPOSE To assess the 6-minute walk test ( 6MWT ) as a predictor of  radiation therapy-induced lung injury ( RTLI ) .  METHODS AND MATERIAL S The 6MWT is a simple , economical , and reproducible test that measures both how far a person can walk in 6 min and any associated changes in vital signs . As part of a prospect i ve trial to study RTLI , a pre-RT 6MWT was performed in 41 patients . The predictive capacities of pre-RT 6MWT , forced expiratory volume in 1 s ( FEV1 ) , and single-breath diffusing capacity for carbon monoxide ( DLCO ) for the development of RTLI were assessed with receiver operating curve ( ROC ) techniques . To evaluate the 6MWT , alone or with mean lung dose ( MLD ) of radiation , as a predictor of RTLI , the rates of RTLI in patient subgroups defined by 6MWT results were compared by using Fisher 's exact test . RESULTS Thirty-one patients with > or =3 months ' follow-up were evaluable . The median baseline 6MWT result was 1400 ft . Of 31 patients , 7 developed Grade > or = 2 RTLI . Of 15 patients with an MLD > 18 Gy ( the median ) , 5 developed RTLI , compared with 2 of 16 with MLD < or = 18 Gy ( p = 0.22 ) . Among those with an MLD < or = 18 Gy , the RTLI rates were 0 of 8 and 2 of 8 for 6MWT results > or = 1400 ft or < 1400 ft , respectively , p = 0.46 . The ROC area under the curve for individual metrics was as follows : FEV1 0.66 , MLD 0.70 , DLCO 0.61 , and 6MWT 0.47 . Combining FEV1 with 6MWT increased the ROC to 0.71 , suggesting that the ratio might be a better predictor than the individual values . Patients with a high 6MWT/FEV1 ratio had a lower rate of RTLI than those with a relatively low ratio . CONCLUSIONS The 6MWT might provide prognostic information beyond pulmonary function tests and dosimetric parameters in predicting RTLI . Additional work is needed to better assess the utility of these functional metrics Studies evaluating predictors of operative outcome for lung resection have focused on physiological measures of cardiorespiratory impairment , but these have proved inadequate . This study evaluated the predictive abilities of six preoperative variables : the global quality of life ( QL ) , social function ( SF ) , and emotional function ( EF ) scales of the European Organization for the Research and Treatment of Cancer 's ( EORTC ) QLQ-C30 question naire , 6-min walk distance ( 6MWD ) , forced expiratory volume ( FEV1 ) , and diffusion capacity ( DLco ) . Operative outcome was represented by the surrogate measure length of stay out of hospital within the first 30 days ( LOSOH ) . A single-centre prospect i ve cohort study evaluating 70 subjects was conducted using multiple regression . LOSOH was bimodally distributed , therefore analysis was undertaken for the entire sample and for two separate groups ( A and B ) . Group B ( n = 4 ) experienced severe complications ( LOSOH = 0–5 days ) and was too small for statistical analysis . Group A ( n = 66 ) suffered fewer and less severe complications ( LOSOH = 14–26 days ) . For the entire sample , age was the sole predictor of LOSOH ( R2 = 0.123 , p = 0.003 ) . In Group A , the strongest predictors of LOSOH were global QL score and 6MWD ( R2 = 0.224 , p < 0.001 ) . LOSOH was inversely correlated with complications . While it remains difficult to predict severe complications in this population , within Group A , health status measures demonstrated a limited ability to predict LOSOH STUDY OBJECTIVE To evaluate the capability of the stair climbing test to predict cardiopulmonary complications after lung resection for lung cancer . DESIGN A prospect i ve cohort of c and i date s for lung resection .  Spirometric assessment and the stair climbing test  were performed the day before operation . Univariate and multivariate analyses were performed to identify predictors of postoperative complications . SETTING Tertiary referral center . PATIENTS A consecutive series of 160 c and i date s for lung resection with lung carcinoma from January 2000 through March 2001 . RESULTS At univariate analysis , the patients with complications were significantly older ( p = 0.02 ) , had a significantly lower FEV(1 ) percentage ( p = 0.007 ) and predicted postoperative FEV(1 ) percentage ( p = 0.01 ) , had a greater incidence of a concomitant cardiac disease ( p = 0.02 ) , climbed a lower altitude at the stair climbing test ( p < 0.0001 ) , and had a lower calculated maximum oxygen consumption ( O(2)max ) [ p = 0.03 ] and predicted postoperative O(2)max ( p = 0.006 ) compared to the patients without complications . At multivariate analysis , the altitude reached at the stair climbing test remained the only significant independent predictor of complications . CONCLUSIONS The stair climbing test is a safe and economical exercise test , and it was the best predictor of cardiopulmonary complications after lung resection BACKGROUND This investigation evaluated whether the performance at a preoperative symptom-limited stair-climbing test was a prognostic factor in resected pathologic stage I non-small cell lung cancer ( NSCLC ) . METHODS Observational analysis was performed on a prospect i ve data base that included 296 patients who underwent pulmonary lobectomy for pathologic stage T1 N0 or T2 N0 NSCLC ( 2000 to 2008 ) . Patients who received induction chemotherapy were excluded . Survival was calculated by the Kaplan-Meyer method . The log-rank test was used to assess differences in survival between groups . The relationships between survival and baseline and clinical variables were determined by Cox multivariate analyses . RESULTS Median follow-up was 43 months . The best cutoff associated with prognosis was an 18-meter stair climb . Median ( months ) survival and 5-year survival of patients who climbed more than 18 meters were significantly longer than those who climbed less than 18 meters ( 97 vs 74 ; 77 % vs 54 % , p=0.001 ) . Cox regression model ( hazard ratio ) showed that climbing more than 18 meters ( 0.5 ; p=0.003 ) , diffusion capacity of the lung for carbon monoxide ( 0.98 ; p=0.02 ) , and pT stage ( 1.8 ; p=0.02 ) were independent prognostic factors . Patients who climbed less than 18 meters had increased deaths from cancer ( 24 % vs 15 % , p=0.1 ) or other causes ( 19 % vs 9 % , p=0.02 ) . CONCLUSIONS Preoperative cardiopulmonary fitness is a significant prognostic factor in patients after resection for early-stage NSCLC . Interventions aim ed at improving exercise tolerance can be useful to improve long-term prognosis after NSCLC operations Patients with lung cancer experience muscle wasting and weakness . Therapeutic exercise may be beneficial but is not always practical . An alternative approach may be neuromuscular electrical stimulation ( NMES ) of the quadriceps muscles , but this has not been formally examined in patients with cancer . Thus , we have undertaken this pilot study to assess feasibility and inform the design of future studies . Sixteen patients were r and omized to receive usual care ( control group ) or usual care plus NMES for four weeks . NMES consisted of daily stimulation to both thighs for up to 30minutes ( frequency 50Hz , " on " cycle 11%-25 % ) . Adherence was assessed by a self-report diary and a semistructured evaluation form . Quadriceps muscle strength , exercise endurance , and free-living physical activity were assessed using a Cybex NORM dynamometer , an endurance shuttle walk test  , and an ActivPAL accelerometer ( mean daily step count ) , respectively . Changes in outcome from baseline were compared between groups by mean differences and their 95 % confidence intervals using independent t-test ( P=0.05 ) . Median ( range ) adherence to the program was 80 % ( 69%-100 % ) . All patients found the NMES device easy to use . Changes in outcome favored the NMES group , with mean differences of 9.4 Nm ( 21 % ) in quadriceps muscle strength , 768 steps ( 15 % ) in free-living activity , and 138 m ( 8 % ) in exercise endurance , but none of the differences were statistically significant . In conclusion , NMES warrants further study in patients with lung cancer BACKGROUND We wanted to determine if cardiopulmonary exercise testing could better identify the threshold where physiologic function is irreparably impaired for patients with borderline pulmonary function who are being considered for lung cancer resection . METHODS We performed an open , prospect i ve preoperative trial and a postoperative outcome evaluation with a combined medical , surgical , and exercise physiology evaluation at three university hospitals . All eligible patients had spirometry , lung volume determination , and quantitative perfusion scanning and performed a cardiopulmonary stress test , stair climbing , and a 12-minute walk for distance .  Functional status was determined with an Eastern Cooperative Oncology Group score , a dyspnea score , and a cardiopulmonary risk index . RESULTS We identified 12 patients who met strict criteria for borderline pulmonary function during a 1-year study period . The mean forced expiratory volume in 1 second ( FEV1 ) was 1.38 L ( 48 % of predicted ) . The mean predicted postoperative FEV1 based on pneumonectomy was 700 mL. Eleven of the patients did the stair climb and 10 passed . All 12 patients achieved a maximum oxygen consumption greater than or equal to 10 mL x kg(-1 ) x min(-1 ) ( mean value , 13.8 mL x kg(-1 ) x min(-1 ) ) . Thirteen operations were performed on the 12 patients . Nine complications occurred in 7 patients . CONCLUSIONS Patients with borderline pulmonary function can undergo resection safely if they have an FEV1 equal to or greater than 1.6 L or 40 % of its predicted value , a predicted postoperative FEV1 of 700 mL or more , a maximum oxygen consumption of 10 mL x kg(-1 ) x min(-1 ) or greater , or stair climbing of three flights or more . Cardiopulmonary stress testing and stair climbing add valuable clinical information for patients with an FEV1 of less than 1.6 Background : The stair-climbing test is commonly used in the preoperative evaluation of lung resection c and i date s , but it is difficult to st and ardize and provides little physiologic information on the performance . Objective : To verify the association between the altitude and the VO2peak measured during the stair-climbing test . Methods : 109 consecutive c and i date s for lung resection performed a  symptom-limited stair-climbing test with direct breath-by-breath measurement of VO2peak by a portable gas analyzer . Stepwise logistic regression and bootstrap analyses were used to verify the association of several perioperative variables with a VO2peak < 15 ml/kg/min . Subsequently , multiple regression analysis was also performed to develop an equation to estimate VO2peak from stair-climbing parameters and other patient-related variables . Results : 56 % of patients climbing < 14 m had a VO2peak < 15 ml/kg/min , whereas 98 % of those climbing > 22 m had a VO2peak > 15 ml/kg/min . The altitude reached at stair-climbing test result ed in the only significant predictor of a VO2peak < 15 ml/kg/min after logistic regression analysis . Multiple regression analysis yielded an equation to estimate VO2peak factoring altitude ( p < 0.0001 ) , speed of ascent ( p = 0.005 ) and body mass index ( p = 0.0008 ) . Conclusions : There was an association between altitude and VO2peak measured during the stair-climbing test . Most of the patients climbing more than 22 m are able to generate high values of VO2peak and can proceed to surgery without any additional tests . All others need to be referred for a formal cardiopulmonary exercise test . In addition , we were able to generate an equation to estimate VO2peak , which could assist in streamlining the preoperative workup and could be used across different setting s to st and ardize this test PURPOSE To assess the utility of the 6-minute walk test ( 6MWT ) as a predictor of  symptomatic radiation-induced pneumonitis ( RP ) .  METHODS As part of a prospect i ve trial to study radiation-induced lung injury , 53 patients receiving thoracic radiotherapy ( RT ) underwent a pre-RT 6MWT , pulmonary function tests ( PFTs ) , and had > or=3-month follow-up for prospect i ve assessment of Grade 2 or worse RP ( requiring medications or worse ) . Dosimetric parameters ( e.g. , the percentage of lung receiving > or=30 Gy ) were extracted from the lung dose-volume histogram . The correlations between the 6MWT and PFT results were assessed using Pearson 's correlation . The receiver operating characteristic technique was used in patient subgroups to evaluate the predictive capacities for RP of the dosimetric parameters , 6MWT results , and PFT results , or the combination ( using discriminant analysis ) of all three metrics . ROCKIT software was used to compare the receiver operating characteristic areas between each predictive model . The association of the decline in 6MWT with the development of RP was evaluated using Fisher 's exact test . RESULTS The pre-RT PFT and 6MWT results correlated weakly ( r = 0.44 - 0.57 , p < or= 0.001 ) , suggesting that they measure somewhat different physiologic functions . Of the 53 patients , 9 ( 17 % ) developed RP . The dose-volume histogram-based dosimetric parameters were the best single-metric model for predicting RP ( e.g. , percentage of lung receiving > or=30 Gy , receiver operating characteristic area 0.73 , p = 0.03 ) . Including the PFT or 6MWT results with the percentage of lung receiving > or=30 Gy did not improve the predictions . The predictive abilities of dosimetric-based models improved when the analysis was restricted to those patients whose tumors were not causing regional lung dysfunction . No correlation was found between the decline in the 6MWT result and the RP rate ( p = 0.6 ) . CONCLUSION Although the PFTs and 6MWT are related to each other , the correlation coefficients were weak , suggesting that they could be measuring different physiologic functions . In the present data set , the addition of the PFTs or 6MWT did not increase the ability of the dosimetric parameters to predict for acute symptomatic RP . Additional work is needed to better underst and the interaction among the PFT results , exercise tolerance ( 6MWT ) , and the risk of RT-induced  lung dysfunction
target: Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness .
background: Background The measurement properties of instruments used to assess functional capacity , physical activity and muscle strength in participants with non-small cell lung cancer ( NSCLC ) have not been systematic ally review ed .
  Method Objectives : To identify outcome measures used to assess these outcomes in participants with NSCLC ; and to evaluate , synthesis e and compare the measurement properties of the outcome measures identified .