Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years

CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network

doi:10.1016/j.chest.2020.06.074

Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years

CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network

Medicine

Résultat de recherche: Article › examen par les pairs

35 Citations (Scopus)

Résumé

Background: Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings. Research Question: This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses. Study Design and Methods: Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations. Results: Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher. Interpretation: This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.

Langue d'origine	English
Pages (de-à)	2532-2545
Nombre de pages	14
Journal	Chest
Volume	158
Numéro de publication	6
DOI	https://doi.org/10.1016/j.chest.2020.06.074
Statut de publication	Published - déc. 2020

Note bibliographique

Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: H. L. reports personal fees for consulting Boehringer Ingelheim. outside of the submitted work. D. D. M. reports grants from CIHR, grants from McGill University, during the conduct of the study. J. B. holds a GlaxoSmithKline (GSK)/CIHR Research Chair on Better Understanding of COPD and Intervention Guides at McGill University and reports other from GlaxoSmithKline, during the conduct of the study; grants from CIHR, grants from Canadian Respiratory Research Network (CRRN), personal fees from Canadian Thoracic Society, personal fees from CHEST, grants from Foundation of the MUHC, grants from Aerocrine, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Grifols, grants and personal fees from GlaxoSmithKline, grants and personal fees from Novartis, grants and personal fees from Trudell, outside the submitted work. J. A. G. was supported by a Scholar Award from the Michael Smith Foundation for Health Research and a Clinical Rehabilitation New Investigator Award from the Canadian Institutes of Health Research and reports grants from Boehringer Ingelheim and personal fees from Agartee Technology Inc, outside of the submitted work. D. E. O. reports grants from AstraZeneca and Boehringer Ingelheim, personal fees from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKlein, outside of the submitted work. B. M. S. is supported by Quebec Health Research Fund, Canadian Institutes of Health Research, National Institutes of Health (USA), Respiratory Health Network of Quebec, Quebec Lung Association and reports grants from NIH, CIHR, AstraZeneca (investigator initiated), the Quebec Health Research Fund, and the Quebec Lung Association. W. C. T. reports grants from Canadian Institute of Heath Research (CIHR/Rx&D Collaborative Research Program Operating Grants- 93326) with industry partners Astra Zeneca Canada Ltd., Boehringer-Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Merck, Novartis Pharma Canada Inc, Nycomed Canada Inc, Pfizer Canada Ltd, during the conduct of the study. F. M. holds a GSK/CIHR Research Chair on COPD at Université Laval; reports grants from AstraZeneca and GlaxoSmithKline, Boehringer Ingelheim, GSK, Sanofi, and Novartis during the conduct of this study; reports personal fees for serving on speaker bureaus and consultation panels from Boehringer Ingelheim, Grifols, and Novartis outside the submitted work; and is involved financially with Oxynov, a company that is developing an oxygen delivery system. D. J. holds a Canada Research Chair in Clinical Exercise & Respiratory Physiology (Tier 2) from the CIHR and reports grants and personal fees for consulting from Boehringer Ingelheim during the conduct of the study, grants and personal fees from AstraZeneca, grants from Boehringer Ingelheim, grants from Novartis, and grants from Tilray, outside the submitted work. None disclosed (A. B., M. K. S.).

Funding Information:
Other contributions: The authors acknowledge the work done by Desi Fuhr who helped collate data, which formed part of the validation cohort of the current study. H. L. was supported by an Endeavour Research Fellowship by the Department of Education and Training, Australia and a Fonds de Recherche du Québec Santé (FRQS) Postdoctoral Training Fellowship.

Funding Information:
FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD; NCT00920348) is currently funded by the Canadian Respiratory Research Network, the Canadian Institutes of Health Research (CIHR; CIHR/Rx&D Collaborative Research Program Operating Grants- 93326), and the industry partners AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline (GSK) Canada Ltd, and Novartis. Previous funding partners were the Respiratory Health Network of the Fonds de la recherche en santé du Québec (FRQS), the Foundation of the McGill University Health Centre, and industry partners: Almirall; Merck , Nycomed; Pfizer Canada Ltd; and Theratechnologies.

Publisher Copyright:
© 2020 American College of Chest Physicians

ASJC Scopus Subject Areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

PubMed: MeSH publication types

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

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10.1016/j.chest.2020.06.074

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@article{4844921693aa4a1fa7bd44f9fe65c40c,

title = "Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years",

abstract = "Background: Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings. Research Question: This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses. Study Design and Methods: Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations. Results: Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher. Interpretation: This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.",

author = "{CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network} and Hayley Lewthwaite and Andrea Benedetti and Stickland, {Michael K.} and Jean Bourbeau and Guenette, {Jordan A.} and Francoic Maltais and Marciniuk, {Dacy D.} and O'Donnell, {Denis E.} and Smith, {Benjamin M.} and Tan, {Wan C.} and Dennis Jensen and AaronK, {S. E.} and R. Chapman and P. Hernandez and Sin, {D. D.} and B. Walker",

note = "Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: H. L. reports personal fees for consulting Boehringer Ingelheim. outside of the submitted work. D. D. M. reports grants from CIHR, grants from McGill University, during the conduct of the study. J. B. holds a GlaxoSmithKline (GSK)/CIHR Research Chair on Better Understanding of COPD and Intervention Guides at McGill University and reports other from GlaxoSmithKline, during the conduct of the study; grants from CIHR, grants from Canadian Respiratory Research Network (CRRN), personal fees from Canadian Thoracic Society, personal fees from CHEST, grants from Foundation of the MUHC, grants from Aerocrine, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Grifols, grants and personal fees from GlaxoSmithKline, grants and personal fees from Novartis, grants and personal fees from Trudell, outside the submitted work. J. A. G. was supported by a Scholar Award from the Michael Smith Foundation for Health Research and a Clinical Rehabilitation New Investigator Award from the Canadian Institutes of Health Research and reports grants from Boehringer Ingelheim and personal fees from Agartee Technology Inc, outside of the submitted work. D. E. O. reports grants from AstraZeneca and Boehringer Ingelheim, personal fees from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKlein, outside of the submitted work. B. M. S. is supported by Quebec Health Research Fund, Canadian Institutes of Health Research, National Institutes of Health (USA), Respiratory Health Network of Quebec, Quebec Lung Association and reports grants from NIH, CIHR, AstraZeneca (investigator initiated), the Quebec Health Research Fund, and the Quebec Lung Association. W. C. T. reports grants from Canadian Institute of Heath Research (CIHR/Rx&D Collaborative Research Program Operating Grants- 93326) with industry partners Astra Zeneca Canada Ltd., Boehringer-Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Merck, Novartis Pharma Canada Inc, Nycomed Canada Inc, Pfizer Canada Ltd, during the conduct of the study. F. M. holds a GSK/CIHR Research Chair on COPD at Universit{\'e} Laval; reports grants from AstraZeneca and GlaxoSmithKline, Boehringer Ingelheim, GSK, Sanofi, and Novartis during the conduct of this study; reports personal fees for serving on speaker bureaus and consultation panels from Boehringer Ingelheim, Grifols, and Novartis outside the submitted work; and is involved financially with Oxynov, a company that is developing an oxygen delivery system. D. J. holds a Canada Research Chair in Clinical Exercise & Respiratory Physiology (Tier 2) from the CIHR and reports grants and personal fees for consulting from Boehringer Ingelheim during the conduct of the study, grants and personal fees from AstraZeneca, grants from Boehringer Ingelheim, grants from Novartis, and grants from Tilray, outside the submitted work. None disclosed (A. B., M. K. S.). Funding Information: Other contributions: The authors acknowledge the work done by Desi Fuhr who helped collate data, which formed part of the validation cohort of the current study. H. L. was supported by an Endeavour Research Fellowship by the Department of Education and Training, Australia and a Fonds de Recherche du Qu{\'e}bec Sant{\'e} (FRQS) Postdoctoral Training Fellowship. Funding Information: FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD; NCT00920348) is currently funded by the Canadian Respiratory Research Network, the Canadian Institutes of Health Research (CIHR; CIHR/Rx&D Collaborative Research Program Operating Grants- 93326), and the industry partners AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline (GSK) Canada Ltd, and Novartis. Previous funding partners were the Respiratory Health Network of the Fonds de la recherche en sant{\'e} du Qu{\'e}bec (FRQS), the Foundation of the McGill University Health Centre, and industry partners: Almirall; Merck , Nycomed; Pfizer Canada Ltd; and Theratechnologies. Publisher Copyright: {\textcopyright} 2020 American College of Chest Physicians",

year = "2020",

month = dec,

doi = "10.1016/j.chest.2020.06.074",

language = "English",

volume = "158",

pages = "2532--2545",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "6",

}

TY - JOUR

T1 - Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years

AU - CanCOLD Collaborative Research Group and the Canadian Respiratory Research Network

AU - Lewthwaite, Hayley

AU - Benedetti, Andrea

AU - Stickland, Michael K.

AU - Bourbeau, Jean

AU - Guenette, Jordan A.

AU - Maltais, Francoic

AU - Marciniuk, Dacy D.

AU - O'Donnell, Denis E.

AU - Smith, Benjamin M.

AU - Tan, Wan C.

AU - Jensen, Dennis

AU - AaronK, S. E.

AU - Chapman, R.

AU - Hernandez, P.

AU - Sin, D. D.

AU - Walker, B.

N1 - Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: H. L. reports personal fees for consulting Boehringer Ingelheim. outside of the submitted work. D. D. M. reports grants from CIHR, grants from McGill University, during the conduct of the study. J. B. holds a GlaxoSmithKline (GSK)/CIHR Research Chair on Better Understanding of COPD and Intervention Guides at McGill University and reports other from GlaxoSmithKline, during the conduct of the study; grants from CIHR, grants from Canadian Respiratory Research Network (CRRN), personal fees from Canadian Thoracic Society, personal fees from CHEST, grants from Foundation of the MUHC, grants from Aerocrine, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, grants and personal fees from Grifols, grants and personal fees from GlaxoSmithKline, grants and personal fees from Novartis, grants and personal fees from Trudell, outside the submitted work. J. A. G. was supported by a Scholar Award from the Michael Smith Foundation for Health Research and a Clinical Rehabilitation New Investigator Award from the Canadian Institutes of Health Research and reports grants from Boehringer Ingelheim and personal fees from Agartee Technology Inc, outside of the submitted work. D. E. O. reports grants from AstraZeneca and Boehringer Ingelheim, personal fees from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKlein, outside of the submitted work. B. M. S. is supported by Quebec Health Research Fund, Canadian Institutes of Health Research, National Institutes of Health (USA), Respiratory Health Network of Quebec, Quebec Lung Association and reports grants from NIH, CIHR, AstraZeneca (investigator initiated), the Quebec Health Research Fund, and the Quebec Lung Association. W. C. T. reports grants from Canadian Institute of Heath Research (CIHR/Rx&D Collaborative Research Program Operating Grants- 93326) with industry partners Astra Zeneca Canada Ltd., Boehringer-Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Merck, Novartis Pharma Canada Inc, Nycomed Canada Inc, Pfizer Canada Ltd, during the conduct of the study. F. M. holds a GSK/CIHR Research Chair on COPD at Université Laval; reports grants from AstraZeneca and GlaxoSmithKline, Boehringer Ingelheim, GSK, Sanofi, and Novartis during the conduct of this study; reports personal fees for serving on speaker bureaus and consultation panels from Boehringer Ingelheim, Grifols, and Novartis outside the submitted work; and is involved financially with Oxynov, a company that is developing an oxygen delivery system. D. J. holds a Canada Research Chair in Clinical Exercise & Respiratory Physiology (Tier 2) from the CIHR and reports grants and personal fees for consulting from Boehringer Ingelheim during the conduct of the study, grants and personal fees from AstraZeneca, grants from Boehringer Ingelheim, grants from Novartis, and grants from Tilray, outside the submitted work. None disclosed (A. B., M. K. S.). Funding Information: Other contributions: The authors acknowledge the work done by Desi Fuhr who helped collate data, which formed part of the validation cohort of the current study. H. L. was supported by an Endeavour Research Fellowship by the Department of Education and Training, Australia and a Fonds de Recherche du Québec Santé (FRQS) Postdoctoral Training Fellowship. Funding Information: FUNDING/SUPPORT: The Canadian Cohort Obstructive Lung Disease (CanCOLD; NCT00920348) is currently funded by the Canadian Respiratory Research Network, the Canadian Institutes of Health Research (CIHR; CIHR/Rx&D Collaborative Research Program Operating Grants- 93326), and the industry partners AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline (GSK) Canada Ltd, and Novartis. Previous funding partners were the Respiratory Health Network of the Fonds de la recherche en santé du Québec (FRQS), the Foundation of the McGill University Health Centre, and industry partners: Almirall; Merck , Nycomed; Pfizer Canada Ltd; and Theratechnologies. Publisher Copyright: © 2020 American College of Chest Physicians

PY - 2020/12

Y1 - 2020/12

N2 - Background: Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings. Research Question: This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses. Study Design and Methods: Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations. Results: Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher. Interpretation: This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.

AB - Background: Up-to-date normative reference sets for cardiopulmonary exercise testing (CPET) are important to aid in the accurate interpretation of CPET in clinical or research settings. Research Question: This study aimed to (1) develop and externally validate a contemporary reference set for peak CPET responses in Canadian adults identified with population-based sampling; and (2) evaluate previously recommended reference equations for predicting peak CPET responses. Study Design and Methods: Participants were healthy adults who were ≥40 years old from the Canadian Cohort Obstructive Lung Disease who completed an incremental cycle CPET. Prediction models for peak CPET responses were estimated from readily available participant characteristics (age, sex, height, body mass) with the use of quantile regression. External validation was performed with a second convenience sample of healthy adults. Peak CPET parameters that were measured and predicted in the validation cohort were assessed for equivalence (two one-sided tests of equivalence for paired-samples and level of agreement (Bland-Altman analyses). Two one-sided tests of equivalence for paired samples assessed differences between responses in the derivation cohort using previously recommended reference equations. Results: Normative reference ranges (5th-95th percentiles) for 28 peak CPET parameters and prediction models for 8 peak CPET parameters were based on 173 participants (47% male) who were 64 ± 10 years old. In the validation cohort (n = 84), peak CPET responses that were predicted with the newly generated models were equivalent to the measured values. Peak cardiac parameters predicted by the previously recommended reference equations by Jones and colleagues and Hansen and colleagues were significantly higher. Interpretation: This study provides reference ranges and prediction models for peak cardiac, ventilatory, operating lung volume, gas exchange, and symptom responses to incremental CPET and presents the most comprehensive reference set to date in Canadian adults who were ≥40 years old to be identified with population-based sampling.

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Normative Peak Cardiopulmonary Exercise Test Responses in Canadian Adults Aged ≥40 Years

Résumé

Note bibliographique

ASJC Scopus Subject Areas

PubMed: MeSH publication types

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