WS01.02 the current state of play regarding exercise testing in cystic fibrosis: co-development with the community

Saynor, Z.L., Gruet, M., Mcnarry, M.A., Button, B., Morrison, L., Wagner, M., Sawyer, A., Hebestreit, H., Stanford, G.E., Radtke, T. and Urquhart, D.S. (2023) WS01.02 the current state of play regarding exercise testing in cystic fibrosis: co-development with the community. Journal of Cystic Fibrosis, 22 (Suppl. 2), S2. (doi:10.1016/S1569-1993(23)00188-1).

Abstract

Objectives: functional exercise testing of people with cystic fibrosis (CF) in clinical practice still lacks global standardisation in both choice of test and test conduct. A representative group from the European CF Society Exercise Working Group (ECFS-EWG), including members from the Physiotherapy Special Interest Group (PhySIG), are aiming to develop guidance and standard operating procedures for an agreed selection of exercise tests, that allow for the comprehensive functional evaluation of people with CF.

Methods: to facilitate test recommendations, an international panel (n = 64; 81.3% Europe), comprising physicians (5%), exercise scientists (14%), physiotherapists (78%), physiotherapy assistants and fitness instructors (3%), were consulted to obtain a snapshot of current practice.

Results: in the last two years, 90.6% of respondents reported using exercise tests, the most common of which were the 6-minute walk test (6 MWT; 79.4%), cycle ergometer cardiopulmonary exercise testing with gas analysis (CPET, 52.4%), the 1-minute sit-to-stand test (1 minSTS; 39.7%), cycle ergometer tests without gas analysis (30.2%) and the 15-level 10-m modified shuttle test (28.6%). When asked to rank exercise tests (excluding the accepted gold standard CPET) based on perceptions of those most rigorously validated, the top 5 were: 1) cycle ergometer tests without gas analysis, 2) treadmill tests without gas analysis, 3) 6 MWT, 4) 1 minSTS and 5) the A-step test.

Conclusions: this multidisciplinary panel has aided the construction of a hierarchy of the most-used and best-validated exercise tests for people with CF. The high rate of utilisation of the 6 MWT, even in mild CF disease where a ceiling effect can be observed, highlights the need for better guidance regarding the other simple alternatives to CPET when evaluating the functional capacity of people with CF. Peripheral muscle testing is rarely used and more research is needed to determine the clinimetric properties of tests.

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Contributors

Author: Z.L. Saynor

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