Petersen MR1, Ragle A-M1, Østergren PB2, Vinther A1,3
1Copenhagen University Hospital, Herlev and Gentofte, Department of Physiotherapy and Occupational Therapy, Copenhagen, Denmark, 2Copenhagen University Hospital, Herlev and Gentofte, Department of Urology, Copenhagen, Denmark, 3Copenhagen University Hospital, Herlev and Gentofte, QD-Research Unit, Copenhagen, Denmark
Background: Current European guidelines recommend all men with prostate cancer undergoing androgen deprivation therapy (ADT) to be offered 12 weeks of supervised combined aerobic and resistance training in order to mitigate treatment related adverse effects that include: Fatigue, decreased muscle strength and physical fitness and an increased risk of developing type 2 diabetes and cardiovascular events. Graded Cycling Test with Talk Test (GCT-TT) and 30-second chair-stand test (30s-CST) are easily performed tests to monitor exercise effect in clinical practice. However, knowledge of the reliability of these tests are necessary to determine if a measured effect can be considered as a real improvement.
Purpose: To investigate the absolute and relative reliability of “Graded Cycling Test with Talk Test” (GCT-TT) and “30-second chair-stand test” (30s-CST) in patients with advanced prostate cancer.
Methods: The study was a test-retest study including 60 men with prostate cancer undergoing ADT. Age: 70.2±6.5 (mean±SD) years. GCT-TT and then, following a short break, 30s-CST were performed and again repeated with a one hour break between test sessions. All tests were conducted by two experienced physiotherapists. Only intra-tester reliability was investigated as the test and re-test of each participant was always performed by the same physiotherapist. Intraclass Correlation Coefficient (ICC2.1), Standard Error of Measurement with 95% Security (SEM95) and Smallest Real Difference (SRD) was calculated.
Results: All 60 participants performed 30s-CST twice without any problems. Two participants were excluded from the analysis of the GCT-TT results. One stopped the test due to discomfort and one was an extreme outlier (133% improvement from test 1 to test 2).
Relative reliability for 30s-CST (ICC2.1) was 0.97 [95% CI: 0.94-0.98] with low measurement error: SEM95: 1.9 repetitions and SRD: 2.6 repetitions. The corresponding results for GCT-TT were: ICC2.1: 0.90 [95% CI: 0.84-0.94], SEM95: 19.9 Watt and SRD: 28.2 Watt.
Conclusion(s): The reliability of 30s-CST and GCT-TT is substantial for men with prostate cancer undergoing ADT. Overall, an average improvement of 1.9 repetitions in the 30s-CST on a group level and three repetitions on an individual level is considered a relevant improvement.
An improvement exceeding 19.9 watts in the GCT-TT represents a real improvement for a group of patients. Individual patients need to improve two steps (30 watts) to achieve a real change.
Implications: 30-second chair-stand test and Graded Cycling Test with Talk Test can be used to measure the effect of exercise in in men with prostate cancer receiving ADT reliably. The measurement error of both tests is sufficiently low to provide a sensitive measure of fitness and lower extremity function for groups as well as individual patients. This is important in future research but most of all for current clinical practice as an increasing number of these patients are offered exercise interventions to ameliorate the potentially debilitating side effects of the testosterone-lowering treatment. The motivational effect of being able to confidently tell your patients that they achieved an improvement cannot be underestimated.
Keywords: Reliability, exercise testing, prostate cancer
Funding acknowledgements: PROTERAPI A/S has kindly lent the stationary bicycle.
Purpose: To investigate the absolute and relative reliability of “Graded Cycling Test with Talk Test” (GCT-TT) and “30-second chair-stand test” (30s-CST) in patients with advanced prostate cancer.
Methods: The study was a test-retest study including 60 men with prostate cancer undergoing ADT. Age: 70.2±6.5 (mean±SD) years. GCT-TT and then, following a short break, 30s-CST were performed and again repeated with a one hour break between test sessions. All tests were conducted by two experienced physiotherapists. Only intra-tester reliability was investigated as the test and re-test of each participant was always performed by the same physiotherapist. Intraclass Correlation Coefficient (ICC2.1), Standard Error of Measurement with 95% Security (SEM95) and Smallest Real Difference (SRD) was calculated.
Results: All 60 participants performed 30s-CST twice without any problems. Two participants were excluded from the analysis of the GCT-TT results. One stopped the test due to discomfort and one was an extreme outlier (133% improvement from test 1 to test 2).
Relative reliability for 30s-CST (ICC2.1) was 0.97 [95% CI: 0.94-0.98] with low measurement error: SEM95: 1.9 repetitions and SRD: 2.6 repetitions. The corresponding results for GCT-TT were: ICC2.1: 0.90 [95% CI: 0.84-0.94], SEM95: 19.9 Watt and SRD: 28.2 Watt.
Conclusion(s): The reliability of 30s-CST and GCT-TT is substantial for men with prostate cancer undergoing ADT. Overall, an average improvement of 1.9 repetitions in the 30s-CST on a group level and three repetitions on an individual level is considered a relevant improvement.
An improvement exceeding 19.9 watts in the GCT-TT represents a real improvement for a group of patients. Individual patients need to improve two steps (30 watts) to achieve a real change.
Implications: 30-second chair-stand test and Graded Cycling Test with Talk Test can be used to measure the effect of exercise in in men with prostate cancer receiving ADT reliably. The measurement error of both tests is sufficiently low to provide a sensitive measure of fitness and lower extremity function for groups as well as individual patients. This is important in future research but most of all for current clinical practice as an increasing number of these patients are offered exercise interventions to ameliorate the potentially debilitating side effects of the testosterone-lowering treatment. The motivational effect of being able to confidently tell your patients that they achieved an improvement cannot be underestimated.
Keywords: Reliability, exercise testing, prostate cancer
Funding acknowledgements: PROTERAPI A/S has kindly lent the stationary bicycle.
Topic: Oncology, HIV & palliative care; Outcome measurement
Ethics approval required: Yes
Institution: The National Committee on Health Research Ethics
Ethics committee: The Research Ethics Commitee in the Capital Region of Denmark
Ethics number: ID: 16037056
All authors, affiliations and abstracts have been published as submitted.
