Table 1.
Overview of Commonly Used Aerobic Exercise Testing Modalities
| CPET | Maximal and Submaximal | 6MWT | 1RM | Multiple-Repetition Maximum | Hand-Grip Dynamometry | |
|---|---|---|---|---|---|---|
| Test description | 8- to 12-min exercise test on a bicycle or treadmill in which the load or speed is progressively increased until maximal criteria are reached, coupled with automated gas exchange systems to obtain Vo2peak | 3- to 12-min exercise test on a bicycle or treadmill in which the load or speed is progressively increased until maximal criteria are reached (or 85% of age-predicted maximum heart rate for submaximal test) METs or Vo2peak is estimated using prediction equations based on achieved treadmill speed/grade and duration or the peak cycle ergometer workload (watts). |
Measures distance covered during 6 min of walking in a 100-ft hallway103 | Maximal amount of weight lifted in one repetition following a series of sets to progress the weight to the maximal capacity | Maximal amount of weight lifted a predefined number of repetitions (eg, 8, 10) with good technique Maximal strength estimated using prediction equations |
Maximal amount of force or average maximum force generated bilaterally over three trials |
| Outcome | Linear metric from <15 mL O2/kg/min (poor) to >95 ml O2/kg/min (endurance trained) | Linear metric from 1 MET (poor) to >16 METs (endurance trained) | Linear metric from <100 m (poor) to >700 m (excellent) | Linear metric from 0 to >500 lb depending on muscle group and exercise performed | Linear metric from 0 to >500 lb depending on muscle group and exercise performed | Linear metric from 0 to >200 lb (age- and sex-based norm-defined ratings) |
| Limitations | Requires advanced equipment and trained personnel | Maximal: requires advanced equipment and trained personnel Submaximal: estimated Vo2peak equations derived from healthy, nononcologic populations |
Ceiling effects | Requires advanced equipment and trained personnel | Requires advanced equipment and trained personnel | Requires specialized equipment |
| Reliability and validity | ++ (cancer: prostate)104 | − | ++ (noncancer)34 | +++ (noncancer)105,106 | + (cancer: breast)38 | +++ (noncancer)107 + (cancer: breast)108 |
| Proof of concept | +++ (noncancer)109 + (cancer: lung)110 |
Maximal: ++ (cancer: mixed)17 Submaximal: + |
++ (cancer: lung)31 | + (cancer: cachexia)111 | − | +++ (noncancer)40 + (cancer: advanced, malnourished)112,113 |
| Prospective validation | ++ (cancer: lung, colorectal, Hodgkin’s)21,22 | − | ++ (cancer: glioma)114 | + (cancer: mixed)36 | − | +++ (noncancer)40 ++ (cancer: GI, lung, cachexia, advanced)41, 42, 43, 44,115,116 |
| Incremental value | ++ (cancer: breast, colorectal)21,110,117 | − | + (cancer: glioma)118 | + (cancer: mixed)36 | − | +++ (noncancer: all-cause mortality, CVD mortality, CVD incidence)119 ± (lung)42,120 |
| Clinical utility | ++ (lung)121 − (other) |
− | − | − | − | − |
| Modifiable | +++ (cancer: mixed, lung)46,122 | ++ (cancer: mixed)46 | ++ (cancer: mixed)123 | +++ (cancer: mixed)45 | +++ (cancer: mixed)45 | +++ (cancer: mixed)45 |
| Ease of use | − (noncancer)25 | Maximal: + Submaximal: ++ |
+++ | − | − | +++ |
| Normative values | +++ (noncancer)16 | +++ (noncancer)103 | +++ (noncancer)103 | + (noncancer)37 | − | + (cancer: advanced)39 |
| Setting | Primary, secondary, tertiary | Primary, secondary, tertiary | Tertiary, certain primary and secondary | Primary, secondary, tertiary | Primary, secondary, tertiary | Primary, secondary, tertiary |
| Patient population | Any | Any | Inoperable Undergoing treatment Frail, elderly Skeletal myopathy Respiratory limitation |
Any | Any | Any |
| Test purpose | Prognostication, guiding exercise training | Prognostication, guiding exercise training | Prognostication | Prognostication, guiding exercise training | Prognostication, guiding exercise training | Prognostication |
Table adapted from Wagner et al.124 Reliability and validity: Has the test demonstrated reliability and validity? Proof of concept: Does the variable differ between patients with and without adverse outcomes? Prospective validation: Can the variable predict future outcomes in a prospective cohort? Incremental value: Does the variable add predictive value over and above standard, clinically established risk markers? Clinical utility: Does the variable change predicted risk sufficiently to modify recommended therapy? Modifiable: Does the variable change with intervention? Ease of use: Is the assessment widely applicable? Reference values: Are published reference values available?
1RM = 1-repetition maximum; 6MWT = six-minute walk test; CPET = cardiopulmonary exercise testing; CVD = cardiovascular disease; GI = gastrointestinal; Vo2peak = maximal oxygen consumption; + = minimal requirements of criteria met, small evidence base; ++ = criteria met, moderate evidence base; +++ = criteria fully met, large evidence base; − = criteria not met or no evidence.