Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis

Buran, Melike Mese; Savci, Sema; Tanriverdi, Aylin; Kahraman, Buse Ozcan; Gunduz, Damla; Sevinc, Can

doi:10.36416/1806-3756/e20230230

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ORIGINAL ARTICLE • J. bras. pneumol. 50 (1) • 2024 • https://doi.org/10.36416/1806-3756/e20230230 copy

Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

This study primarily aimed to investigate the clinical determinants of the Modified Incremental Step Test (MIST) in adults with non-cystic fibrosis bronchiectasis (NCFB). A secondary objective was to compare the cardiopulmonary responses after the MIST and Incremental Shuttle Walk Test (ISWT), two commonly adopted symptom-limited maximum field tests in chronic respiratory diseases.

Methods:

Forty-six patients with clinically stable bronchiectasis participated in this cross-sectional study. MIST and ISWT were performed to determine exercise capacity, while disease severity, fatigue, and quality of life were assessed using the Bronchiectasis Severity Index (BSI), the Fatigue Severity Scale (FSS), and St. George’s Respiratory Questionnaire (SGRQ), respectively. Quadriceps muscle strength was evaluated using a hand-held dynamometer, walking speed with a wireless inertial sensing device, and the level of physical activity (steps/day) with a pedometer.

Results:

The BSI score, quadriceps muscle strength, daily step count, and the SGRQ total score explained 61.9% of the variance in the MIST (p < 0.001, R² = 0.67, AR² = 0.619). The BSI score (r = -0.412, p = 0.004), quadriceps muscle strength (r = 0.574, p = 0.001), daily step count (r = 0.523, p < 0.001), walking speed (r = 0.402, p = 0.006), FSS score (r = -0.551, p < 0.001), and SGRQ total score (r = -0.570, p < 0.001) correlated with the MIST. The patients achieved higher heart rates (HR), HR%, desaturation, dyspnea, and leg fatigue in the MIST compared to the ISWT (p < 0.05).

Conclusions:

Disease severity, quadriceps muscle strength, physical activity level, and quality of life were determinants of MIST. The advantages of the MIST, including higher cardiopulmonary response than ISWT and greater portability, which facilitates its use in various settings, make MIST the preferred choice for investigating symptom-limited exercise capacity in patients with NCFB.

Keywords:
bronchiectasis; exercise capacity; step test; physical activity; walking speed; quality of life

Variables	Mean (SD)	Range
Age (years)	59.30 (7.72)	41 - 74
Body weight (kg)	73.98 (12.59)	48 - 97
Body mass index (kg/m²)	27.93 (4.41)	20.20 - 37.90
Fat-free mass (kg)	51.12 (10.29)	30.80 - 74.40
Disease duration (years)	13.43 (11.36)	1 - 50
Smoking history (pack-years)	10.28 (21.25)	0 - 120
Etiology, n (%)
Idiopathic	16 (35)	-
Post-infectious problems	12 (27)	-
Autoimmune diseases	9 (19)	-
Respiratory disease (asthma, COPD) Other reasons (toxic inhalation) Medication use, n (%) Inhaled bronchodilator Inhaled corticosteroid Mucolytics Antihypertensive Glucose-lowering medication Lipid-modifying medication	9 (19) 21 (45.65) 7 (15.21) 4 (8.69) 10 (21.73) 4 (8.69) 2 (4.34)	- - - - - - -
FEV1 (pred%)	75.58 (19.13)	27 - 110
FVC (pred%)	81.04 (17.89)	41 - 118
MRC score	1.71 (0.54)	1 - 3
BSI score	4.5 (2.68)	2 - 12
8-m gait speed (m/s)	1.16 (0.16)	0.86 - 1.63
Quadriceps (N)	122.54 (24.46)	77.47 -180.44
Number of steps (steps/day)	6,418.74 (2,225.30)	2,813.00 -11,479.00
Walking distance (km/day)	3.94 (1.58)	1.54 - 7.48
Energy expenditure (kcal/day)	260.16 (117.76)	92.94 -626.47
Total physical activity duration (min/day)	67.8 (21.00)	31.2 - 112.8
Fatigue Severity Scale score	5.45 (3.22)	2.25 - 12.75
SGRQ total	32.36 (12.40)	9.36 - 63.67
SGRQ symptom	40.86 (16.53)	0.00 - 76.23
SGRQ activity	44.02 (15.79)	11.16 - 79.79
SGRQ impact	22.51 (14.28)	4.51 - 64.09

Variables	MIST NOSs
Variables	r	P
Age (years)	-0.290†	0.050
Gender	0.008‡	0.957
Height (m)	0.137†	0.364
Body weight (kg)	0.100†	0.508
Body mass index (kg/m²)	0.024†	0.873
Fat-free mass (kg)	0.195†	0.195
Disease duration (years)	-0.193‡	0.198
Smoking history (pack-years)	0.092‡	0.542
FEV1 (pred%)	0.456†	0.001*
FVC (pred%)	0.403†	0.005*
BSI score	-0.412 ‡	0.004*
ISWT distance (m)	0.788†	<0.001*
8-m gait speed (m/s)	0.402†	0.006*
Quadriceps (N)	0.574†	<0.001*
Number of steps (steps/day)	0.523†	<0.001*
Walking distance (km/day)	0.629†	<0.001*
Energy expenditure (kcal/day)	0.528†	<0.001*
Total physical activity duration (min/day)	0.378†	0.001*
Fatigue Severity Scale score	-0.551‡	<0.001*
SGRQ total	-0.570†	<0.001*
SGRQ symptom	-0.190†	0.206
SGRQ activity	-0.541†	<0.001*
SGRQ impact	-0.525‡	<0.001*

Independent variables	B	SE	95% CI	t	p
Constant	86.932	49.436	-13.092 to 186.895	1.758	0.087
BSI score	-6.028	1.971	-10.015 to 2.041	-3.058	0.004*
Quadriceps (N)	8.447	0.2504	3.381 to 13.512	3.381	0.002*
Number of steps (steps/day)	0.006	0.003	0.00 to 0.012	2.138	0.039*
SGRQ total	-1.75	0.551	-2.865 to -0.635	-3.174	0.003*

Variables	ISWT	MIST	95% CI	p
Outcome	401.67 (73.65) meters	152.93 (55.00) steps	-	-
Time, min	6.86 (0.80)	8.36 (2.02)	-116.42 to -6.92	< 0.001*
SpO₂, %	95.45 (3.69)	95.13 (3.83)	-0.87 to 0.22	0.238
∆ SpO₂	- 0.8 (3.12)	1.45 (3.03)	-1.20 to -0.10	0.021*
∆ SpO₂ ≥ 4%, n	4 (2 moderate, 2 severe)	7 (1 mild, 4 moderate, 2 severe)	-	< 0.001*
Heart rate, beats/min	102.06 (16.35)	132.02 (19.90)	24.29 to 35.62	< 0.001*
Heart rate, % maximum predicted	63.60 (10.54)	82.15 (11.70)	21.97 to 10.90	< 0.001*
Dyspnea	1.67 (1.30)	3.21 (1.47)	1.05 to 2.03	< 0.001*
Leg fatigue	6.85 (6.52)	12.19 (2.76)	-11.17 to -9.67	< 0.001*
Reasons for ending the test SpO₂ < 80%, n (%)	-	2 (4.34)	-	-
Leg fatigue, n (%) Dyspnea, n (%) Leg fatigue and dyspnea, n (%)	4 (8.69) - -	15 (32.60) 4 (8.69) 7 (15.21)	- - -	- - -

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[1] Correspondence to: Melike Mese Buran, Yunus Emre Neighborhood, Sarkı Street, 6/2 Ankara, Turkey. Telephone: +90507 004 52 10. E-mail: pt.melikemese@gmail.com