Functional assessment using the Glitttre Endurance Test in chronic obstructive pulmonary disease (COPD)

The intervention will be an eight week pulmonary rehabilitation program in which participants will attend twice a week for exercise training in a gymnasium, The intervention will be delivered by physiotherapists with experience in pulmonary rehabilitation. Pulmonary rehabilitation is part of usual care. Participants will attend two sessions per week for approximately 1 hour per session during which time they will perform 20 minutes of stationary cycling, 20 minutes of walking (over-ground or using a treadmill), 10 minutes of upper limb strength and endurance training (e.g. lat pull down and pect dec using a fixed weight machine for strength training and free weights for endurance training) and 10 minutes of lower limb strength training (e.g. quads and leg press using a fixed weight machine, sit to stand, steps, wall squats). The intensity and duration of the exercises is based on the participant’s performance at their initial assessment. For walking training the initial intensity will be set at 80% of the six-minute walk test speed. For stationary cycling, the initial intensity will be set at 60 % of the peak work rate estimated using the distance walked in the best six-minute walk test based on the equation of Hill et al 2008. Participants will exercise at their individually prescribed exercise intensity and duration but their exercise sessions will be in the gymnasium with other participants. A number of tests of exercise capacity will be performed before and after the pulmonary rehabilitation program. These tests will be: the 6 minute walk test, the endurance shuttle walk test (ESWT) (Revill et al, 1999) and the Glittre Activities of Daily Living (Glittre ADL) test (Skumlien et al 2006) which are standard tests regularly used in pulmonary rehabilitation programs. Participants will perform one modified Glittre ADL test in which no weighted backpack will be worn. The study will also develop and evaluate a new test, the Glittre Endurance test, which will be a modification of the Glittre ADL test The Glittre Endurance test will be performed on the same track as the Glittre ADL test. However, the Glittre Endurance test will be performed without a backpack. For this test participants will be asked to perform the test at a speed equivalent to 90% of the speed that achieved in the Glittre ADL test (without a backpack) and to keep going for as long as possible (to a maximum of 20 minutes) or until unable to keep up the pace. The pace will be set by an audio signal. No verbal encouragement will be given during the test. Participants will be asked to score their dyspnoea and rate of perceived exertion using the 0-10 category-ratio scale (Borg 1982) at the beginning and end of the test. Pulse rate and oxygen saturation (SpO2) will be measured during the test by a pulse oximeter. The test will be terminated at patients request or at the discretion of the clinician based on clinical signs and symptoms. Energy expenditure will be measured during the Glittre Endurance test and the ESWT using an activity monitors, the Axivity AX3 (New Castle up on Tyne, UK) and the Actigraph GT1M (Pensacola, FL, USA). Physical activity levels of participants before commencing the pulmonary rehabilitation program will be measured over seven days by wearing of the activity monitor. Participants will be invited to participate and will be provided with the Participant Information Sheet and any questions arising will be answered by the physiotherapists involved in the study. After agreement, participants will be asked to sign the Participant Consent Form and to attend the pulmonary rehabilitation service for testing. The participation in the study is voluntary. Subjects can withdraw at any time without having to give a reason. The intervention will be supervised so adherence will be monitored by attendance at exercise training sessions.