Criação de um novo step test incremental para a avaliação da capacidade de exercício em pessoas com doença pulmonar obstrutiva crónica

Abstract

New models of pulmonary rehabilitation (PR) programs, especially home-based programs, are suggested in literature to enhance the access of PR for people with chronic obstructive pulmonary disease (COPD). In home environment, easy-to-use testing options are required for the assessment of exercise capacity and the prescription of exercise, namely step tests. The systematic review of this thesis identified and determined the level of evidence of the measurement properties of the step tests applied in COPD population, verifying that most of them were adapted from the 6-minute walk test, that is, with a self-paced profile. Low level of evidence for them measurement properties was also found. Therefore, the development of a new step test for the COPD population, with an incremental profile, based on the characteristics of the incremental shuttle walk test (ISWT) was an important area to explore. For this purpose, an additional study was developed with people without disabilities (article I), with the aim to verify whether an adaptation of a known submaximal step test with a maximum profile could have a maximal cardiorespiratory response. The results identified a maximal response. Subsequently, a study was also developed to analyze the impact of a home-based PR program on people with COPD (article II), in which the results demonstrated clinical effects and safety of the program. A study with the development of the new step test and its application at home environment, with the assessment of its measurement properties - validity and reliability (article III) was performed; however, based on the results, despite the test being reliable, it still cannot be considered valid for COPD population. Finally, the last study (article IV) on the interpretability of the new step test was developed, presenting a prediction equation, in which age was the determining variable for the variability of the results. These findings constitute new evidence for a new step test to be applied to people with COPD, but further studies on the determination of its measurement properties are important.