The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients

Abstract

Andrea Zanini,1,2 Marina Aiello,3 Francesca Cherubino,1 Elisabetta Zampogna,1 Andrea Azzola,4 Alfredo Chetta,3 Antonio Spanevello1,5 1Division of Pneumology, IRCCS Rehabilitation Institute of Tradate, Salvatore Maugeri Foundation, Tradate, Italy; 2Division of Internal and Respiratory Medicine, Malcantonese Hospital, Giuseppe Rossi Foundation, Castelrotto, Switzerland; 3Respiratory Disease and Lung Function Unit, Department of Clinical and Experimental Medicine, University of Parma, Padiglione Rasori, Parma, Italy; 4Division of Pneumology, Department of Internal Medicine, Ospedale Civico, Lugano, Switzerland; 5Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy Background: Individuals with COPD may present reduced peripheral muscle strength, leading to impaired mobility. Comprehensive pulmonary rehabilitation (PR) should include strength training, in particular to lower limbs. Furthermore, simple tools for the assessment of peripheral muscle performance are required.Objectives: To assess the peripheral muscle performance of COPD patients by the sit-to-stand test (STST), as compared to the one-repetition maximum (1-RM), considered as the gold standard for assessing muscle strength in non-laboratory situations, and to evaluate the responsiveness of STST to a PR program.Methods: Sixty moderate-to-severe COPD inpatients were randomly included into either the specific strength training group or into the usual PR program group. Patients were assessed on a 30-second STST and 1-minute STST, 1-RM, and 6-minute walking test (6MWT), before and after PR. Bland–Altman plots were used to evaluate the agreement between 1-RM and STST. Results: The two groups were not different at baseline. In all patients, 1-RM was significantly related to the 30-second STST (r=0.48, P<0.001) and to 1-minute STST (r=0.36, P=0.005). The 30-second STST was better tolerated in terms of the perceived fatigue (P=0.002) and less time consuming (P<0.001) test. In the specific strength training group significant improvements were observed in the 30-second STST (P<0.001), 1-minute STST (P=0.005), 1-RM (P<0.001), and in the 6MWT (P=0.001). In the usual PR program group, significant improvement was observed in the 30-second STST (P=0.042) and in the 6MWT (P=0.001).Conclusion: Our study shows that in stable moderate-to-severe inpatients with COPD, STST is a valid and reliable tool to assess peripheral muscle performance of lower limbs, and is sensitive to a specific PR program.Keywords: sit-to-stand test, strength training, COPD