Validation and Refinement of Prediction Models to Estimate Exercise Capacity in Cancer Survivors Using the Steep Ramp Test.
To further test the validity and clinical usefulness of the steep ramp test (SRT) in estimating exercise tolerance in cancer survivors by external validation and extension of previously published prediction models for peak oxygen consumption (Vo2peak) and peak power output (Wpeak).



Cross-sectional study.



Multicenter.



Cancer survivors (N=283) in 2 randomized controlled exercise trials.



Not applicable.



Prediction model accuracy was assessed by intraclass correlation coefficients (ICCs) and limits of agreement (LOA). Multiple linear regression was used for model extension. Clinical performance was judged by the percentage of accurate endurance exercise prescriptions.



ICCs of SRT-predicted Vo2peakand Wpeakwith these values as obtained by the cardiopulmonary exercise test were .61 and .73, respectively, using the previously published prediction models. 95% LOA were ±705mL/min with a bias of 190mL/min for Vo2peakand ±59W with a bias of 5W for Wpeak. Modest improvements were obtained by adding body weight and sex to the regression equation for the prediction of Vo2peak(ICC, .73; 95% LOA, ±608mL/min) and by adding age, height, and sex for the prediction of Wpeak(ICC, .81; 95% LOA, ±48W). Accuracy of endurance exercise prescription improved from 57% accurate prescriptions to 68% accurate prescriptions with the new prediction model for Wpeak.



Predictions of Vo2peakand Wpeakbased on the SRT are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeakcan be used cautiously (eg, supplemented with a Borg score) to aid endurance exercise prescription.
Department of Physical Therapy, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands. Electronic address: m.stuiver@nki.nl.
Martijn M
MM
Stuiver
Department of Public & Occupational Health/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
Caroline S
CS
Kampshoff
Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Saskia
S
Persoon
Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Wim
W
Groen
Department of Public & Occupational Health/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
Willem
W
van Mechelen
Department of Public & Occupational Health/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.
Mai J M
MJM
Chinapaw
Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands.
Johannes
J
Brug
Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Frans
F
Nollet
Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Marie-José
MJ
Kersten
SportMáx, Maxima Medical Center, Eindhoven, The Netherlands.
Goof
G
Schep
Department of Epidemiology and Biostatistics/EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands; Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia.
Laurien M
LM
Buffart
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005080:Exercise Test / Q000379:methods* / Q000592:standards*; D005081:Exercise Therapy / Q000379:methods / Q000592:standards; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation*; D010101:Oxygen Consumption; D015203:Reproducibility of Results
Exercise test; Exercise therapy; Neoplasms; Rehabilitation; Validation studies